Is there a need to irradiate cellular products for transfusion to potential organ donors and those used for perfusion of harvested organs?

A colleague in Denver is curious to learn what others do regarding:

1. irradiation of cellular blood products that are transfused to potential organ DONORS (either living or about to be deceased).
2. irradition of blood that is used to perfuse organs in transport to the eventual recipient.

The inquiring colleague admits that she had not given any consideration to irradiating cellular blood products intended for transfusion of organ donors (or perfusion of harvested organs) until one of the evening shift technologists questioned whether the blood bank or hospital had any policy regarding the need to irradiate blood products being transfused to potential organ donors. In one recent case they proceeded to irradiate cellular blood products before administering them to a soon-to-be cadaveric organ donor, "out of caution".

The inquiring colleague wonders if others have had similar concerns? Is anyone aware of reports of transfusion associated Graft-v-Host Disease (TA-GVHD) complications traced to mononuclear cells that were introduced into the organ donor or harvested organ, due to a blood transfusion or organ perfusate? Furthermore, the inquiring colleague wonders at what point an organ recipient becomes sufficiently immune compromised to be considered at some risk of GVHD? The organ being transplanted would presumably be a source of problematic lymphocytes.

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The following comments have been received.

ADDENDA Apr. 20, 2004

1. A colleague at a solid organ transplant center in the Pacific Northwest reports that her academic center has seen at least 3 cases of classic "transfusion-related" graft vs. host disease in liver transplant recipients. In all of these cases they were able to show (by HLA typing) that the source of the lymphocytes was from the donor organ. All cases were fatal, one dying within a couple of weeks of the diagnosis. Of the other two, one underwent an unsuccessful hematopoietic stem cell transplant, dying from sepsis before he could engraft, the other died within a month before he could be transplanted with his HLA-matched sibling. The Pacific Northwest center indicates that they do not routinely irradiate blood components intended for organ transplant donors, nor do they routinely irradiate components for organ transplant recipients.

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Ira A. Shulman, MD