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Mushroom-poisoned man home after liver transplant, offers messages on mushroom safety, organ donatio

A 24-year-old Salinas man who mistakenly ate “Death Cap” mushrooms and was saved by a 4 am Christmas Day liver transplant at UCSF Medical Center went home to his family on Saturday, January 4.  Family members gathered from afar to help him, his wife—and a new baby on the way—to enjoy a combined Christmas and New Year’s celebration kept waiting for his recovery.

The young man asked that his name not be revealed, but he and family members helped UCSF Medical Center doctors and nurses to tell his story in hopes that others would learn about the dangers of poisonous wild mushrooms, and about the nationwide need for organ donations. 

His doctors say that he would have died without a series of quick actions. His wife took him to the emergency room at the Salinas Valley Memorial Healthcare System, and alerted doctors that he had eaten wild mushrooms. Upon advice from the California Poison Control System, he was quickly transported to the care of liver experts at UCSF, where hepatologist Nathan Bass, MD, and transplant surgeon Ryutaro Hirose, MD, listed him for an emergency liver transplant.

Then, thanks to the life-giving decision of a family in another state whose relative passed away, the Salinas man received a donated organ just in time—shortly before the mushroom toxin destroyed the last of his own liver cells.

POISON HOTLINE

The Salinas man’s message for mushroom lovers:  Don’t eat mushrooms that you pick. Anyone who develops any symptoms after eating wild mushrooms—or has questions about whether to eat them—should call the California Poison Control System Hotline at 1-800-8-POISON (1-800-876-4766) 

Clinical pharmacists, nurses and physicians who specialize in the diagnosis and treatment of poisoning are available 24 hours a day, and have access to translators to provide assistance in numerous languages for those who do not speak English.

A California native with relatives in Mexico, the young man had eaten wild-picked mushrooms in Mexico that looked identical to those he spotted by the side of the road in Monterey County on December 22. He was cautious enough to check with relatives in an attempt to reassure himself they were safe, but 12 hours after eating them he was struck with severe vomiting, diarrhea and pain. 

His mistake is unfortunately a common one, says Kent R. Olson, MD, executive medical director of the California Poison Control System (CPCS), and clinical professor of pharmacy and medicine at UCSF. Poisonous mushrooms in Northern California look very similar to edible varieties that grow here and in Europe, Asia and elsewhere in the Americas. Members of families that have collected mushrooms for many years in their native countries, or collectors who rely on guidebooks, may over-estimate their ability to distinguish safe mushrooms from the look-alike deadly varieties.

“Every year, especially after the heavy rains that promote mushroom growth, the CPCS receives many calls about wild mushroom ingestion.  We advise people not to eat wild mushrooms unless they have been properly trained to recognize poisonous varieties or the mushrooms have been certified safe by a recognized expert,” Olson said.

The CPCS website is CPCS.  Its toxicologists also can direct those who find mushrooms to a recognized mushroom expert, trained to identify poisonous varieties that could appear familiar and safe.  On a non-emergency basis, the Mycological Society of San Francisco (www.mssf.org) can suggest experts in Northern California, and the North American Mycological Society (http://www.namyco.org/) maintains a mushroom poisoning case registry. The Mycological Society also offers classes on mushroom identification and organizes guided mushroom walks in the Bay Area.

“We have reports of Amanita phalloides fruiting abundantly all over the Bay Area this week,” said David Rust, president of the Mycological Society of San Francisco.  “Not only is the range of the Death Cap increasing every year, but there are more of them and they fruit throughout the winter.  This is a problem that will only get worse.”

ORGAN DONATION
The Salinas man’s cousin, a young woman from Riverside, California, added another message for all:  “I had been thinking about organ donation, but had not made up my mind,” she said.  “My cousin is like a brother to me. When I think of how lucky we are that he could receive a transplant, now I’m certain that I want to be an organ donor if I should die.” 

Peggy Devney, clinical nurse specialist with the UCSF Liver, Kidney and Pancreas Transplant Service, said, “The new year is a good time for people to talk with their families, and one thing to bring up is your decision whether to donate your organs when you no longer need them. It’s not enough to sign an organ-donor card or put a pink dot on your driver’s license. Your organs cannot be donated without your family’s permission, and the only way to give them the comfort that this gift of life is the right choice in the case of an unexpected death, is to tell them now.”

Information about how to become an organ donor is available from the California Transplant Donor Network (www.ctdn.org and 1-888-570-9400).

It takes only a portion—as small as one-fourth of one Amanita phalloide mushroom cap—to damage or even destroy a person’s liver, said UCSF liver specialist Nathan Bass, MD, professor of medicine and medical director of liver transplant at UCSF Medical Center. “This young man was lucky because his symptoms were quickly identified as possible mushroom poisoning,” Bass said. Abdominal pain, cramping, severe vomiting and profuse diarrhea are usually delayed six to 12 hours or more after eating the mushrooms - and like many others, this patient did not at first link his symptoms to the mushrooms he’d eaten at lunch, thinking instead of the shrimp he ate at dinner. 

Once those initial symptoms subside, a patient may temporarily feel better, and here the young man was fortunate again because the UCSF liver specialists detected signs of rapidly increasing liver failure. The hope for such patients is that their livers will recover and regenerate, so they will not need a transplant, but Bass and attending transplant surgeon Ryutaro Hirose, MD realized the need to quickly list the patient as an urgent candidate for a liver transplant. Word went out through the nationwide transplant donor network, and within six hours, on Christmas Eve, an organ was offered from a hospital in another state.

“In those six hours, his liver enzymes (an indication of liver failure) shot up through the roof,” Hirose said.  By 4 am Christmas morning, when the donated liver had arrived and been examined and Hirose and fellow surgeon Andrew Posselt, MD began the transplant, most of the cells in the young man’s own liver had been destroyed by the toxin.

Later, Hirose learned that no other suitable liver became available within the time that would have been necessary to save the patient’s life.

“This was a wonderful Christmas Day gift for our patient,” Hirose said.  “And it was a gift, generously given by the donor’s family.  They suffered a terrible loss on Christmas Eve, yet they offered the gift of life to our patient and undoubtedly to several others in need of organ transplants.”

TRANSPLANT SERVICE
 
The Liver, Kidney and Pancreas Transplant Service of UCSF Medical Center(Organ Transplant) is led by Professor of Surgery John Roberts, MD. UCSF Chair of Surgery Nancy Ascher, MD, is past chair of the U.S. Secretary of Health and Human Services’ transplant policy committee and past president of the American Society of Transplant Surgeons.

The UCSF liver transplant service is the oldest full-service adult and pediatric liver transplant program in Northern California.  Because of the shortage of suitable donated organs, UCSF has been a leader in living-donor liver transplants for both children and adults. UCSF is a member of a nine-institution NIH-supervised study of the safety and efficacy of living donor transplants for patients and donors.

UCSF kidney transplant surgeons have performed more transplants than any other center in the world; in 2001, more than 300 adult and pediatric patients received kidney transplants.  The transplant service is a leader in innovations to reduce organ rejection and improve quality of life for patients before and after transplant, and in new procedures such as transplants of pancreatic islet cells to treat diabetes.

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NOTES:
UCSF ORGAN TRANSPLANT SERVICES: To Contact the UCSF Medical Center Transplant Services, call: UCSF Liver Transplant Service: (415) 353-1888/  Kidney or Pancrease Transplant Service:  353-1551. Heart and Lung Transplant Service: (415) 476-3503. Or see the website: Organ Transplant

CALIFORNIA POISON CONTROL SYSTEM:  The California Poison Control System is a statewide network of trained experts providing immediate free treatment advice and assistance over the telephone in case of exposure to poisonous, hazardous or toxic substances. The CPCS is California’s leading source of poison help and information to both the public and health professionals and is accessible, toll-free, 24 hours a day, 365 days a year.  The CPCS website is http://www.calpoison.org
CPCS is authorized and funded by the State of California and consists of four divisions managed by the UC San Francisco School of Pharmacy. They are located at Valley Children’s Hospital in Fresno/Madera, UC Davis Medical Center in Sacramento, UC San Diego Medical Center and the UCSF-affiliated San Francisco General Hospital Medical Center.  The CPCS also has two additional Regional Education Programs located in Los Angeles and Orange counties. The Orange County branch is hosted by Children’s Hospital of Orange County (CHOC).