Successful Retransplantation of a Kidney Allograft Affected by Thrombotic Microangiopathy Into a Second Transplant Recipient

Kamar, Nassim; Rischmann, P.; Guilbeau‐Frugier, Céline; Sallusto, Fédérico; Khedis, M.; Delisle, Marie–Bernadette; Noury, D.; Fort, Marylise; Rostaing, Lionel

doi:10.1053/j.ajkd.2008.03.037

Cited by 11 publications

(11 citation statements)

References 9 publications

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“…From a medical perspective, the act of returning an organ that has once been donated (hereafter, organ restitution) is not permissible if serious safety issues arise due to returning the organ. Accumulating cases have reported on the reuse of transplanted kidneys 4–11. The anecdotal success of this procedure does not suggest it could routinely be accomplished safely.…”

Section: Discussionmentioning

confidence: 99%

Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses

et al. 2019

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In this article, we perform a thought experiment about living donor kidney transplantation. If a living kidney donor becomes in need of renal replacement treatment due to dysfunction of the remaining kidney after donation, can the donor ask the recipient to give back the kidney that had been donated? We call this problem organ restitution and discussed it from the ethical viewpoint. Living organ transplantation is a kind of ‘designated donation’ and subsequently has a contract-like character. First, assuming a case in which original donor (A) wishes the return of the organ which had been transplanted into B, and the original recipient (B) agrees, organ restitution will be permissible based on contract-like agreement. However, careful and detailed consideration is necessary to determine whether this leaves no room to question the authenticity of B’s consent. Second, if B offers to give back the organ to A, then B’s act is a supererogatory act, and is praiseworthy and meritorious. Such an offer is a matter of virtue, not obligation. Third, if A wishes B to return the organ, but B does not wish/allow this to happen, it is likely difficult to justify returning the organ to A by violating B’s right to bodily integrity. But B’s refusal to return the donated organ cannot be deemed praiseworthy, because B forgets the great kindness once received from A. Rather than calling this an obligation, we encourage B to consider such virtuous conduct.

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Section: Discussionmentioning

confidence: 99%

Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses

et al. 2019

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“…There were a handful of cases involving heart allografts that were re‐transplanted due to peri‐operative brain death in the first recipient . There were other reports of liver re‐use and there were four cases of kidney transplants: two were deceased donor kidney and two were live donor kidney . The first re‐use of a deceased donor kidney was performed in 1993 in which the initial recipient suffered brain death 8 days post‐transplant .…”

Section: Discussionmentioning

confidence: 99%

Renal allograft re‐use and herpetic re‐infection

et al. 2015

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ABSTRACT:A middle-aged man received a kidney transplant from a deceased multiorgan donor. The recipient suffered cardiac arrest several days postoperatively and sustained hypoxic brain injury and was declared brain dead. Following the family's consent, the allograft kidney was retrieved and re-transplanted into a man with end-stage renal failure secondary to reflux nephropathy. The liver was not transplanted due to suspicion of fatty changes based on macroscopic appearance. After transplantation of other organs, liver histology revealed coagulative parenchymal necrosis with nuclear inclusions and moderate parenchymal cholestasis, suggestive of herpes viral hepatitis. Renal implantation biopsy showed histiocytes with enlarged nuclei containing viral inclusions in the capsular fibrous tissue, with positive immunostaining for herpes simplex virus (HSV). Anti-viral therapy was commenced immediately after obtaining histological evidence of donor HSV infection. Our recipient had pre-formed immunoglobulin G antibodies to HSV-1 and HSV-2, and was immunoglobulin M negative pre-transplant. HSV viraemia was detected day 5 post-transplant with a viral load of 7688 copies/mL by polymerase chain reaction assay. The recipient completed a 30 day course of intravenous ganciclovir before switching to oral valganciclovir as standard cytomegalovirus prophylaxis. The HSV polymerase chain reaction became undetectable on day 7 of intravenous ganciclovir and has remained undetectable. The patient remains well 9 months posttransplant with an estimated glomerular filtration rate of 61 mL/min per 1.73 m 2 . Although renal allograft re-use has been shown to be technically possible with a good outcome in this recipient, this does raise issues including assessment of allografts that have undergone repeated severe ischaemic insults and the potential of transmission of infections.Both renal allograft re-transplantation and transmission of HSV through solid organ transplantation have only rarely been reported. CASE REPORTA multi-organ donor (donor A), declared brain dead due to cerebral hypoxia, donated a kidney and pancreas to a middle-aged type 1 diabetic man (recipient A) who had previously passed cardiac workup and was active on the kidney-pancreas waiting list. The other kidney, lungs and liver from the same donor were transplanted into other recipients. The results of viral serology and nucleic acid test (NAT) of donor A indicated they had previously been exposed to cytomegalovirus (CMV), Epstein Barr virus (EBV), varicella zoster virus (VZV) and herpes simplex virus type 2 (HSV-2), but there was no indication of active viral infection (Table 1).Despite uneventful surgery and immediate graft function, recipient A suffered a myocardial infarction and sustained cardiac arrest on the first post-operative day. While he was successfully resuscitated after 20 min of cardiac massage and oxygenation, he remained intubated and requiring inotropic support and shortly thereafter suffered a bleed related to the pancreatic anastomosis with a reduction...

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“…The authors infer that if a named ADP recipient was not transplanted, the ADP donor should have control over a "coupon" for a future recipient of their choice. This has never been an ethically accepted practice in the United States, and is similar to the rare few and tragic occurrences of early recipient death or disease permitting kidney reuse into a second recipient (4,5).…”

Section: To the Editormentioning

confidence: 99%

“Do the Right Thing. It Will Gratify Some People and Astonish the Rest.“—M. Twain

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Pelletier

et al. 2016

American Journal of Transplantation

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Successful Retransplantation of a Kidney Allograft Affected by Thrombotic Microangiopathy Into a Second Transplant Recipient

Cited by 11 publications

References 9 publications

Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses

Will you give my kidney back? Organ restitution in living-related kidney transplantation: ethical analyses

Renal allograft re‐use and herpetic re‐infection

“Do the Right Thing. It Will Gratify Some People and Astonish the Rest.“—M. Twain

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