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Table 5.4. Relative contraindications to organ donation by organ type

Heart/Lung

Liver

Pancreas

Kidney

High dose inotropes

Wall motion abnormalities

Chest trauma Abnormal CXR

Prolonged cold ischemia

Hepatic trauma Amylase elevation AST, ALT elevations Glucose elevation

Hepatitis B core antibody

Hepatitis C

Steatosis

Prolonged warm and cold ischemia

Fatty pancreas

Hepatitis C

Prolonged warm and cold ischemia

Age > 60; < 6 Hypertension Diabetes

Hepatitis C

Prolonged warm and cold ischemia tion. One of the best indicators of whether or not a liver should be used is the intraoperative assessment of an experienced donor surgeon. This is also true for pancreas donors since glucose levels may be elevated due to exogenously administered glucose and steroids as well as to catecholamine release and insulin resistance from trauma. Likewise, an elevated serum amylase does not always reflect pancreatic trauma and should not in isolation be used to preclude pancreatic organ donation. A history of early renal disease, such as mild hypertension and diabetes, may also be compatible with organ donation. A renal biopsy can be obtained to assess the degree of pathology, if any, prior to transplantation. Likewise, in older donors, if glomerulosclerosis is present, both kidneys may be implanted. In children less than 6 years of age, and depending on size, the kidneys can be implanted separately or en bloc. Although heart and lung donor criteria are somewhat more restrictive, depending on the potential recipient's condition, these criteria can be expanded. Cadaveric heart donors should have a normal chest x-ray, electrocardiogram, isoenzymes, and echocardiogram. Lung donors should not have any chest trauma and should have negative sputum cultures and a PaO2 > 350 torr on an FiO2 of 1.0. Again, examination of the organs by a skilled heart and lung donor surgeon may be necessary before excluding a potential donor.

Due to the risk of organ dysfunction and failure with increasing cold ischemia time, preservation times should be minimized to avoid exacerbating the current donor shortage. Safe acceptable cold ischemic times vary with each organ and, as a general rule, are as follows: heart/lung 6 hours, liver 12 hours, and pancreas 18 hours. Since delayed renal graft function predicts long-term survival, attempts should be made to limit preservation times. When kidneys are cold stored, they should be transplanted within 18-24 hours, and when machine-perfused within 24-30 hours.

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