Evaluation of Transplanting Organs from Drowned Donors




Han, Caleb
Ho, Seraphina
Jung, Isaac

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George Mason University


Background Donor-derived infections, transmitted from organ donor to organ recipient, while infrequent, often lead to the death of the organ recipient because of their compromised immune systems. A recent CDC publication reported that organ transplants from drowned organ donors potentially exposed to environmental molds (e.g. Scedosporium) through the aspiration of water may lead to invasive mold infections (IMIs) in the recipients of the exposed organs [1]. Scedosporium, a pathogenic soil-dwelling saprophyte often found in polluted water bodies, has emerged as the most common cause of drowned donor derived invasive fungal infections (IFIs), and can manifest as pneumonia, CNS disease, and dissemination [2]. Despite the significant developments made in regards to understanding IMIs from drowned donors, between 2000 and 2016, out of the 61 published cases of scedosporiosis following solid organ transplantation (SOT), 36 of these cases resulted in death, a high mortality rate of 59% [3]. Furthermore, in 2023, Xiaoli Lin and colleagues analyzed the perioperative infections, microbiological results, early transplant outcomes, and first-year clinical outcomes of 38 drowned donor renal recipients. The analyses revealed that when compared to the control group, drowned donors exhibited a significantly higher rate of positive fungal cultures (36.84% vs.13.15%,), and recipients displayed an increased prevalence of gram-negative bacteria (23.68% vs.5.26%) as well as multidrug-resistant GNB infections (18.42% vs. 3.95%) [4]. Additionally, studies regarding IMIs have identified a correlation between the necessary immunosuppressive medications taken by SOT recipients required to prevent organ rejection, and increased risks of contracting invasive mold infections (IMIs) [1, 5]. Currently, one of the most pressing issues in transplantation is the shortage of organs. To address this challenge, there is a growing emphasis on promoting the use of deceased donors, including drowned donors, in organ transplantation, despite the risk of IMIs. Due to persistent shortage of kidneys and livers for transplantation, most transplant centers have been considered to obtain and use the organs even from drowned donors [6]. However, there has been no report on the effects of kidney and/or liver transplants from drowned donors in light of graft failure and recipients’ mortality rates. Thus, studies on the outcomes of drowned donor kidney and liver transplants are required in comparison to other common accidents and injuries (i.e. Drug intoxication, Gunshot wound, Blunt injury, and Asphyxiation) to understand potentials of the drowned donor kidney and liver transplantation as another transplant resource. OBJECTIVE We aimed to investigate differences in graft failure and patient mortality rate between drowning, gunshot, drug intoxication, asphyxiation, and blunt injury.