This case report describes the transplantation of a kidney from an A1B donor to a recipient who was blood group A2B. The donor/recipient pair were ABO mismatched but compatible. In the majority of cases, A1 antibodies fail to react at 37 degrees C and are of no clinical significance. However, hemolytic transfusion reactions due to A1 antibodies active at 37 degrees C have been reported but are extremely rare. When the opportunity for transplantation arose for this patient, who had received multiple blood transfusions because of dialysis, the question of safety concerning the subject of transplanting across ABO sub-grouping mismatches was presented. Inquiries regarding this matter proved fruitless and the transplant was performed mainly due to the lack of preformed anti-A, antibodies in the recipient at the time of transplant. It was hoped that the A2B recipient would fail to make an anti-A1 antibody due to antigen exposure or if it did, would not pose a hazard to the allograft. Therefore we present our experience with a patient who was successfully transplanted across an ABO incompatible sub-grouping, A1B allograft to an A2B recipient.
Medical examiners frequently deny requests by tissue procurement organizations for heart valves intended for allograft transplantation. Most of these denials are in cases of sudden apparent natural death, often where a cardiac cause is suspected. The basis of denial in these cases is that the heart must be removed and the valves procured off site under sterile conditions. This prevents the medical examiner from determining and documenting the cause of death. A dissection technique was therefore devised to increase the number of heart valves available for allograft transplantation and to simultaneously allow the pathologist to document a cardiac cause of sudden death. Interagency procedures, the dissection technique, and case summaries are provided.
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