MDMA intoxication in a potential organ donor with cardiac arrest

• Autor(a) principal: Castro, André Lobo
• Data de Publicação: 2020
• Outros Autores: Tarelho, Sónia, Almeida, Dina, Sousa, Lara, Franco, João, Teixeira, Helena M.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10400.26/37721; https://doi.org/10.1093/jat/bkaa042
• topic: MDMA; Organ Donor; Forensic Toxicology; Substance Abuse Detection; 3,4-Methylenedioxyamphetamine

Amphetamine and its derivatives’ consumption is still an important public health issue, namely in terms of compounds variability and disposition to consumers. However, some of them, like MDMA, still live in the illicit market, with continuous success. Nevertheless, there is always new information and data on MDMA intoxication, both in vivo and in post-mortem context. The authors report an intoxication case with MDMA, in an 18 years old male, considered a potential organ donor after a cardiac arrest. Whole blood samples were collected in vivo, at the Emergency Room (ER), and post-mortem, at the National Institute of Legal Medicine and Forensic Sciences. After a general screening procedure, samples were extracted by SPE (OASIS® MCX), followed by GC-MS analysis. The whole blood post-mortem sample was positive for lidocaine (< 500 ng/mL), compatible with the ER intervention, and positive for MDMA (2278 ng/mL) and MDA (49 ng/mL), while whole blood samples collected in vivo (during the maintenance of the individual under advanced life support), were positive for MDMA (504 ng/mL to 1918 ng/mL) and MDA (20 ng/mL to 89 ng/mL). Samples were negative for other substances, namely ethanol, other drugs of abuse and medicines.Results interpretation is pivotal to understand the behaviour of the substance. Thus, in this case, MDMA post-mortem behaviour should be carefully evaluated, considering as possible influencers, in the specific context of the case, the time lapse between death verification, maintenance of the advanced life support and body manipulation for organ collection purposes. Also referred and discussed is the ante-mortem/post-mortem ratio of MDMA obtained values, compared with literature references. There is no doubt that death was due to MDMA intoxication, but information from the analysis performed on the in vivo samples suggests that this type of sample should also be considered, in a complementary role, whenever possible.