Question

Is Alzheimer's disease a medical contraindication for organ donation?

Response from Francis Leo Delmonico, MD

The most common form of dementia is Alzheimer's disease (AD), which involves parts of the brain that control thought, memory, and language. Millions of Americans suffer from AD. The disease usually begins after age 60 and the risk increases with age. AD is a progressive and fatal disorder.[1]



AD is named after Dr. Alois Alzheimer, who nearly a century ago noted changes in the brain of a patient who had died of mental illness. These changes included abnormal clumps (now called beta-amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles).[2]



Dementia can also be caused by factors that are vascular in pathological process; thus, dementia can be mixed in etiology by coexistent atherosclerotic disease and AD lesions.[3]



AD is not a contraindication to deceased organ donation per se; however, the coexistent atherosclerotic pathology of the brain that may result in the death of a patient with AD may also affect abdominal organ function and suitability for transplantation. For example, atherosclerotic disease of the hepatic and renal arteries may result in the discard of organs recovered from brain-dead patients who have AD. Since patients with AD are usually older than 60 years of age, individual assessment is necessary. Heart and lung recovery from such older-age donors is rare.



There are other causes of dementia that mimic AD and may be a contraindication to organ donation. These include viral infections such as HIV, brain tumors, and syphilis. Standard measures of evaluation of potential organ donors, such as serology testing and computerized tomography of the brain, are useful to differentiate these conditions.

Supported by an independent educational grant from Fujisawa Healthcare.