CASESCASES

Dr Deepak BhonagiriDr Deepak Bhonagiri

Intravenous Drug UseIntravenous Drug Use

28 yr old 28 yr old Out of hospital arrest, found with IV needle in Out of hospital arrest, found with IV needle in

cubital fossacubital fossa Hypoxic brain injury, brain death diagnosed 19 Hypoxic brain injury, brain death diagnosed 19

days following initial presentationdays following initial presentation What is the window period for BBV What is the window period for BBV

transmission?transmission? What if there are urgent heart/lung/liver What if there are urgent heart/lung/liver

recipients?recipients?

Ex- IV drug userEx- IV drug user

45 yr old, Gr V subarachnoid haemorrhage45 yr old, Gr V subarachnoid haemorrhage Family state that he had “hepatitis C” and was Family state that he had “hepatitis C” and was

seeing doctor about it. Last seen re “hepatitis” 5 seeing doctor about it. Last seen re “hepatitis” 5 yrs ago. No records availableyrs ago. No records available

Serology return negative for HepC, Hep B and Serology return negative for HepC, Hep B and HIVHIV

What are the false negative rates for serology?What are the false negative rates for serology? Is NAT/PCR helpful in decision making in this Is NAT/PCR helpful in decision making in this

setting?setting?

Hepatitis BHepatitis B

52 yr old Gr V subarachnoid haemorrhage52 yr old Gr V subarachnoid haemorrhage History of hepatitis BHistory of hepatitis B Hep B surface antigen +Hep B surface antigen + What is the rate of false positives for What is the rate of false positives for

HBsAg?HBsAg? Risk of transmission?Risk of transmission?

False positive?False positive?

56 yr old, intracranial haemorrhage on 56 yr old, intracranial haemorrhage on warfarinwarfarin

Brain death diagnosed and organ donation Brain death diagnosed and organ donation and retrieval proceedsand retrieval proceeds

Next morning VDRL result +Next morning VDRL result + What do you do? How do you manage What do you do? How do you manage

recipients?recipients? What is the rate of false positive for What is the rate of false positive for

VDRL?VDRL?

Northern NSWNorthern NSW

38 yr old female, large parietal CVA with 38 yr old female, large parietal CVA with bleeding into CVA leading to brain deathbleeding into CVA leading to brain death

Family gives history of Ross river virus Family gives history of Ross river virus infection 14 yrs agoinfection 14 yrs ago

How do you manage?How do you manage? Do you wait for results of test to return Do you wait for results of test to return

before retrieval?before retrieval? Do recipients need specific management?Do recipients need specific management?

Recipient becomes donorRecipient becomes donor

32 yr old female recipient of lung 32 yr old female recipient of lung transplant has hypoxic arrest due to likely transplant has hypoxic arrest due to likely CMV pneumoniaCMV pneumonia

Considered for DCDConsidered for DCD What is the risk of transmission of CMV to What is the risk of transmission of CMV to

recipients?recipients?

Chicken PoxChicken Pox

26 yo with varicella pneumonia has a 26 yo with varicella pneumonia has a hypoxic cardiac arrest and is brain dead hypoxic cardiac arrest and is brain dead 2/7 later2/7 later

She received 2 days of acyclovir at he She received 2 days of acyclovir at he time of referral for organ donationtime of referral for organ donation

What is the risk of transmission of VZV What is the risk of transmission of VZV from this donor?from this donor?

MROMRO

21 yr old with traumatic brain injury has a 21 yr old with traumatic brain injury has a hypoxic cardia arrest and is brain deadhypoxic cardia arrest and is brain dead

He is colonised with MRSA and VRE and He is colonised with MRSA and VRE and is growing MRAB in sputumis growing MRAB in sputum

What is the risk of transmission of MROs What is the risk of transmission of MROs to the recipients?to the recipients?