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Organ transplantation

Organ transplantation from T. cruzi-infected donors

There is little experience and information related to transmission of T. cruzi during organ transplantations from infected donors, but, as in the case of blood transfusion, persons receiving an organ from an infected donor may be infected with the parasite and develop acute Chagas disease.81-91 Due to immunosuppressive treatment in the organ receiver, a small number of parasites present in the graft are able to develop very quickly.

Among the recently reviewed cases of solid organ transplantations from T. cruzi-infected donors to naive recipients in Argentina and Brazil, and in the United States (for the 2001-11 period), most of them are related to kidney, liver, and heart transplantations, but transmission through lung transplantation has also been reported.89,90 Also, these reviews show that transmission of T. cruzi from an infected donor is not a general rule, and the proportion of recipients infected during organ transplantation appears to depend on the organ type (heart transplantation from a T. cruzi-infected donor seems to have the most serious implications). Moreover, while some of the recipients infected during transplantation died from Chagas disease, in most of the cases reviewed, prompt treatment of infected recipients with trypanocidal drugs was effective. The use of organs from infected donors continues to be debated, but it is distorted by the disparity between the number of organ transplantation candidates on the waiting list, the available organs, and the intense pressure that exists to safely expand the donor pool. In this context, several guidelines and recommendations related to organ transplants from T. cruzi-infected donors have been published in Argentina,89 the United States,92 and Spain.93 Generally speaking, the different working groups state that the transplantation of an organ from an infected donor is acceptable and feasible when intensive monitoring for T. cruzi infection in the recipient is followed and prompt therapy with trypanocidal drugs can be administered. All working groups recommend avoiding transplanting hearts from T. cruzi-infected donors; in Argentina, hearts from infected donors are currently discarded.89 For other organs from T. cruzi-infected donors, the informed consent of the recipient is needed. In Argentina, all organ donors are tested for T. cruzi infection at the time of organ procurement, while in the United States and Spain, screening of potential donors born in Latin America is recommended. Moreover, infected living donors should receive trypanocidal treatment for 30 days prior to donation to allow clearance of parasitemia, and donation should take place as soon as possible after completion of treatment. More research is needed to improve experience and information related to the transmission of T. cruzi during organ transplantations from infected donors, and it should be a top priority of the governments of endemic and nonendemic countries to adapt safety policies aiming to prevent potential transmission occurring under these circumstances.

 
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