Successful organ transplantation after treatment of fatal cyanide poisoning with hydroxocobalamin

Abstract

Background. Cyanide-poisoned patients are potential organ donors provided that organs are not damaged by the poison or by antidotal treatment. Case study. A patient with third-degree burns and smoke inhalation-associated cyanide poisoning confirmed by measurements of whole blood cyanide was found in cardiac arrest and administered epinephrine and hydroxocobalamin (5 g + 5 g). Cardiac activity resumed, but the patient was declared brain dead on the third day of hospitalization when coma deteriorated to a shock state with refractory hypoxemia. Kidneys, heart, and liver were removed and transplanted into four patients. Gross pre-transplantation inspection of the donor organs and renal histology showed no evidence that hydroxocobalamin caused organ toxicity. Donor organs functioned normally through follow-up periods of several months. Conclusion. Anoxic cardiac arrest following acute cyanide poisoning treated with hydroxocobalamin (5 g + 5 g) was not a contraindication to organ transplantation after confirmed encephalic death in this patient.

Keywords :

• Hydroxocobalamin
• Cyanide poisoning
• Organ
• Transplantation

Notes

*Dr. Fortin has served as a consultant for EMD Pharmaceuticals, an affiliate of Merck KGaA. Dr. Fortin acknowledges the assistance of Jane Saiers, Ph.D. in writing this case report. Dr. Saiers' work was funded by EMD Pharmaceuticals.