SaBTO Aide Memoire

This quick reference guide is designed for transplant clinicians to help decision-making when considering the use of organs for transplantation from donors with infection, malignancy and other potentially transmissible diseases.

This list is not exhaustive and the presence or absence of a disease in this document does not imply the appropriateness or otherwise of using organs from such a donor. 

The ultimate decision to use any organ for transplantation rests solely with the transplant clinician in consultation with and with the consent of the patient.

However, we strongly recommend that, where there is any uncertainty, the transplant team seek advice from a clinician with relevant expertise (e.g. microbiologist or infection specialist experienced in transplantation; oncologist or oncological surgeon) regarding the possible risks and consequences of donor transmitted disease.

If a potential recipient has an allergy to any medication recommended in this guide, clinicians should seek expert advice on alternative agents.

In line with current guidance, potential organ recipients must be carefully counselled and give informed consent.

Finally, it should be noted that disease transmission does not necessarily imply any fault on the part of the transplanting team.

For the purpose of this tool, transplant candidates have been classified as exceptional, urgent or routine. Health care professionals should exercise judgement about which category is most appropriate for their patient.

Balancing risk against benefit is particularly important in the case of children and young adults, where the risk of waiting list mortality may be less and longevity with a graft much greater.

Hence consideration of minimal and selected low risk grafts only may be more appropriate in child and young adult recipients, depending on clinical urgency and following discussion with the patient and/or their family, depending on age.

Definitions

Transplant urgency

Exceptional

This refers to patients in whom, without a transplant, death might be anticipated within 7 days.

Urgent

This refers to patients with at least one of the following:

• Anticipated death without a transplant within 7 days to 1 month. Examples include:
  • Lack of dialysis access in a kidney transplant candidate
  • Early or late hepatic artery thrombosis with intra-hepatic sepsis in a liver transplant candidate
• Imminent likelihood of permanent removal from the list due to disease progression or other considerations. Examples include:
  • Patient with primary liver cell cancer approaching exclusion criteria
  • Severe, progressive cardiac or lung disease in a heart or lung transplant candidate
  • A candidate under major psychological stress awaiting a graft
• Very low likelihood of the patient receiving another (or better) organ offer in the coming year. Examples include:
  • A highly sensitised kidney candidate, such as those in tier A of the 2019 kidney or pancreas offering schemes
  • A long waiting heart or lung candidate with the option of a well-matched donor organ

Routine

This refers to all other potential recipients.

Advice on use

Do not use

The risk of donor transmitted disease is likely to outweigh benefits from transplantation in all but extreme cases.

Higher risk - could be acceptable for transplantation

There is risk of donor transmitted disease, but the risk can be set against the benefits of transplantation and it may be appropriate to proceed with selected patients, especially those in the Exceptional and Urgent categories.

It may be appropriate to seek specialist advice. A decision to proceed to transplant under these circumstances requires specific patient discussion and consent.

Acceptable for transplantation

The risk of donor transmitted disease is either very low or can be effectively managed when it occurs, such as CMV infection. This would not normally prevent a standard transplant proceeding.

Access the key guidance that SaBTO and the Donor Organ Risk Assessment (DORA) working group used to develop the content within this quick reference guide.

• SaBTO microbiological safety guidelines
• Transplantation of organs from donors with a history of cancer
• Geographical Disease Risk Index