Fat Embolism Syndrome as Cause of Death in a Multiorgan Donor With Successful Utilization of Thoracic and Abdominal Organs.

Abstract

Fat embolism syndrome is an under-reported consideration in organ donation and is most often associated with long-bone trauma and intramedullary fixation. We describe a deceased donor who, after a traffic accident with bilateral femoral fractures treated by bilateral intramedullary nailing, developed hypoxemia, encephalopathy out of proportion to sedation, and a petechial rash consistent with fat embolism syndrome by clinical criteria. Despite intensive care, brain death was determined according to national standards and donation after brain death proceeded. Donor optimization followed lung-protective ventilation and standard hemodynamic targets. Predonation assessments met acceptance thresholds, and procurement showed no macroscopic intravascular fat in graft vessels with only scattered fat droplets in the abdominal cavity without luminal obstruction. The heart, bilateral lungs, liver, pancreas, and both kidneys were transplanted. Early courses were uncomplicated, with immediate heart and liver function, primary graft dysfunction grade 0 at 72 hours for the lungs, early insulin independence after pancreas transplantation, and primary kidney graft function. No embolic phenomena attributable to donor fat embolism syndrome were observed, and three-month follow-up was unremarkable. These findings support physiology-based evaluation rather than categorical exclusion of donors with suspected fat embolism syndrome.