Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease where the body’s immune system mistakenly attacks healthy tissues. This condition is characterized by periods of flare-ups and remission. People with lupus can sometimes be organ donors, but eligibility is not determined by the lupus diagnosis alone. Instead, it depends on the health of the specific organ being considered and the overall activity level of the disease. The evaluation process focuses on whether the disease has caused irreversible damage and if the donation poses an unacceptable risk to the recipient.
How Lupus Affects Organ Systems
Lupus creates complications for donation because the disease is systemic, meaning it can cause chronic inflammation and damage throughout the body. The immune system generates autoantibodies that target the body’s own cells and proteins, leading to widespread tissue injury. This mechanism can directly compromise the function of major organs, making them unsuitable for transplantation.
The kidneys are a frequent target, with lupus nephritis causing inflammation and scarring that often leads to kidney failure. The heart can suffer from carditis, affecting the heart muscle, valves, or the lining around the heart. The lungs may also be impacted, leading to pleurisy or interstitial lung disease, which severely reduces their capacity. Comprehensive screening is required to ensure that any donated tissue is structurally and functionally sound.
Criteria for Deceased Organ Donation
When a person with lupus dies, the decision to proceed with donation is made on a case-by-case basis by the Organ Procurement Organization (OPO). The disease itself is not an absolute contraindication, but the extent of organ damage is the determining factor. Clinicians will review the donor’s medical history to assess the long-term effects of lupus on the specific organ being considered.
Corneas, bone tissue, and certain other tissues are often deemed acceptable, as they are less likely to be functionally compromised by the autoimmune process. Solid organs like the heart, liver, or lungs may be eligible if a recent medical review confirms minimal long-term damage and normal function. The OPO must confirm the absence of an active, widespread disease flare-up at the time of death, as active inflammation can make organs unsafe for transplant. Extensive testing, including functional assessments, is performed to ensure the organ is viable and that the benefits outweigh the potential risks to the recipient.
Restrictions on Living Organ Donation
The situation for living organ donation, such as a kidney or a segment of the liver, is much more restrictive for individuals with lupus. Almost all transplant centers will prohibit living donation for a person with a confirmed diagnosis of SLE, even if the disease is in long-term remission. The primary concern is the unacceptable risk posed to the donor’s long-term health.
Surgical stress and the subsequent recovery period are known triggers for lupus flare-ups, which could be life-threatening to the donor. Removing a healthy organ, like one kidney, places a greater burden on the remaining one, which may prematurely fail due to latent or future lupus damage. Since lupus nephritis affects both kidneys equally, a person with SLE has a higher lifetime risk of developing end-stage renal disease compared to the general population. The medical community considers this risk too high for an elective procedure, prioritizing the donor’s future well-being.
The Importance of Recipient Safety Screening
Recipient safety is the final and most important layer of scrutiny applied to any organ considered for donation from a lupus patient. The screening process includes mandatory testing to mitigate two primary risks: disease transmission and infection. While lupus itself is not transmissible, the organ may harbor residual inflammation that could compromise its function in the recipient.
Pathologists may perform biopsies on the donated organ to check for evidence of active inflammation or microscopic scarring that would prevent successful transplantation. Extensive serology checks are required to screen for infectious diseases, as lupus patients are often treated with immunosuppressive medications that can mask or increase the risk of certain infections. This final review ensures that only the safest and most viable organs are utilized, protecting the immunocompromised recipient from unnecessary complications.