Death of Healthy Volunteers and Professionals on Duty for Cadaveric Graft Shipment : Transplantation

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Death of Healthy Volunteers and Professionals on Duty for Cadaveric Graft Shipment

Boggi, Ugo1; Amorese, Gabriella2; Focosi, Daniele3

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doi: 10.1097/TP.0b013e318219ebd1
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Death of a living organ donor is universally considered a disaster, having devastating effects on public opinion. Deceased donor transplantation poses ethical questions but cannot rise the concerns on donor safety typical of living donation. Hence, it is generally considered “safer.” However, considering the organizational and logistical complexity of cadaveric donation, accidental death of healthy volunteers and professionals caring for graft shipment is a disagreeable price. Perhaps, unconsciously, we all know we have to pay this price for the success of transplantation: what we do not know is exactly how much we do have to pay. Englesbe and Merion (1) reported sporadic fatalities in the United States (Aviation Safety Network [2] IDs 19900911-1 and 20070604-0, wikibase 38890), France (wikibase 43982), Brazil (ID 19760122-1 [3]), and Germany. Englesbe and Merion did not mention another fatality that occurred in Spain (one death: ID 20001125-0). Many more “near-misses” have been reported, for example, from Germany (wikibase 72222) and United Kingdom (ID 20101119-0). Anyway, no registry exists for transplant- related accidents, and surgeon surveys looking for accidents have been performed only in the United States (1). The overall worldwide (excluding Italy) fatality is 28 in the past 30 years. Anyway, this is likely an underestimation because of poor reporting, and ratios of fatal accidents per donated organ are almost impossible to calculate without a registry.

We attempted estimation of this death risk for Italy, whereas between 2004 and 2009, at least nine persons died as a consequence of three mishaps occurred during organ shipment. Englesbe and Merion (1) reported only the one that occurred on February 24, 2004 (20040224-0), where six persons (including two heart surgeons, one physician assistant, and three pilots) died when their plane crashed into a mountain near Cagliari (Sardinia). On April 22, 2005, a volunteer shipping two kidneys died in a car crash between Siena and Pisa (both in Tuscany) (4). Finally, on February 7, 2009, two pilots died when their aircraft crashed in Trigoria (Rome), shortly after taking off from Ciampino to Modena (Emilia Romagna; ID 20090207-0).

In the same period (2004–2009) in Italy, there were 6737 deceased organ donors leading to 18,722 organ transplants. Consequently, the risk of death of a healthy volunteer or professional is 0.13% when estimated per deceased donor and 0.048% when estimated per transplanted organ (5). Admittedly, this is a rough estimation because, at least in Italy and between 2004 and 2009, this risk might have been even greater. Indeed, although at the numerator we could have missed some deaths, the denominator should be probably lower than 18,722, because not all transplanted organs were shipped.

Death of volunteers and health professionals involved in organ transplantation has probably a lower impact on medical community and public opinion than death of living organ donors. Actually, these fatalities are not too different as they are; anyhow, deaths of persons fallen to allow others to be transplanted. We emphasize that deceased donor-related incidents and deaths should be surveyed as systematically as live donation is. The creation of an international registry summarizing the ratios of fatalities per transplanted organ could encourage improvement of safety measures and suggest different organization of transplant networks.

Ugo Boggi1

Gabriella Amorese2

Daniele Focosi3

1Division of General and Transplant Surgery in Uremic and Diabetic Patients

Azienda Ospedaliero-Universitaria Pisana

Pisa, Italy

2Division of Anesthesia and Intensive Care

Azienda Ospedaliero Universitaria Pisana

Pisa, Italy

3Division of Immunohaematology

Azienda Ospedaliero Universitaria Pisana

Pisa, Italy

REFERENCES

1.Englesbe MJ, Merion RM. The riskiest job in medicine: Transplant surgeons and organ procurement travel. Am J Transplant 2009; 9: 2406.
2.Aviation Safety Network. Available at: http://aviation-safety.net/database. Accessed December 29, 2010.
3.Garcia VD, Vasconcelos L, Abbud-Filho M. The riskiest job in medicine: Transplant surgeons and organ procurement travel. Am J Transplant 2010; 10: 1334.
4.“Dies in a car accident while transporting organs for transplantation. He was a Civil Protection volunteer.” Asaps News (in Italian). Available at: http://www.asaps.it/indexpage_n.php?id=5075&cat=&sezione=News&pubblicazione=02.05.2005. Accessed December 29, 2010.
5.Centro Nazionale Trapianti (CNT). Available at: http://www.trapianti.salute.gov.it/cnt/cntStatistiche.jsp?sotmenu=normativa&area=cnt-generale&label=datdoc&menu=menuPrincipale&titolo=2009&etichetta=+-+Anno+2009&anno=2009. AccessedDecember, 27, 2010.
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