Telephone Consent in Tissue Donation: Effectiveness and Efficiency in Postmortem Tissue Generation

One reason for the loss of donors is the impossibility to contact family members for an interview. We sought to determine the effectiveness [(donors/total deaths) x 100] and efficiency [(donors/potential donors) x 100] of the telephone interview to obtain tissue for transplant purposes.

METHODS

A prospective, comparative cross-sectional study was performed on the personal and telephone interviews with family members during the tissue donation application process from January 1, 2004 to December 31, 2005.

RESULTS

Of the 3625 deaths hospital registered, we obtained 770 potential donors (21%). On 65% of occasions (503/770), the interview was held personally; on 29% (222/770), it had to be held over the telephone; and on 6% (45/770), family members could not be located. The refusals by family members over the telephone represented 48% (106/222), and the refusals during personal interviews were 37% (188/503). A positive family answer was obtained over the telephone on 116/431 donations (27%), and in the physical presence of the coordinator for 315/431 donors (73%). The donations obtained over the telephone were only for corneas in 83% (96/116) of cases, and for multiple tissues in 17% (20/116). The donor-generation effectiveness reached 9% in personal interviews and 12% if the telephone interviews were included. The donor generation efficiency reached 43% for personal interviews and 59% when telephone interviews were included. The use of the telephone enabled a 16% increase in tissue generation with a year-on-year increase of 4%.

CONCLUSIONS

The telephone has shown itself to be a useful tool for obtaining tissues postmortem.

Effects of NGF and BDNF on baseline glutamate and dopamine release in the hippocampal formation of the adult rat

It has been shown using in vitro techniques that BDNF and NGF evoke neurotransmitter release in the hippocampus but this phenomenon has not been demonstrated in vivo to date. We therefore performed in vivo microdialysis in urethane-anesthetized Fischer 344 rats. The microdialysis probe was implanted stereotaxically into the CA1 area of the hippocampus. Three hours after the implantation of the probe, glutamate (Glu) and dopamine (DA) levels had reached a stable baseline. Four baseline samples were collected every 15 min at a flow rate of 1 microL/min. The growth factors were delivered (1 microL/10 min) using a microinjector attached to the microdialysis probe. We found that BDNF and NGF, when administered into the hippocampus, evoked dopamine and glutamate release in a dose-dependent fashion. NGF produced a biphasic response in the release of Glu, and a uniphasic response in the release of DA, both of which were calcium dependent. The neurotransmitter release induced by NGF was blocked by tetrodotoxin, indicating neuronal origin of this response. The BDNF induced release of DA and Glu was decreased in low calcium conditions, indicating that it is at least partially calcium dependent. Furthermore, BDNF-induced neurotransmitter release was partially blocked by pre-treatment with K252a, an antagonist for tyrosine kinase receptors, indicating that BDNF is acting through Trk receptors to induce neurotransmitter release. These results demonstrate a close relationship between the growth factors BDNF and NGF and the neurotransmitters DA and Glu in the hippocampus of intact animals.

Effects of type of flow, plants and addition of organic carbon in the removal of zinc and chromium in small-scale model wetlands

Constructed wetlands are used for the treatment of wastewater containing metals. In order to clarify the role of plants, flow and the impact of organic matter, an investigation of three factors, each at two different levels, was carried out in small-scale model wetlands. The evaluated factors and levels were: type of flow (subsurface and surface); presence of plants (planted with Typha latifolia and unplanted) and addition of organic matter (with and without). Eight different experimental units were run for a year. The units were fed with synthetic wastewater containing chromium (VI) (1.5 mg L(-1)), zinc (1.5 mg L(-1)), macro, micronutrients and organic matter (to those units in which this factor was being investigated). Subsurface flow wetlands showed a significantly higher rate of chromium removal in comparison with surface flow systems (97 and 60 mg m(-2) d(-1), respectively). Planted systems removed significantly more chromium compared to unplanted systems (85 and 76 mg m(-2) d(-1), respectively), and the addition of organic matter increased the removal rate in a comparison with the units without it (88 and 69 mg m(-2) d(-1), respectively). Similar results were found for zinc; however, the addition of organic matter made no significant difference to zinc removal.

Model experiments on improving nitrogen removal in laboratory scale subsurface constructed wetlands by enhancing the anaerobic ammonia oxidation

Anaerobic ammonia oxidation (Anammox) has been identified as a new general process-strategy for nitrogen removal in wastewater treatment. In order to evaluate the role and effects of the Anammox process in wetlands, laboratory-scale model experiments were performed with planted fixed bed reactors. A reactor (planted with Juncus effusus) was fed with synthetic wastewater containing 150-200 mg L(-1) NH4+ and 75-480 mg L(-1) NO2(-). Under these operating conditions, the plants were affected by the high ammonia and nitrite concentrations and the nitrogen removal rate fell within the same range of 45-49 mg N d(-1) (equivalent to 0.64-0.70 g Nm(-2)d(-1)) as already reported by other authors. In order to stimulate the rate of nitrogen conversion, the planted reactor was inoculated with Anammox biomass. As a result, the rate of nitrogen removal was increased 4-5-fold and the toxic effects on the plants also disappeared. The results show that, in principle, subsurface flow wetlands can also function as an "Anammox bioreactor". However, the design of a complete process for the treatment of waters with a high ammonia load and, in particular, the realisation of simple technical solutions for partial nitrification have still to be developed.

Use of Quality Index in the Evaluation of Organ Procurement and Transplant Programs in a University Hospital

AIM

To evaluate organ procurement efficiency at Hospital Clinic of Barcelona (HCP), a University Hospital, in 2000 and 2003 compared with other Catalan, other Spanish, and American (US) results.

METHODS

Efficacy rate of the donor procurement was calculated per million population per year (pmp/y). Efficacy rate in kidney, liver, and heart transplantation was calculated also in pmp/y. We evaluated 1-year graft survival.

RESULTS

During this period, the average rate number of donors was 49.1 pmp/y in HCP, 38 in Catalonia, 33.4 in Spain, and 21.7 in the United States. The average rate of kidney transplantation was 74 pmp/y in HCP, 55 in Catalonia, 47 in Spain, and 24.6 in the United States. The average rate of liver transplantation was 44.5, 26.6, 23.2, and 18 pmp/y, respectively. The average rate of heart transplantation was 13.3, 8.5, 7.8, and 6.4 pmp/y, respectively. One-year graft survival in HCP was 90.6% for kidney, 89.5% for liver, and 88.2% for heart transplants.

DISCUSSION

The results show that organ procurement and transplantation programs in HCP are efficient. The organizational model is based on a hospital transplant coordinator and efficient, well-trained transplant teams.

Evaluation of transplant procurement management courses: an educational project as a tool for the optimization of transplant coordination

The process of obtaining organs and tissues includes a series of procedures and skills that are fundamental to obtain a large number and high quality of transplants. Health professionals involved in transplant coordination require robest and comprehensive training to integrate the donation-transplantation process within the clinical health care field. Based on a learning-through-experience model, Transplant Procurement Management (TPM) designed various courses adapted to local educational need to train transplant coordinators, to increase active donor detection, and to promote a positive attitude towards donation; namely, Advanced, Introductory and New Life Cycle courses respectively. Moreover, TPM has coordinated international programs (INTERCATT and INTERITALY). Since 1991, the model has included 29 Advanced courses (1215 participants), 22 Introductory courses (575 pupils), and 7 New Life Cycle courses (more than 400 attendees). The Advanced courses were attended by medical (intensive care unit, nephrology, and others) and nursing professionals. Assessment of the educational program showed achievement of teaching objectives. The evaluation averages above 3.5 (scale, 1-5) for content, presentation, and ability to answer questions. Likewise, the program's organization showed an average score of 4.4. The acquired knowledge was assessed by means of a self-evaluation test (correct answers >69%). Practical skills assessed through direct observation showed an average of 7 (scale, 1-10). The TPM educational program offers a range of necessary knowledge and skills to increase organ donation. Health professionals concerned about the organ shortage may find TPM training useful to increase their knowledge.

The process of adult living liver donation

OBJECTIVE

To evaluate both the opinion that living liver donors have of the process and the psychological, economic, and social consequences of donation.

MATERIAL AND METHODS

Six months after the donation, an anonymous survey was sent to 22 donors of the right liver lobe between March 2000 and December 2002.

RESULTS

15 surveys were returned with all of the questions answered. Almost all the donors had no prior knowledge of living donation. When they were considered to be suitable donors, all of them felt happy, 21% were scared and 15% felt joy and insecurity. The information provided was well understood and accurately described the experiences of 93% of donors. All donors understood the vital risk, and 93% understood that transplantation is not always completely successful. All donors would repeat the experience. Mean hospital stay was 12.6 days. Mean convalescence was 50.6 days. Salaried donors were on sick leave for a mean of 96.4 days (21-150 days), causing financial problems in six cases (36%), due to no financial compensation and compulsory redundancy in one case. All donors had completely recovered at six months after donation.

DISCUSSION

Adult living donation of the right liver lobe is an accepted therapeutic alternative. In order to regulate medical and economic protection to avoid additional disturbances after donation, the public, patients, and physicians require more complete information about living donation.

Persistence of intracranial diastolic flow in transcranial Doppler sonography exploration of patients in brain death

OBJECTIVE

The persistence of cerebral blood flow (CBF) in patients with whole brain death (BD) diagnosis is an unusual phenomenon. We describe patients with whole BD diagnosed despite persistence of intracranial blood flow on transcranial Doppler sonography (TDS).

MATERIALS AND METHODS

From January 2001 to December 2002, we reviewed the records of 11 patients. Etiology of BD was craniocephalic trauma in 2 cases, schemic cerebrovascular accident (CVA) in 4 cases, Hemorrhagic CVA in 3 cases, subaracnoid hemorrhage in 1 case, and acute hydrocephalus in 1 case. Six patients had a cerebral decompressive mechanism. In all patients, TDS was used to confirm BD after clinical diagnosis. Additionally, all patients underwent an electroencephalogram (EEG). In 3 patients cerebral angiography (CA) and in 2 others radionuclide angiography (RA) with Tc99m HMPAO were done.

RESULTS

All TDS studies showed persistent telediastolic positive flow in at least 1 artery. Because the TDS did not confirm the clinical diagnosis of BD, EEG tests were performed showing silence of bioelectrical activity. Those cases showed CA or RA results with a complete absence of CBF.

CONCLUSION

The TDS technique directly evaluates the intracranial but not the intracerebral circulation. For this reason, during the BD diagnosis for patients with previous decompressive techniques, it was possible to find persistence of intracranial telediastolic flow using TDS. In those cases, it is advisable to use other tests to confirm the clinical diagnosis of BD.

The living kidney donation process: the donor perspective

OBJECTIVE

To evaluate the living kidney donation (LKD) process using donors' opinions on the impact on social, emotional, and financial aspects affecting donor quality of life.

MATERIALS AND METHODS

From May 2000 to December 2002, we studied 22 donors of living kidneys at the Hospital Clinic, Barcelona, Spain, who completed an anonymous survey 6 months after donation.

RESULTS

Most donors (86%) had themselves informed the recipient about their wish to donate, the other 14% were asked by family members. Eighty-eight percent stated that the information provided to the donor about the evaluation process was well explained and understood whereas 12% disagreed with the statement. At the time of thin decision, 90.5% of donors understood the vital risk. For 95%, the explanations about the process corresponded with the actual experience. One hundred percent of donors stated after donation that they would again favor it. Mean hospital stay was 6 days (range, 3-9 days). Those donors with a labor contract have been out of work for an average of 57.8 days (range, 18 days to 6 months). Twenty-five percent of donors admitted financial effects as a result of donation. All but 1 felt completely recovered with the same quality of life after donation.

DISCUSSION

LKD is a good therapeutic alternative. Some aspects should be developed, such as more information about living donation and the need to considering donors as healthy persons without loss of earnings. Recognition of the benefits of living donation requires more wide participation of all citizens nationally.

Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors

Our aim was to analyze the short- and long-term function of kidneys procured from non- heartbeating donors (NHBD) by means of three techniques: in situ perfusion (ISP), total body cooling (TBC) and normothermic recirculation (NR). Fifty-seven potential NHBD were included. Mean warm ischemia time was 68.9 +/- 35.6 min. Forty-four kidneys were obtained from donors perfused with ISP, 8 with TBC, and 8 with NR. Eighteen kidneys (32%) started functioning immediately, 29 (52%) showed delayed graft function (DGF) and 9 (16%) showed primary non function (PNF). The actuarial graft survival rate was 76.4% at 1 year and 56% at 5 years. The patient survival rate was 89.3% at 5 years. Incidence of DGF and PNF was significantly lower in kidneys perfused with NR than those with ISP or TBC (P < 0.01). Duration of DGF was shorter in kidneys obtained through TBC than in kidneys obtained with ISP (P < 0.05). In conclusion, NR reduces the incidence of DGF and may be considered the method of choice for kidney procurement from NHBD.

Medial prefrontal transection enhances social interaction. I: behavioral studies

Behavioral effects of a medial prefrontal cortex (MPFC) transection were assessed in animal tests of anxiety. Social investigation and plus-maze open arm exploration increased in MPFC damaged animals relative to sham ones. MPFC lesions prevented D-amphetamine (2 mg/kg, i.p.) induced social investigation decrease and exaggerated general locomotion increase. Diazepam (1 mg/kg, i.p.) and MPFC synergistically increased open arm exploration on a second (repeated) plus-maze trial. These results suggest that the MPFC would be implicated in a generalized mechanism of warning enabling emission of appropriate responses to anxiogenic stimuli. Although, this lesion did not modify motor activity itself, the pattern of the motor activation induced by amphetamine was altered. The role of the MPFC areas in the behavioral response associated with fear is discussed.

Melatonin acts on the nucleus accumbens to increase acetylcholine release and modify the motor activity pattern of rats

Brain microdialysis coupled to high performance liquid chromatography with electrochemical detection (HPLC-ED) was used to evaluate the influence of melatonin on extracellular concentration of acetylcholine (ACh) in the nucleus accumbens (NAc) of rats. Motor activity was simultaneously monitored during the dialysis sessions with an activity meter. Melatonin and prazosin were administered locally through the dialysis probe. It was found that melatonin dose-dependently increased accumbens ACh. Melatonin (3 microM) decreased horizontal activity and increased vertical activity, while another dose (100 microM) enhanced both horizontal and vertical activity. Prazosin, a putative melatonin antagonist, blocked the effects of melatonin on both motor activity and ACh release when given 20 min before melatonin. Overall, these results suggest that melatonin modulates the release of ACh in the NAc and the pattern of motor activity in the rat.

Renal transplantation with limit donors: to what should the good results obtained be attributed?

BACKGROUND

With the aim of offsetting the reduction in donors of kidneys for transplantation, we extended the acceptance criteria, considering donors over 60 years old.

METHODS

The results obtained in 84 transplants carried out with this type of donor (group A) was compared with those of a control group of 125 transplants carried out with kidneys from donors under 60 years old (group B). The protocol for selection of donors was appropriate creatinine clearance, minimum proteinuria, and normal renal scan. The histological study was not included because it was not considered appropriate to assess the extent of the possible glomerulosclerosis, as this has a focal, segmented distribution. There were no significant differences between the recipients except for age (57.8 years old in group A vs. 39.2 years in group B).

RESULTS

After the transplantation, there were significant differences in the duration of hospitalization (26.8 days vs. 21.8 days, P<0.009), annual plasma creatinemia (177, 225, 233, 235, and 205 micromol/L vs. 136, 150, 121, 111, and 133 micromol/L, P<0.0002/0.0004), graft survival (87%, 85%, 81%, 81%, and 81% vs. 89%, 88%, 86%, 86%, and 85%, P<0.03), and patient survival (92%, 89%, 85%, 85%, and 85% vs. 99%, 99%, 97%, 96%, and 95%, P<0.0004). Death of the patient was the only significantly more frequent cause of graft loss among group A patients (7 vs. 1 death, P<0.004). No kidney was "never working" and none were lost because of chronic rejection.

CONCLUSIONS

It was concluded that elderly donors should be considered as suitable for transplantation irrespective of their chronological age, provided that they fulfill the acceptance criteria. The quality of life achieved was comparable in both groups. Despite the lower renal function in group A, this remained constant during the follow-up period.