To the Editor:
We appreciate the comments by Dr. Detry with regard to our report describing the transmission of T-cell lymphoma to four recipients of solid organ transplants (1–2), and we hope this will spur debate about the future diagnostic evaluation given to donors being considered for donation after cardiac death (DCD). Even under the best circumstances, complications like this one will occur, and we can only hope to minimize potential outcomes by systematically addressing all possible diagnoses prior to organ recovery. While the expanded use of organs from DCD donors may save lives by providing a greater number of organs to patients on the waitlist (3–5), we must maintain our vigilance to avoid any potential pitfall. At some institutions, methods are in place to maximize the viability of potential donor organs by aggressive management of all potential donors prior to donation (6). A similar protocol to systematically investigate all possible diagnoses in the donor may be in order, particularly in the case of DCD donors when pre-donation management might be hurried. This will minimize potential risk to future recipients. It is our stance that DCD donors may require even greater scrutiny than donors following brain death, and our report outlines many potential modalities previously mentioned in the literature that are available to the surgeon at the time of organ recovery; the simplest being the time honored exploration and palpation of all abdominal and thoracic organs. As the public becomes more informed about organ donation, we hope that the number of people consenting to donation will increase. We know that our policies and procedures can adapt to make organ donation as safe and effective as possible for patients who need it. The organ pool is safe and rare events are just that, rare.