Transplantation in the face of severe donor sepsis: pushing the boundaries?

Most current transplantation guidelines suggest that bacteremia or bacterial sepsis precludes organ donation. However, various investigators report good outcomes when donor bacteremia was discovered incidentally posttransplant or when bacteremia was cleared before organ retrieval. The authors present the case of a donor who underwent surgical repair of a congenital heart defect complicated by refractory septic shock with positive blood cultures for cloxacillin-sensitive Staphylococcus aureus until time of death. Hemorrhagic and necrotic foci were noted on the renal capsules at time of organ retrieval. The donor liver appeared grossly unremarkable. One year after transplantation, the 3 recipients continue to do well with no known sequelae of having received organs from a Staphylococcus aureus -septic donor. The authors conclude that with appropriate perioperative antibiotics targeted at an organism with known sensitivities and consideration of a modified immunosuppressive protocol, even organs from individuals with known severe sepsis at the time of retrieval may be appropriate for donation.