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Trela KC, Salerno CT, Chuba E, Dhawan R. Donation After Circulatory Death Heart Transplantation: A Narrative Review. J Cardiothorac Vasc Anesth 2024; 38:2047-2058. [PMID: 38981770 DOI: 10.1053/j.jvca.2024.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/10/2024] [Accepted: 03/31/2024] [Indexed: 07/11/2024]
Abstract
Heart transplantation is the definitive treatment for refractory, end-stage heart failure. The number of patients awaiting transplantation far exceeds available organs. In an effort to expand the donor pool, donation after circulatory death (DCD) heart transplantation has garnered renewed interest. Unlike donation after brain death, DCD donors do not meet the criteria for brain death and are dependent on life-sustaining therapies. Procurement can include a direct strategy or a normothermic regional perfusion, whereby there is restoration of perfusion to the organ before explantation. There are new developments in cold storage and ex vivo perfusion strategies. Since its inception, there has been a steady improvement in post-transplant outcomes, largely attributed to advancements in operative and procurement strategies. In this narrative review, the authors address the unique considerations of DCD heart transplantation, including withdrawal of care, the logistics of procuring and resuscitating organs, outcomes compared with standard donation after brain death, and ethical considerations.
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Affiliation(s)
- Kristin Constantine Trela
- Department of Anesthesia and Critical Care Medicine, University of Chicago, Chicago, IL, United States.
| | - Christopher T Salerno
- Section of Cardiothoracic Surgery, University of Chicago, Chicago, IL, United States
| | - Emuejevoke Chuba
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richa Dhawan
- Department of Anesthesia and Critical Care Medicine, University of Chicago, Chicago, IL, United States
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2
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Shim L, Wensley C, Casement J, Parke R. What determinants impact deceased organ donation consent in the adult intensive care unit? An integrative review exploring the perspectives of staff and families. Aust Crit Care 2024; 37:638-650. [PMID: 38216416 DOI: 10.1016/j.aucc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Deceased organ donation saves lives. Donation processes in New Zealand operate under an opt-in system, which requires consent from families of patients diagnosed with brain death or circulatory death while in the intensivecare unit. The donation demand and supply mismatch is a global phenomenon. OBJECTIVES The objective of this study was to understand the determinants of deceased organ donation decisions in the adult intensive care setting from the perspectives of staff and families. METHODS An integrative review based on Whittemore and Knafl's approach searched literature through databases CINAHL Plus, SCOPUS, Proquest Medline Ovid, and manual ancestry searches. Inclusion/exclusion criteria screened for pertinent literature, which were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Selected studies were appraised using a generic scoring tool, and data were systematically extracted and coded onto spreadsheets using inductive, thematic analysis. RESULTS A total of 21 studies (12 qualitative, seven quantitative, two mixed methods) were included. Publication dates ranged from 1993 to 2021 from multiple countries (18 opt-in, three opt-out systems). Four overarching themes pertaining to families and staff were generated. Important knowledge related to families' knowledge deficits around brain death, the purpose of ventilation, donation procedures, patients' wishes, and staffs' lack of training. Challenging communication highlighted miscommunications due to language choices and interrupted continuity of care during staff-family interactions. Internal determinants explored the cultural, spiritual, and emotional perspectives of families, while staff faced a sense of burden and conflicting values in delivering care between donors and recipients. External determinants related to the clinical environment impacting on grieving families, while for the staff, it explained concerns around resources and organisational processes. CONCLUSIONS Factors underpinning deceased organ donation are multifaceted and complex. Staff actions and families' decisions are inextricably intertwined. Modifiable factors include a lack of formal training and communicational skills and environmental limitations of an intensive care setting.
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Affiliation(s)
- Lydia Shim
- Auckland City Hospital Department of Critical Care Medicine, Te Toka Tumai, Grafton, New Zealand; School of Nursing, The University of Auckland, Faculty of Medical and Health Sciences, Grafton, New Zealand.
| | - Cynthia Wensley
- School of Nursing, The University of Auckland, Faculty of Medical and Health Sciences, Grafton, New Zealand.
| | - Jonathan Casement
- Organ Donation New Zealand, New Zealand Blood Service, 71 Great South Rd, Epsom PO Box 99 431, Newmarket, Auckland 1149, New Zealand; Intensive Care Unit, North Shore Hospital, Waitemata, Te Whatu Ora, Auckland, New Zealand.
| | - Rachael Parke
- School of Nursing, The University of Auckland, Faculty of Medical and Health Sciences, Grafton, New Zealand; Cardiothoracic and Vascular Intensive Care Unit, Te Toka Tumai Auckland, Grafton, New Zealand.
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3
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Gunst J, Souter MJ. Management of the brain-dead donor in the intensive care unit. Intensive Care Med 2024; 50:964-967. [PMID: 38598128 DOI: 10.1007/s00134-024-07409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Jan Gunst
- Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Michael J Souter
- Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA
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4
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Circelli A, Antonini MV, Gamberini E, Nanni A, Benni M, Castioni CA, Gordini G, Maitan S, Piccioni F, Tarantino G, Prugnoli M, Spiga M, Altini M, Di Benedetto F, Cescon M, Solli P, Catena F, Ercolani G, Russo E, Agnoletti V. EISOR Delivery: Regional experience with sharing equipe, equipment & expertise to increase cDCD donor pool in time of pandemic. Perfusion 2024; 39:85-95. [PMID: 35645162 PMCID: PMC9149662 DOI: 10.1177/02676591221103535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Donation after circulatory death (DCD) programs are expanding in Europe, in the attempt to expand donors pool. Even in controlled DCD donors, however, a protracted warm ischemia time occurring in the perimortem period might damage organs, making these unsuitable for transplantation. Implementing a strategy of extracorporeal interval support for organ retrieval (EISOR), a regional reperfusion with normothermic, oxygenated blood provides a physiologic environment allowing extensive assessment of potential grafts, and potentially promotes recovery of native function. Here we report the results of a multi-center retrospective cohort study including 29 Maastricht Category III controlled DCD donors undergoing extracorporeal support in a regional DCD/EISOR Training Center, and in the network of referring In-Training Centers, under the liaison of the regional Transplant Coordination Center during COVID-19 pandemic, between March 2020 and November 2021. The study aims to understand whether a mobile, experienced EISOR team implementing a consistent technique and sharing its equipe, expertise and equipment in a regional network of hospitals, might be effective and efficient in implementing the regional DCD program activity even in a highly stressed healthcare system.
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Affiliation(s)
- Alessandro Circelli
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| | - Marta Velia Antonini
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Emiliano Gamberini
- Anesthesia and Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Andrea Nanni
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
- Transplant Procurement Management, AUSL della Romagna, Cesena, Italy
| | - Marco Benni
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| | - Carlo Alberto Castioni
- Department of Anesthesia and Intensive Care, IRCCS Istituto delle Scienze Neurologiche, Bellaria Hospital, Bologna, Italy
| | - Giovanni Gordini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna
| | - Stefano Maitan
- Intensive Care Unit, Morgagni - Pierantoni Hospital, AUSL della Romagna, Forlì, Italy
| | - Federico Piccioni
- Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppe Tarantino
- Emilia-Romagna Transplant Reference Centre, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Manila Prugnoli
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
- Transplant Procurement Management, AUSL della Romagna, Cesena, Italy
| | - Martina Spiga
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| | - Mattia Altini
- Health Direction Unit, Azienda Unità Sanitaria Locale della Romagna, Ravenna, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo Cescon
- General Surgery and Transplantation Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Piergiorgio Solli
- Department of Cardio-Thoracic Surgery and Hearth & Lung Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fausto Catena
- General and Emergency Surgery, Bufalini Hospital - AUSL della Romagna, Cesena, Italy
| | - Giorgio Ercolani
- General and Oncologic Surgery, Morgagni - Pierantoni Hospital, AUSL Romagna, Forlì, Italy
- Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emanuele Russo
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
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Alshammari A, Brown M. Attitudes That Might Impact upon Donation after Brain Death in Intensive Care Unit Settings: A Systematic Review. Healthcare (Basel) 2023; 11:1857. [PMID: 37444690 DOI: 10.3390/healthcare11131857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Organ donation and transplantation can save or improve the quality of life of people worldwide. However, there are many challenges associated with organ donation, as the demand for organs greatly outstrips supply. Additionally, there are brain-dead patients who could be potential organ donors. It is thus important to determine the attitudes affecting organ donation and transplantation in intensive care unit settings. AIM this study aimed to identify attitudes that might affect organ donation and transplantation in intensive care unit settings. METHODOLOGY Five electronic databases (CINAHL, Medline, PsycINFO, Scopus, and EMBASE) were searched systematically. A systematic search strategy was formulated. The quality of each study was assessed using the MMAT quality appraisal tool. RESULTS A total of seven studies were included. The findings of this systematic review demonstrate that education, policy, and continuing professional development could help to address barriers to donation. CONCLUSIONS therefore, to influence organ donation and transplantation positively, the main themes evaluated in this systematic review provide an opportunity to influence organ donation and transplantation attitudes in intensive care unit settings.
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Affiliation(s)
- Areej Alshammari
- Northern Area Armed Forces Hospital, Hafar Albatin, King Khaild Military City 39748, Saudi Arabia
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Michael Brown
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
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6
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Gibson JE, Campbell T, Gibson K, Kottemann K, Krause MA, Pack L. Collaborative Approach to Organ Donation in a Level II Trauma Center. AACN Adv Crit Care 2023; 34:88-94. [PMID: 37289629 DOI: 10.4037/aacnacc2023552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Although a shortage of organ donors is a continuing global problem in health care, obtaining authorization for donation after an individual experiences a traumatic nonsurvivable event can be difficult. OBJECTIVE To improve organ donation practices at a level II trauma center. METHODS After reviewing trauma mortality cases and performance improvement metrics with their organ procurement organization's hospital liaison, leaders at the trauma center implemented a multidisciplinary performance improvement initiative to engage the facility's donation advisory committee, provide education for staff members, and increase program visibility to create a more donation-friendly culture for the facility. RESULTS The initiative led to an improved donation conversion rate and a greater number of organs procured. Continued education increased staff and provider awareness of organ donation, contributing to the positive outcomes. CONCLUSION A multidisciplinary initiative that includes continuing staff education can improve organ donation practices and program visibility, ultimately benefiting patients in need of organ transplantation.
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Affiliation(s)
- Jesse E Gibson
- Jesse E. Gibson is Trauma Program Director, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Teisha Campbell
- Teisha Campbell is Hospital Development Liaison II, LifeLink of Georgia, Norcross, Georgia
| | - Kyle Gibson
- Kyle Gibson is Nurse Practitioner, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Kim Kottemann
- Kim Kottemann is Director of Professional Programs and Transplant Center Relations, LifeLink of Georgia, Norcross, Georgia
| | - Morgan A Krause
- Morgan A. Krause is Trauma Research Coordinator, Northeast Georgia Medical Center, Gainesville, Georgia
| | - Leigh Pack
- Leigh Pack is Trauma Research Coordinator, Northeast Georgia Medical Center, 743 Spring St NE, Gainesville, GA 30501
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7
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Kidney Donation after circulatory death: The Veneto Region experience in Italy. TRANSPLANTATION REPORTS 2023. [DOI: 10.1016/j.tpr.2023.100129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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8
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Mulder J, Sonneveld H, Van Raemdonck D, Downar J, Wiebe K, Domínguez-Gil B, Healey A, Desschans B, Neyrinck A, Blanco AP, van Dusseldorp I, Olthuis G. Practice and challenges for organ donation after medical assistance in dying: A scoping review including the results of the first international roundtable in 2021. Am J Transplant 2022; 22:2759-2780. [PMID: 36100362 PMCID: PMC10092544 DOI: 10.1111/ajt.17198] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 01/25/2023]
Abstract
The procedure combining medical assistance in dying (MAiD) with donations after circulatory determination of death (DCDD) is known as organ donation after euthanasia (ODE). The first international roundtable on ODE was held during the 2021 WONCA family medicine conference as part of a scoping review. It aimed to document practice and related issues to advise patients, professionals, and policymakers, aiding the development of responsible guidelines and helping to navigate the issues. This was achieved through literature searches and national and international stakeholder meetings. Up to 2021, ODE was performed 286 times in Canada, the Netherlands, Spain, and Belgium, including eight cases of ODE from home (ODEH). MAiD was provided 17,217 times (2020) in the eight countries where ODE is permitted. As of 2021, 837 patients (up to 14% of recipients of DCDD donors) had received organs from ODE. ODE raises some important ethical concerns involving patient autonomy, the link between the request for MAiD and the request to donate organs and the increased burden placed on seriously ill MAiD patients.
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Affiliation(s)
- Johannes Mulder
- Anesthesiology/Intensive Care Department, Isala Hospitals, Zwolle, The Netherlands.,Family Medicine Centre Dalfsen, Zwolle, The Netherlands
| | - Hans Sonneveld
- Anesthesiology/Intensive Care Department, Isala Hospitals, Zwolle, The Netherlands
| | | | - James Downar
- Department of Critical Care, University of Ottawa, Ottawa, Canada
| | - Kim Wiebe
- Shared Health Services, Canada, Winnipeg, Canada
| | | | - Andrew Healey
- Intensive Care Department, William Osler Health System Hospitals, Brampton, Canada.,Trillium Gift of Life Donation, Canada
| | - Bruno Desschans
- Transplant Centre Leuven, University Hospital Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Transplant Centre Leuven, University Hospital Leuven, Leuven, Belgium
| | | | - Ingeborg van Dusseldorp
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, The Netherlands
| | - Gert Olthuis
- IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Ray A, Manara AR, Mortimer AM, Thomas I. Brain herniation on computed tomography is a poor predictor of whether patients with a devastating brain injury can be confirmed dead using neurological criteria. J Intensive Care Soc 2022; 23:453-458. [PMID: 36751360 PMCID: PMC9679895 DOI: 10.1177/17511437211040019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background It is unclear if the presence of compartmental brain herniation on neuroimaging should be a prerequisite to the clinical confirmation of death using neurological criteria. The World Brain Death Project has posed this as a research question. Methods The final computed tomography of the head scans before death of 164 consecutive patients confirmed dead using neurological criteria and 41 patients with devastating brain injury who died following withdrawal of life sustaining treatment were assessed by a neuroradiologist to compare the incidence of herniation and other features of cerebral swelling. Results There was no difference in the incidence of herniation in patients confirmed dead using neurological criteria and those with devastating brain injury (79% vs 76%, OR 1.23 95%, CI 0.56-2.67). The sensitivity and specificity of brain herniation in patients confirmed dead using neurological criteria was 79% and 24%, respectively. The positive and negative predictive value was 81% and 23%, respectively. The most sensitive computed tomography of the head findings for death using neurological criteria were diffuse sulcal effacement (93%) and basal cistern effacement (91%) and the most specific finding was loss of grey-white differentiation (80%). The only features with a significantly different incidence between the death using neurological criteria group and the devastating brain injury group were loss of grey-white differentiation (46 vs 20%, OR 3.56, 95% CI 1.55-8.17) and presence of contralateral ventricular dilatation (24 vs 44%, OR 0.41, 95% CI 0.20-0.84). Conclusions Neuroimaging is essential in establishing the cause of death using neurological criteria. However, the presence of brain herniation or other signs of cerebral swelling are poor predictors of whether a patient will satisfy the clinical criteria for death using neurological criteria or not. The decision to test must remain a clinical one.
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Affiliation(s)
- Andrew Ray
- Consultant in Intensive Care
Medicine, Southmead Hospital, Bristol, UK
| | - Alex R Manara
- Consultant in Intensive Care
Medicine, Southmead Hospital, Bristol, UK,Alex R Manara, The Intensive Care Unit,
Southmead Hospital, Southmead Road, Bristol BS10 5NB, UK.
| | - Alex M Mortimer
- Consultant in Neuroradiology, Southmead Hospital, Bristol, UK
| | - Ian Thomas
- Consultant in Intensive Care
Medicine, Southmead Hospital, Bristol, UK
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10
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Bokek-Cohen Y, Abu-Rakia R, Azuri P, Tarabeih M. The View of the Three Monotheistic Religions Toward Cadaveric Organ Donation. OMEGA-JOURNAL OF DEATH AND DYING 2022; 85:429-444. [PMID: 35678288 DOI: 10.1177/0030222820947585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Religious concerns regarding the legitimacy of cadaveric organ donation have been found to be major inhibiting factors for people to consent to donate organs post-mortem for transplantation; this constitutes a major cause for the grave shortfall of available organs for transplantation. The purpose of this review is to explore the view of the three monotheistic religions, namely Christianity, Islam, and Judaism, toward cadaveric organ donation. The literature review reveals that all three monotheistic religions support cadaveric organ donation but within certain restrictions. We provide a detailed description of the approach of each religion and the inhibiting considerations as interpreted by religious authorities. Health professionals need to collaborate with faith leaders in order to optimize the education of the public of believers with regard to the benefits stemming from organ donation. Developing transplantation medicine does not depend solely on technical capabilities and expertise; rather, this development should go hand in hand with religious, traditional and cultural beliefs and rituals. Providing a believer with a religious authority about cadaveric organ donation is very effective in helping families and individuals cope with difficult and critical decisions.
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Affiliation(s)
| | | | - Pazit Azuri
- School of Nursing, Academic College of Tel Aviv
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11
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Santos PARD, Teixeira PJZ, Moraes Neto DMD, Cypel M. Donation after circulatory death and lung transplantation. J Bras Pneumol 2022; 48:e20210369. [PMID: 35475865 PMCID: PMC9064622 DOI: 10.36416/1806-3756/e20210369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022] Open
Abstract
Lung transplantation is the most effective modality for the treatment of patients with end-stage lung diseases. Unfortunately, many people cannot benefit from this therapy due to insufficient donor availability. In this review and update article, we discuss donation after circulatory death (DCD), which is undoubtedly essential among the strategies developed to increase the donor pool. However, there are ethical and legislative considerations in the DCD process that are different from those of donation after brain death (DBD). Among others, the critical aspects of DCD are the concept of the end of life, cessation of futile treatments, and withdrawal of life-sustaining therapy. In addition, this review describes a rationale for using lungs from DCD donors and provides some important definitions, highlighting the key differences between DCD and DBD, including physiological aspects pertinent to each category. The unique ability of lungs to maintain cell viability without circulation, assuming that oxygen is supplied to the alveoli-an essential aspect of DCD-is also discussed. Furthermore, an updated review of the clinical experience with DCD for lung transplantation across international centers, recent advances in DCD, and some ethical dilemmas that deserve attention are also reported.
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Affiliation(s)
- Pedro Augusto Reck Dos Santos
- . Department of Cardiothoracic Surgery, Mayo Clinic (AZ) USA.,. Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Paulo José Zimermann Teixeira
- . Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil.,. Departamento de Clínica Médica, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | | | - Marcelo Cypel
- . Division of Thoracic Surgery, University of Toronto, University Health Network, Toronto (ON) Canada
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Baroni S, Marudi A, Rinaldi S, Ghedini S, Magistri P, Piero Guerrini G, Olivieri T, Dallai C, Talamonti M, Maccieri J, Benedetto FD, Bertellini E. Cytokine mass balance levels in donation after circulatory death donors using hemoadsorption: Case series report. Int J Artif Organs 2022; 45:642-646. [PMID: 35426347 DOI: 10.1177/03913988221091288] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The use of hemadsorption has been purposed to reduce cytokine levels during the reperfusion phase during donation after circulatory death (DCD) programs. This paper aims to describe a cases series of the inflammatory cytokine levels before and after hemadsorption during normothermic reperfusion in DCD donors of liver and kidneys. In this observational pilot paper, we describe 8 DCD donors of liver or kidneys in our center from the year 2018 to 2019. All DCD donor subjects had similar age, were younger than 60 years, without evident critical conditions, no liver or kidney dysfunction known, and they presented with poor neurological outcomes instrumentally and clinically documented. We observed in our patients an interesting reduction of IL-10 and TNF-α levels during the normothermic reperfusion with hemadsorption. We transplanted all livers and kidneys from DCD donors without significant compliances.
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Affiliation(s)
- Stefano Baroni
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Andrea Marudi
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Simone Rinaldi
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Silvia Ghedini
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Bologna, Italy
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Piero Guerrini
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiziana Olivieri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Chiara Dallai
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Marta Talamonti
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Jessica Maccieri
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Bologna, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Bertellini
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
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13
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Endocrine Management and Hormone Replacement Therapy in Cardiac Donor Management: A Retrospective Observational Study. Transplant Proc 2021; 53:2807-2815. [PMID: 34756710 DOI: 10.1016/j.transproceed.2021.08.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/27/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pituitary dysfunction after brainstem death can cause various hormone deficiencies in potential heart donors. The aim of this study was to evaluate the relationship between hormone replacement therapy (HRT; including antidiuretic hormone analog, thyroid hormone, and methylprednisolone) in heart donors and the recipients' outcomes after heart transplantation (HTx). METHODS We retrospectively analyzed HTxs performed between January 2012 and October 2018. Donor and recipient characteristics were retrieved with a focus on endocrine parameters and HRT. The primary outcome was primary graft dysfunction (PGD). Secondary outcomes were the 30-day and 2-year mortality of the recipients. Univariate and multivariate Cox regression analyses were applied. RESULTS The study included 297 HTxs. PGD occurred in 56 recipients (18.9%). In the multivariable Cox analysis, methylprednisolone and thyroxine treatment in donors were associated with a lower odds for PGD (odds ratio [OR], 0.43; 95% CI, 0.19-1.01; P = .052; and OR,: 0.34; 95% CI, 0.15-0.76; P = .009, respectively). In multivariate analysis, thyroxine treatment in donors was associated with a lower odds of PGD (OR, 0.38; 95% CI, 0.17-0.86; P = .020). Donor thyroxine supplementation also had a beneficial effect on recipients' 2-year survival (OR, 0.53; 95% CI, 0.29-0.96; P = .036). CONCLUSIONS Combined thyroxine and methylprednisolone treatment could be a protective factor against PGD. Thyroxine administration was associated with better 2-year survival in recipients.
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Potter JE, Elliott RM, Kelly MA, Perry L. Education and training methods for healthcare professionals to lead conversations concerning deceased organ donation: An integrative review. PATIENT EDUCATION AND COUNSELING 2021; 104:2650-2660. [PMID: 33775500 DOI: 10.1016/j.pec.2021.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To determine which training methods positively influenced healthcare professionals' communication skills and families' deceased organ donation decision-making. METHODS An integrative review using systematic methods and narrative synthesis for data analysis. Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (EBSCO), Embase (OVID) and ProQuest Dissertations & Theses Global, were searched between August 1997 and March 2020, retrieving 1019 papers. Included papers (n = 14) were appraised using the Medical Education Research Study Quality Instrument. RESULTS Training programmes offered theory, experiential learning, feedback and debriefing including self-reflection, the opportunity to role-play and interact with simulated participants within realistic case scenarios. Programmes reported observed and self-rated improvements in communication learning and confidence. The methodological quality score averaged 13, (72% of maximum); few studies used an experimental design, examined behavioural change or families' perspectives. Weak evidence suggested training could increase organ donation authorisation/consent rates. CONCLUSIONS Multiple training strategies are effective in improving interprofessional healthcare professionals' confidence and learning of specialised communication. Methodological limitations restricted the ability to present definitive recommendations and further research is warranted, inclusive of family decision-making experiences. PRACTICE IMPLICATIONS Learning of specialised communication skills is enhanced by using multiple training strategies, including role-play and debriefing.
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Affiliation(s)
- Julie E Potter
- University of Technology Sydney, Faculty of Health, Ultimo, Australia; Royal North Shore Hospital, Department of Medical Oncology, St Leonards, Australia.
| | - Rosalind M Elliott
- University of Technology Sydney, Faculty of Health, Ultimo, Australia; Royal North Shore Hospital, Department of Intensive Care, St Leonards, Australia; Northern Sydney Local Health District, Nursing and Midwifery Directorate, St Leonards, Australia.
| | - Michelle A Kelly
- University of Technology Sydney, Faculty of Health, Ultimo, Australia; Curtin University, Curtin School of Nursing, Bentley, Australia.
| | - Lin Perry
- University of Technology Sydney, Faculty of Health, Ultimo, Australia; Prince of Wales Hospital, Department of Endocrinology, Randwick, Australia.
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Lu J, Xu L, Zeng Z, Xue C, Li J, Chen X, Zhou P, Lin S, Liao Y, Du X, Yang R, Zheng S. Normothermic ex vivo Heart Perfusion Combined With Melatonin Enhances Myocardial Protection in Rat Donation After Circulatory Death Hearts via Inhibiting NLRP3 Inflammasome-Mediated Pyroptosis. Front Cell Dev Biol 2021; 9:733183. [PMID: 34532321 PMCID: PMC8438322 DOI: 10.3389/fcell.2021.733183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/11/2021] [Indexed: 01/06/2023] Open
Abstract
Objective The adoption of hearts from donation after circulatory death (DCD) is a promising approach for the shortage of suitable organs in heart transplantation. However, DCD hearts suffer from serious ischemia/reperfusion injury (IRI). Recent studies demonstrate that nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome-mediated pyroptosis is a novel target to ameliorate myocardial IRI. Melatonin is shown to inhibit NLRP3 inflammasome-mediated pyroptosis. Therefore, this study is designed to verify the hypothesis that melatonin can protect the heart graft preserved with ex vivo heart perfusion (EVHP) against myocardial IRI via inhibiting NLRP3 inflammasome-mediated pyroptosis in a rat model of DCD. Methods Donor-heart rats were randomly divided into three groups: (1) Control group: non-DCD hearts were harvested from heart-beating rats and immediately preserved with allogenic blood-based perfusate at constant flow for 105 min in the normothermic EVHP system; (2) DCD-vehicle group; and (3) DCD-melatonin group: rats were subjected to the DCD procedure with 25 min of warm ischemia injury and preserved by the normothermic EVHP system for 105 min. Melatonin (200 μmol/L) or vehicle was perfused in the cardioplegia and throughout the whole EVHP period. Cardiac functional assessment was performed every 30 min during EVHP. The level of oxidative stress, inflammatory response, apoptosis, and NLRP3 inflammasome-mediated pyroptosis of heart grafts submitted to EVHP were evaluated. Results Twenty five-minute warm ischemia injury resulted in a significant decrease in the developed pressure (DP), dP/dt max , and dP/dt min of left ventricular of the DCD hearts, while the treatment with melatonin significantly increased the DP, dP/dt max of the left ventricular of DCD hearts compared with DCD-vehicle group. Furthermore, warm ischemia injury led to a significant increase in the level of oxidative stress, inflammatory response, apoptosis, and NLRP3 inflammasome-mediated pyroptosis in the hearts preserved with EVHP. However, melatonin added in the cardioplegia and throughout the EVHP period significantly attenuated the level of oxidative stress, inflammatory response, apoptosis, and NLRP3 inflammasome-mediated pyroptosis compared with DCD-vehicle group. Conclusion EVHP combined with melatonin post-conditioning attenuates myocardial IRI in DCD hearts by inhibiting NLRP3 inflammasome-mediated pyroptosis, which might expand the donor pool by the adoption of transplantable DCD hearts.
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Affiliation(s)
- Jun Lu
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liwei Xu
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zifeng Zeng
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chuqing Xue
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiale Li
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiong Chen
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pengyu Zhou
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shaoyan Lin
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuhui Liao
- Molecular Diagnosis and Treatment Center for Infectious Diseases, Dermatology Hospital, Southern Medical University, Guangzhou, China
| | - Xianjin Du
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ronghua Yang
- Department of Burn Surgery, The First People's Hospital of Foshan, Foshan, China
| | - Shaoyi Zheng
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Nolin T, Walther S. The relationship between life-sustaining treatment limitation and organ donation in Swedish intensive care: A nationwide register study. Acta Anaesthesiol Scand 2021; 65:1095-1101. [PMID: 33866543 DOI: 10.1111/aas.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Life-sustaining treatment limitation (LSTL) on the intensive care unit (ICU) may affect the rate of organ donation after brain death (DBD). The primary aim of this study was to examine whether there is a relationship between LSTL and DBD. Furthermore, we aimed to determine the rate of LSTL involved in ICU deaths and to describe technical and procedural characteristics of LSTL on Swedish ICUs. METHODS This was an observational cohort study on all ICU deaths (n = 13 156) in Sweden between 2014 and 2017. We analysed differences in DBD rates between deaths in ICU with and those without LSTL, using descriptive statistics and logistic regression. RESULTS After excluding 1084 deaths on specialised ICUs and units not registering goals of treatment, the study population comprised 12 072 deaths including 615 DBDs, of which 7865 had LSTL, 1706 had no LSTL and 2501 had no stated goals of treatment. The final cohort on which the relationship between DBD and LSTL was analysed comprised 9571 deaths including 419 DBDs. When no LSTL was documented, the rate of organ donation was 9.5% compared to 3.3% when LSTL was documented (P < .001). LSTL was associated with a lower DBD rate after adjusting for patient- and ICU-related factors (OR 0.41, 95% CI 0.31-0.53, P < .001). CONCLUSION There was an inverse relationship between LSTL and DBD amongst patients who died on the ICU. This relationship remained after adjusting for factors known to influence organ donation. The reason remains to be determined.
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Affiliation(s)
- Thomas Nolin
- Department of Anaesthesiology Central Hospital Kristianstad Sweden
- The Swedish Intensive Care Registry Karlstad Sweden
| | - Sten Walther
- Department of Cardiovascular Anaesthesia and Intensive Care Heart Centre and Department of Medical and Health Sciences Faculty of Medicine and Health Sciences Linköping University Linköping Sweden
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Physiotherapy in Patients on the Organ Donation Pathway: A Survey of Current Practice. Transplant Proc 2021; 53:2157-2161. [PMID: 34389166 DOI: 10.1016/j.transproceed.2021.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of the survey was to identify the current practices of physiotherapists in the management of patients on the organ donation pathway. METHODS The author conducted a cross-sectional telephone survey. Participants were 16 physiotherapists working in intensive care units (ICU) in Queensland, who were involved in the care of patients on the organ donation pathway. RESULTS In Queensland ICUs, only 57% of hospitals have formal guidelines for physiotherapy management of patients on the organ donation pathway. When comparing the frequency of interventions with organ donation status, 86% of physiotherapists reported increasing the frequency of interventions once a patient was considered for organ donation. Clinical reasoning was reported as the primary factor affecting intervention choice for 67% of physiotherapists, with no difference in frequency, or choice of intervention in patients for donation after circulatory death, compared with donation after brain death. In hospitals with a level I ICU (with infrequent exposure to organ donation), the use of protocols was supported by 100% of participants, whereas in hospitals with a level II and III ICU (and greater exposure), only 31% of participants supported the use of protocols. CONCLUSIONS There are wide variations and a lack of formal guidelines for physiotherapy management of patients on the organ donation pathway; however, clinical reasoning appears to be favored above protocolized management in hospitals with level II and level III ICUs.
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Li J, Xue C, Ling X, Xie Y, Pavan D, Chen H, Peng Q, Lin S, Li K, Zheng S, Zhou P. A Novel Rat Model of Cardiac Donation After Circulatory Death Combined With Normothermic ex situ Heart Perfusion. Front Cardiovasc Med 2021; 8:639701. [PMID: 34368241 PMCID: PMC8342755 DOI: 10.3389/fcvm.2021.639701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: In heart transplantation, the adoption of hearts from donation after circulatory death (DCD) is considered to be a promising approach to expanding the donor pool. Normothermic ex situ heart perfusion (ESHP) is emerging as a novel preservation strategy for DCD hearts. Therefore, pre-clinical animal models of ESHP are essential to address some key issues before efficient clinical translation. We aim to develop a novel, reproducible, and economical rat model of DCD protocol combined with normothermic ESHP. Methods: Circulatory death of the anesthetized rats in the DCD group was declared when systolic blood pressure below 30 mmHg or asystole was observed after asphyxiation. Additional 15 min of standoff period was allowed to elapse. After perfusion of cold cardioplegia, the DCD hearts were excised and perfused with allogenic blood-based perfusate at constant flow for 90 min in the normothermic ESHP system. Functional assessment and blood gas analysis were performed every 30 min during ESHP. The alteration of DCD hearts submitted to different durations of ESHP (30, 60, and 90 min) in oxidative stress, apoptosis, tissue energy state, inflammatory response, histopathology, cell swelling, and myocardial infarction during ESHP was evaluated. Rats in the non-DCD group were treated similarly but not exposed to warm ischemia and preserved by the normothermic ESHP system for 90 min. Results: The DCD hearts showed compromised function at the beginning of ESHP and recovered over time, while non-DCD hearts presented better cardiac function during ESHP. The alteration of DCD hearts in oxidative stress, apoptosis, tissue energy state, histopathological changes, cell swelling, and inflammatory response didn't differ among different durations of ESHP. At the end of 90-min ESHP, DCD, and non-DCD hearts presented similarly in apoptosis, oxidative stress, inflammatory response, myocardial infarction, and histopathological changes. Moreover, the DCD hearts had lower energy storage and more evident cell swelling compared to the non-DCD hearts. Conclusion: We established a reproducible, clinically relevant, and economical rat model of DCD protocol combined with normothermic ESHP, where the DCD hearts can maintain a stable state during 90-min ESHP.
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Affiliation(s)
- Jiale Li
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chuqing Xue
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao Ling
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu Xie
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Desai Pavan
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huimin Chen
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qinbao Peng
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shaoyan Lin
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kunsheng Li
- Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Shaoyi Zheng
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pengyu Zhou
- Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Menna Barreto LN, Cabral ÉM, Buffon MR, Mauro JEP, Pruinelli L, de Abreu Almeida M. Nursing Diagnosis for Potential Organ Donors: Accuracy Study. Clin Nurs Res 2021; 31:60-68. [PMID: 34180268 DOI: 10.1177/10547738211019435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective was to analyze the diagnostic accuracy of Impaired physiological balance syndrome in potential brain-dead organ donors. It is a study of diagnostic accuracy. Data was retrospectively collected from 145 medical records through the filling out of an instrument containing 25 indicators of the nursing diagnosis (ND). Descriptive and inferential statistics were used. The prevalence of the ND was 77 (53.1%). The indicator with the best measures of accuracy was altered heart rate. Therefore, it has the best predictive capacity for determining the ND. It was identified that the absence of the indicators altered heart rate, hyperglycemia, and altered blood pressure is associated with the absence of the ND, while the presence of the indicators hyperthermia, hypothermia, and altered heart rhythm is associated with the presence of the ND. Accurate indicators will assist in diagnostic inference and the interventions and results will have greater chances of targeting and effectiveness.
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Obstacles to obtaining Informed Consent from the Perspective of Transplant Coordinators: A Qualitative Study. HEPATITIS MONTHLY 2021. [DOI: 10.5812/hepatmon.111210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Background: The lack of consent to donate body organs leads to an increase in the death rate of patients on the waiting list for transplantation. Unwillingness of families is known as the main obstacle to organ donation, and the media has an essential role in motivating organ donation. Objectives: This study aimed to explore obstacles to obtaining consent for organ donation from transplant coordinators’ perspective throughout Iran. Methods: In this qualitative study, 13 in-depth semi-structured face-to-face interviews were conducted with transplant coordinators from November 2018 to March 2019. The participants were investigated using a purposive sampling method. The participants’ age and work experience ranged between 32 - 49 years and 6 - 25 years, respectively. Open-ended questions were asked from the participants in a private room. An experienced interviewer explained the study’s objectives to the coordinators, and each interview lasted on average 50 minutes. The interview scripts were analyzed using a content analysis method. Results: The findings highlighted the difficulty of obtaining consent from brain-dead patients’ families. The obstacles could be internal or external. External determinants were healthcare providers’ lack of empathy, inadequate consultation from doctors outside the hospital, media content, and uninformed comments from relatives. Internal determinants were hoping for recovery, denial, and disagreement among family members. Conclusions: The healthcare team should have a better connection with families to obtain organ donation consent from them. Therefore, a training program must be developed for the treatment team so that they show more supportive behavior and improve quality of care in hospitals before and after brain death.
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21
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Intensivtherapie bei potenziellen Organspendern. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2021. [DOI: 10.1007/s00398-020-00408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Dyla A, Zając M, Mielnicki W. Severe Acute Respiratory Distress Syndrome in Potential Organ Donors-Rescue Prone Positioning: A Case Report. Transplant Proc 2020; 53:1342-1344. [PMID: 33358525 DOI: 10.1016/j.transproceed.2020.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/03/2020] [Accepted: 10/30/2020] [Indexed: 11/29/2022]
Abstract
Organ transplantation is a recognized treatment for many critical organ insufficiencies. One of the main problems in transplantation is the mismatch between organ donation and demand. It is very important to improve donor eligibility after brain stem death and to minimize insult to donatable organs by appropriate donor management. We present prone positioning as an effective supportive method of organ optimization in patients with acute respiratory distress syndrome with severe hypoxemia and hemodynamic instability.
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Affiliation(s)
- Agnieszka Dyla
- Anaesthesiology and Intensive Care Unit, District Hospital in Oława, Oława, Poland.
| | - Marta Zając
- Anaesthesiology and Intensive Care Unit, District Hospital in Oława, Oława, Poland
| | - Wojciech Mielnicki
- Anaesthesiology and Intensive Care Unit, District Hospital in Oława, Oława, Poland
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Opt-out policy and the organ shortage problem: Critical insights and practical considerations. Transplant Rev (Orlando) 2020; 35:100589. [PMID: 33232867 DOI: 10.1016/j.trre.2020.100589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
The legal shift to an opt-out system of consent for deceased organ donation is now official in England, Wales and Scotland. While it is commendable that national governments across the United Kingdom have publicly signalled their serious engagement with organ donation, it remains questionable that opt-out policy can in and of itself solve the public health issue of organ shortage. Opt-out policy risks becoming a futile solution if it fails to attend to key factors in clinical practice. Thus, this article provides critical insights and practical considerations in order to work towards increasing the availability of organs for transplantation: 1) organ donation specialists on their own are not enough, a collaborative hospital culture of donation is also needed; 2) investment in innovative perfusion technologies is fundamental to increase both the quantity and quality of organs utilised for transplants; and 3) opt-out does not solve the enduring problem of consent or authorization for donation, rather than hoping that opt-out will shift the societal culture of donation and make donation the default choice, it is necessary to acknowledge that families' authorization remains essential and their emotional experience can neither be minimized nor excluded altogether. Importantly, consent rates are not the only factor to account for overall deceased donation rates. The organ shortage cannot be solely attributed to a matter of negative public attitudes reversible by law. Doing that does a disservice to the public and diverts strategic attention and resources from fostering the organizational and technological enablers of organ donation in clinical practice.
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Jutras M, Williamson D, Chassé M, Leclair G. Development and validation of a liquid chromatography coupled to tandem mass spectrometry method for the simultaneous quantification of five analgesics and sedatives, and six of their active metabolites in human plasma: Application to a clinical study on the determination of neurological death in the intensive care unit. J Pharm Biomed Anal 2020; 190:113521. [PMID: 32861167 DOI: 10.1016/j.jpba.2020.113521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/13/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022]
Abstract
A sensitive and selective high-performance liquid chromatographic method coupled to tandem mass spectrometry was developed and validated for the quantification of morphine, hydromorphone, fentanyl, midazolam and propofol and their metabolites morphine-3-β-d-glucuronide, morphine-6-β-d-glucuronide, hydromorphone-3-β-d-glucuronide, 1'-hydroxymidazolam-β-d-glucuronide, α-hydroxymidazolam and 4-hydroxymidazolam in human plasma using potassium oxalate/sodium fluoride mixture as anticoagulant. Human plasma samples (0.4 mL) to which were added a mixture of eleven deuterated internal standards were subjected to solid phase extraction using a mixed-mode polymeric Oasis PRiME MCX in 96-well format. Propofol was selectively eluted and further derivatized using 2-Fluoro-1-methylpyridinium p-toluenesulfonate, whereas the remaining 10 analytes were eluted separately and further concentrated. The derivatized propofol was analyzed separately in a second injection. The analytes were chromatographically separated on a Kinetex phenyl-hexyl analytical column in gradient elution mode, using a mobile phase consisting of aqueous ammonium formate/formic acid buffer and methanol. The overall run time was 8 min. Detection was performed using an AB/SCIEX 4000 QTRAP instrument with positive electrospray ionization employing scheduled multiple reaction monitoring mode. The lower limits of quantification ranged from 0.02 to 5 ng/mL depending on the analyte. Calibration curves covered a concentration range of 1000× in all cases but 1'-hydroxymidazolam-β-d-glucuronide where it covered a range of 500 × . The validated method was accurate and precise, the intra-day accuracy and precision of quality control samples (4 concentration levels, n = 6 each) being within 91.5-112 % and 1.3-13.2 % (coefficient of variation), respectively, and inter-day (n = 24; 4 days) accuracy and precision of quality control samples (3 concentration levels) being within 94.8-103.5 % and 3.2-11.2 % (coefficient of variation). Mean absolute extraction recoveries were above 60 % for all compounds, except for hydromorphone-3-β-d-glucuronide (44 %) and for 1'-hydroxymidazolam-β-d-glucuronide (33 %). Internal standard corrected matrix effect ranged from -4.8 to 3.8 % in normal plasma and in plasma containing 1 % hemolyzed blood. Analytes were stable (above 90 %) in plasma and blood for 19 h at 22 °C, in blood for 90 h at 5 °C, in plasma for 60 days at -20 °C, for 4 months at -70 °C and after three freeze-thaw cycles, and in the injection solvent for at least 3 days in the autosampler. The present method is successfully being applied in a multicenter clinical study for the analysis of plasma samples from patients in intensive care units from a number of Canadian hospitals.
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Affiliation(s)
- Martin Jutras
- Platform of Biopharmacy, Faculty of Pharmacy, Université de Montréal, H3T 1J4, Canada.
| | - David Williamson
- Platform of Biopharmacy, Faculty of Pharmacy, Université de Montréal, H3T 1J4, Canada; Research Center and Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, H4J 1C5, Canada.
| | - Michaël Chassé
- Faculty of Medecine, Université de Montréal, H3T 1J4, Canada; Research Center and Department of Medicine (Critical Care), Centre Hospitalier de l'Université de Montréal, H2X 0A9, Canada.
| | - Grégoire Leclair
- Platform of Biopharmacy, Faculty of Pharmacy, Université de Montréal, H3T 1J4, Canada.
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Krupic F. The Impact of Religion and Provision of Information on Increasing Knowledge and Changing Attitudes to Organ Donation: An Intervention Study. JOURNAL OF RELIGION AND HEALTH 2020; 59:2082-2095. [PMID: 31838627 PMCID: PMC7359157 DOI: 10.1007/s10943-019-00961-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
One of the most significant developments in recent history has probably been organ donation and organ transplantation. They are frequently the only treatment available in certain cases. However, there is an ever-increasing discrepancy between the number of people needing transplantation and the organs available, because the decision to donate an organ is up to each individual. The study aims to assess the impact of the intervention on knowledge, attitudes and practices on organ donation among religious immigrants in Sweden. Data were collected through three group interviews using open-ended questions and qualitative content analysis. Thirty-six participants, 18 males and 18 females from six countries, participated in the focus group interviews. The analysis of the collected data resulted in two main categories: "Religion in theory and practice" and "More information-more knowledge about organ donation" including seven subcategories. Understanding of religion and religiosity, happiness by taking the class, the practice of religion in everyday life, the overcoming the prejudices in religion, having more information about organ donation and the donations process, as well as that the increased information changes people's minds, were some of things the informants emphasised as predictors of the decision of organ donation. A class dealing with religion, the religious aspects of organ donation and the way the Swedish healthcare system is organised increased people's knowledge and changed their attitudes so they became potential organ donors. More intervention studies are needed in every field of medicine to build confidence and give time to educate and discuss issues with potential organ donors in Sweden.
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Affiliation(s)
- Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Mölndal, Sweden.
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göthenburg, Sweden.
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Manara AR, Thomas I. Current status of organ donation after brain death in the UK. Anaesthesia 2020; 75:1205-1214. [DOI: 10.1111/anae.15038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 01/07/2023]
Affiliation(s)
- A. R. Manara
- Department of Intensive Care Medicine and Anaesthesia Southmead Hospital Bristol UK
| | - I. Thomas
- Department of Intensive Care Medicine and Anaesthesia Southmead Hospital Bristol UK
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Baroni S, Melegari G, Brugioni L, Gualdi E, Barbieri A, Bertellini E. First experiences of hemoadsorption in donation after circulatory death. Clin Transplant 2020; 34:e13874. [PMID: 32339334 DOI: 10.1111/ctr.13874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/19/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Stefano Baroni
- Department of Intensive Care and Critical Care Medicine, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Gabriele Melegari
- Department of Intensive Care and Critical Care Medicine, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Lucio Brugioni
- Department of Intensive Care and Critical Care Medicine, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Eugenia Gualdi
- School of Anaesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Barbieri
- School of Anaesthesia and Intensive Care, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisabetta Bertellini
- Department of Intensive Care and Critical Care Medicine, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
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Milross LA, O'Donnell TG, Bucknall TK, Pilcher DV, Ihle JF. Exploring staff perceptions of organ donation after circulatory death. Aust Crit Care 2020; 33:175-180. [DOI: 10.1016/j.aucc.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 04/06/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
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Joffe AR, deCaen A, Garros D. Misinterpretations of Guidelines Leading to Incorrect Diagnosis of Brain Death: A Case Report and Discussion. J Child Neurol 2020; 35:49-54. [PMID: 31566107 DOI: 10.1177/0883073819876474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Guidelines describe the process necessary for the diagnosis of brain death. We present a case of a 3-month-old former 36-week-gestation infant after a prolonged out-of-hospital cardiac arrest of 37 minutes who was clinically diagnosed as brain dead at 120 hours after the event. Unusual findings included a normal slightly sunken anterior fontanelle, normal cerebral blood flow perfusion scan at 73 hours after the event, only localized parieto-temporal edema on the latest computed tomographic (CT) scan of the brain at 48 hours after the event, and discussion of whether nonconvulsive seizures could have confounded the examination for brain death. In light of these unusual findings, we discuss and highlight what may be common misinterpretations of brain death guidelines that led to the mistaken diagnosis of death (as opposed to severe neurologic injury) in this child.
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Affiliation(s)
- Ari R Joffe
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada
| | - Allan deCaen
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada
| | - Daniel Garros
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada
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Barreto LNM, Cabral ÉM, Chies N, Almeida MDA. Indicadores clínicos para o diagnóstico de enfermagem Síndrome do equilíbrio fisiológico prejudicado para doadores de órgãos. ESCOLA ANNA NERY 2020. [DOI: 10.1590/2177-9465-ean-2019-0341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Selecionar indicadores clínicos para o diagnóstico de enfermagem em desenvolvimento Síndrome do equilíbrio fisiológico prejudicado para potenciais doadores de órgãos em morte encefálica. Método Estudo de consenso de especialistas, realizado através da técnica Delphi, dos indicadores clínicos de um diagnóstico de enfermagem em desenvolvimento. A amostra do estudo foi intencional mediante convite e constituída por 37 enfermeiros que atenderam a critérios de inclusão. Os indicadores que obtiveram um consenso igual ou maior que 70% foram considerados validados. Resultados Especialistas recomendaram 25 dos 44 indicadores avaliados, dos quais oito pertenciam ao grupo Alterações endócrino-metabólicas, sete ao grupo Alterações hemodinâmicas e/ou cardiovasculares, cinco ao grupo Alterações ventilatórias, dois ao grupo Alterações nutricionais e três ao grupo Alterações de coagulação, inflamatórias e/ou imunológicas. Conclusão e implicações para a prática Esse novo diagnóstico de enfermagem pode colaborar com o desenvolvimento de conhecimento da enfermagem na área de doação de órgãos, contribuindo para o ensino e pesquisa, além de acarretar implicações para a prática, proporcionando acurácia diagnóstica e embasando a implementação e a avaliação de intervenções que impactam na melhora da manutenção do potencial doador.
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Affiliation(s)
| | - Éder Marques Cabral
- Hospital São Camilo, Brasil; Universidade Federal do Rio Grande do Sul, Brasil
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New Strategies to Expand and Optimize Heart Donor Pool: Ex Vivo Heart Perfusion and Donation After Circulatory Death: A Review of Current Research and Future Trends. Anesth Analg 2019; 128:406-413. [PMID: 30531220 DOI: 10.1213/ane.0000000000003919] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Heart transplantation remains the definitive management for end-stage heart failure refractory to medical therapy. While heart transplantation cases are increasing annually worldwide, there remains a deficiency in organ availability with significant patient mortality while on the waiting list. Attempts have therefore been made to expand the donor pool and improve access to available organs by recruiting donors who may not satisfy the standard criteria for organ donation because of donor pathology, anticipated organ ischemic time, or donation after circulatory death. "Ex vivo" heart perfusion (EVHP) is an emerging technique for the procurement of heart allografts. This technique provides mechanically supported warm circulation to a beating heart once removed from the donor and before implantation into the recipient. EVHP can be sustained for several hours, facilitate extended travel time, and enable administration of pharmacological agents to optimize cardiac recovery and function, as well as allow assessment of allograft function before implantation. In this article, we review recent advances in expanding the donor pool for cardiac transplantation. Current limitations of conventional donor criteria are outlined, including the determinants of organ suitability and assessment, involving transplantation of donation after circulatory death hearts, extended criteria donors, and EVHP-associated assessment, optimization, and transportation. Finally, ongoing research relating to organ optimization and functional ex vivo allograft assessment are reviewed.
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Abstract
OBJECTIVES To systematically review the global published literature defining a potential deceased organ donor and identifying clinical triggers for deceased organ donation identification and referral. DATA SOURCES Medline and Embase databases from January 2006 to September 2017. STUDY SELECTION All published studies containing a definition of a potential deceased organ donor and/or clinical triggers for referring a potential deceased organ donor were eligible for inclusion. Dual, independent screening was conducted of 3,857 citations. DATA EXTRACTION Data extraction was completed by one team member and verified by a second team member. Thematic content analysis was used to identify clinical criteria for potential deceased organ donation identification from the published definitions and clinical triggers. DATA SYNTHESIS One hundred twenty-four articles were included in the review. Criteria fell into four categories: Neurological, Medical Decision, Cardiorespiratory, and Administrative. Distinct and globally consistent sets of clinical criteria by type of deceased organ donation (neurologic death determination, controlled donation after circulatory determination of death, and uncontrolled donation after circulatory determination of death) are reported. CONCLUSIONS Use of the clinical criteria sets reported will reduce ambiguity associated with the deceased organ donor identification and the subsequent referral process, potentially reducing the number of missed donors and saving lives globally through increased transplantation.
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Jawitz OK, Raman V, Barac Y, Mulvihill MS, Moore C, Choi AY, Hartwig M, Klapper J. Impact of Donor Brain Death Duration on Outcomes After Lung Transplantation. Ann Thorac Surg 2019; 108:1519-1526. [PMID: 31271742 DOI: 10.1016/j.athoracsur.2019.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Donor brain death duration (BDD) may impact posttransplant graft function and survival in lung transplant. METHODS We queried the 2007 to 2018 United Network for Organ Sharing Registry for adult recipients undergoing first-time isolated lung transplant. Cox proportional hazard modeling with splines enabled identification of 3 donor brain death intervals for subsequent analysis: short (<24 hours), reference (24-60 hours), and long (>60 hours). The primary outcome was posttransplant survival. RESULTS In total, 19,721 donors and recipients met inclusion criteria. Median time from donor brain death until cross-clamp was 36.6 hours (interquartile range, 19.5). Unadjusted overall survival between cohorts was equivalent (log-rank P = .42); however, longer BDD was associated with improved bronchiolitis obliterans syndrome (BOS)-free survival (log-rank P < .001). On multivariable Cox proportional hazards regression, BDD was not associated with recipient survival (P > .05). Similarly, logistic regression did not identify an independent association between BDD and primary graft dysfunction (P > .05). Increased BDD was, however, associated with a decreased risk of acute rejection (long vs reference; adjusted odds ratio, 0.78; 95% confidence interval, 0.64-0.94) and improved BOS-free survival (long vs reference; adjusted hazard ratio, 0.88; 95% confidence interval, 0.81-0.96). CONCLUSIONS Donor BDD is not associated with posttransplant survival or primary graft dysfunction. Long donor BDD, however, is associated with a decreased risk for acute rejection and improved BOS-free survival. Therefore, lung allografts from donors with a prolonged length of time from brain death until explant should not be viewed less favorably by donor selection centers.
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Affiliation(s)
- Oliver K Jawitz
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
| | - Vignesh Raman
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Yaron Barac
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael S Mulvihill
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Carrie Moore
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ashley Y Choi
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matthew Hartwig
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jacob Klapper
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Manara AR. All human death is brain death: The legacy of the Harvard criteria. Resuscitation 2019; 138:210-212. [DOI: 10.1016/j.resuscitation.2019.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 12/16/2022]
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Management of the brain-dead donor in the ICU: general and specific therapy to improve transplantable organ quality. Intensive Care Med 2019; 45:343-353. [PMID: 30741327 PMCID: PMC7095373 DOI: 10.1007/s00134-019-05551-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/28/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To provide a practical overview of the management of the potential organ donor in the intensive care unit. METHODS Seven areas of donor management were considered for this review: hemodynamic management; fluids and electrolytes; respiratory management; endocrine management; temperature management; anaemia and coagulation; infection management. For each subchapter, a narrative review was conducted. RESULTS AND CONCLUSIONS Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations, or extrapolations from general ICU management strategies, and not on evidence from randomized controlled trials. The cardiorespiratory management of brain-dead donors is very similar to the management of critically ill patients, and the same applies to the management of anaemia and coagulation. Central diabetes insipidus is of particular concern, and should be diagnosed based on clinical criteria. Depending on the degree of vasopressor dependency, it can be treated with intermittent desmopressin or continuous vasopressin, intravenously. Temperature management of the donor is an area of uncertainty, but it appears reasonable to strive for a core temperature of > 35 °C. The indications and controversies regarding endocrine therapies, in particular thyroid hormone replacement therapy, and corticosteroid therapy, are discussed. The potential donor should be assessed clinically for infections, and screening tests for specific infections are an essential part of donor management. Although the rate of infection transmission from donor to receptor is low, certain infections are still a formal contraindication to organ donation. However, new antiviral drugs and strategies now allow organ donation from certain infected donors to be done safely.
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Organ donation after circulatory death: current status and future potential. Intensive Care Med 2019; 45:310-321. [DOI: 10.1007/s00134-019-05533-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/14/2019] [Indexed: 01/26/2023]
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Nanni Costa A, Procaccio F. Organ donation after neurological or circulatory death? Two is better than one. Minerva Anestesiol 2018; 84:1337-1339. [DOI: 10.23736/s0375-9393.18.13111-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sandiumenge A, Ramírez-Estrada S, Mazo C, Rubiera M, Boned S, Domínguez-Gil B, Pont T. Donor referral from outside the intensive care unit: A multidisciplinary cooperation model using communication apps and redefining refereal criteria. Med Intensiva 2018; 44:142-149. [PMID: 30396791 DOI: 10.1016/j.medin.2018.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/11/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We evaluate the impact of a web-based collaborative system on the referral of possible organ donors from outside of the intensive care unit (ICU). STUDY DESIGN Cohort prospective study. SETTINGS University hospital. PATIENTS AND INTERVENTION In 2015 a virtual collaborative system using a cross-platform instant messaging application replaced the previous 2014 protocol for the referral of patients outside of the ICU with a severe brain injury in whom all treatment options were deemed futile by the attending team to the donor coordination (DC). Once the DC evaluated the medical suitability and likelihood of progression to brain death (BD), the option of intensive care to facilitate organ donation (ICOD) was offered to the patient's relatives. This included admission to the ICU and elective non-therapeutic ventilation (ENTV), where appropriate. RESULTS A two-fold increase of referrals was noted in 2015 [n=46/74; (62%)] compared to 2014 [n=13/40; (32%)]; p<0.05. Patients were mostly referred from the stroke unit (58.6%) in 2015 and from the emergency department (69.2%) in 2014 (p<0.01). Twenty (2015: 42.5%) and 4 (2014: 30.7%) patients were discarded as donors mostly due to medical unsuitability. Family accepted donation in 16 (2015: 62%) and 6 (2014: 66%) cases, all admitted to the ICU and 10 (2015: 62.5%) and 3 (50%) being subject to ENTV. Ten (2015: 66.6%) and 5 (2014: 83.3%) patients progressed to BD, 60.5±20.2 and 44.4±12.2h after referral respectively. Nine (2015) and 4 (2014) of these patients became utilized donors, representing 29.0% (2015) and 13.0% (2014) of the BD donors in the hospital during the study period (p<0.05). CONCLUSION The implementation of a virtual community doubled the number of patients whose families were presented with the option of donation prior to their death.
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Affiliation(s)
- A Sandiumenge
- Transplant Coordination Department, Vall d'Hebron University Hospital, Barcelona, Spain; Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Ramírez-Estrada
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - C Mazo
- Transplant Coordination Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M Rubiera
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - S Boned
- Stroke Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - T Pont
- Transplant Coordination Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Abstract
BACKGROUND Kidneys derived from brain-dead (BD) donors have lower graft survival rates compared with kidneys from living donors. Complement activation plays an important role in brain death. The aim of our study was therefore to investigate the effect of C1-inhibitor (C1-INH) on BD-induced renal injury. METHODS Brain death was induced in rats by inflating a subdurally placed balloon catheter. Thirty minutes after BD, rats were treated with saline, low-dose or high-dose C1-INH. Sham-operated rats served as controls. After 4 hours of brain death, renal function, injury, inflammation, and complement activation were assessed. RESULTS High-dose C1-INH treatment of BD donors resulted in significantly lower renal gene expression and serum levels of IL-6. Treatment with C1-INH also improved renal function and reduced renal injury, reflected by the significantly lower kidney injury marker 1 gene expression and lower serum levels of lactate dehydrogenase and creatinine. Furthermore, C1-INH effectively reduced complement activation by brain death and significantly increased functional levels. However, C1-INH treatment did not prevent renal cellular influx. CONCLUSIONS Targeting complement activation after the induction of brain death reduced renal inflammation and improved renal function before transplantation. Therefore, strategies targeting complement activation in human BD donors might clinically improve donor organ viability and renal allograft survival.
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Barriers and Enablers to Organ Donation After Circulatory Determination of Death: A Qualitative Study Exploring the Beliefs of Frontline Intensive Care Unit Professionals and Organ Donor Coordinators. Transplant Direct 2018; 4:e368. [PMID: 30046658 PMCID: PMC6056272 DOI: 10.1097/txd.0000000000000805] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background A shortage of transplantable organs is a global problem. The purpose of this study was to explore frontline intensive care unit professionals' and organ donor coordinators' perceptions and beliefs around the process of, and the barriers and enablers to, donation after circulatory determination death (DCDD). Methods This qualitative descriptive study used a semistructured interview guide informed by the Theoretical Domains Framework to interview 55 key informants (physicians, nurses, and organ donation coordinators) in intensive care units (hospitals) and organ donation organizations across Canada. Results Interviews were analyzed using a 6-step systematic approach: coding, generation of specific beliefs, identification of themes, aggregation of themes into categories, assignment of barrier or enabler and analysis for shared and unique discipline barriers and enablers. Seven broad categories encompassing 29 themes of barriers (n = 21) and enablers (n = 4) to DCDD use were identified; n = 4 (14%) themes were conflicting, acting as barriers and enablers. Most themes (n = 26) were shared across the 3 key informant groups while n = 3 themes were unique to physicians. The top 3 shared barriers were: (1) DCDD education is needed for healthcare professionals, (2) a standardized and systematic screening process to identify potential DCDD donors is needed, and (3) practice variation across regions with respect to communication about DCDD with families. A limited number of differences were found by region. Conclusions Multiple barriers and enablers to DCDD use were identified. These beliefs identify potential individual, team, organization, and system targets for behavior change interventions to increase DCDD rates which, in turn, should lead to more transplantation, reducing patient morbidity and mortality at a population level.
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Affiliation(s)
- Stefan G Tullius
- From Harvard Medical School and Brigham and Women's Hospital, Boston (S.G.T.); and Johns Hopkins University School of Medicine and the Johns Hopkins Hospital, Baltimore (H.R.)
| | - Hamid Rabb
- From Harvard Medical School and Brigham and Women's Hospital, Boston (S.G.T.); and Johns Hopkins University School of Medicine and the Johns Hopkins Hospital, Baltimore (H.R.)
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Mojtabaee M, Sadegh Beigee F, Ghorbani F. Deceased Organ Donation From Pediatric Donors: Does the Literature Really Help Us? Implication for More Powerful Guidelines. Transplant Proc 2018; 49:1708-1711. [PMID: 28923612 DOI: 10.1016/j.transproceed.2017.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Brain-dead pediatric donors have always been the focus of attention because of the higher quality, utility, and possibility of their organ donation. However, donors under the age of 5 years always necessitate making more challenging management efforts, which are not clearly implied in most parts of the guidelines. METHODS The data obtained from 79 brain-dead pediatric donors of the Organ Procurement Unit of Masih Daneshvari Hospital, Tehran, Iran, were assessed. The donors were divided into 2 groups, including donors under 5 years of age (group A) and those between 5 and 12 years of age (group B). Metabolic, hemodynamic, hematologic, and electrolyte status as well as the suitability for donation were compared in the study groups. RESULTS Of 1252 donors, 6.3% were under 12 years of age. Trauma and drug toxicity were the two primary causes of brain death in group A. In comparison, trauma and brain tumor were the leading causes of brain death in group B. The prevalence of both hyperglycemia and respiratory acidosis was significantly higher in group A (P < .05). However, severe anemia and coagulopathy were more prevalent in group B (P < .05). The high-dose inotropic administration was used for 42.4% of the donors in group A, whereas only 26% of the donors in group B needed a high dose of inotropes (P < .05). The mean quantity of organ harvested per donor was 2.1 and 2.25 in groups A and B, respectively. Furthermore, donor loss was not significantly different in both groups. CONCLUSIONS The occurrence of different complications in donors under the age of 5 years requires special treatment considerations that should be the center of attention in the related guidelines. Organ donation per donor indicates that donors under the age of 5 years are a valuable resource for organ procurement.
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Affiliation(s)
- M Mojtabaee
- Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Sadegh Beigee
- Lung Transplantation Research Center (LTRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - F Ghorbani
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Eira CSLD, Barros MITD, Albuquerque AMPD. Organ donation: the reality of an intensive care unit in Portugal. Rev Bras Ter Intensiva 2018; 30:201-207. [PMID: 29995086 PMCID: PMC6031415 DOI: 10.5935/0103-507x.20180040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/03/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To clinically and demographically characterize potential organ donors admitted to a general intensive care unit and analyze data on donated organs. METHODS This retrospective study was conducted from 2010 to 2015 and analyzed demographic and clinical variables and the number of harvested organs and tissues. RESULTS A total of 92 potential organ donors were identified, of whom eight were non-effective donors and 84 were effective donors (59.5% were expanded criteria donors). The mean age of the potential donors was 60.7 years, and the majority were men. Hemorrhagic stroke accounted for 55.4% of brain deaths. The most common blood type among the donors was A Rh+ (43.5%), and the most common comorbidity was arterial hypertension (43.3%). The most frequently collected organs were the kidneys (84.5%) and liver (66.7%). The average number of organs harvested per donor was 2.8, and this ratio was smaller for donors with expanded criteria compared to other donors. CONCLUSION In most cases, potential organ donors died of brain death, were older than middle age, were male and were victims of a hemorrhagic stroke. The majority of the donors were expanded criteria donors and donated an average of two to three organs. The organs donated most frequently were the kidneys and liver.
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Nakamura MT, Rodio GE, Tchaicka C, Padilha EF, Jorge AC, Duarte PAD. Predictors of Organ Donation Among Patients With Brain Death in the Intensive Care Unit. Transplant Proc 2018; 50:1220-1226. [PMID: 29731163 DOI: 10.1016/j.transproceed.2018.02.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/19/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Despite the improved care of potential organ donors with probable brain death (BD) in the intensive care unit (ICU), few epidemiologic and clinical data are available in developing countries. OBJECTIVES To evaluate ICU patients with suspected BD aiming to identify factors possibly related to success (organ donation) or failure (nondonation). METHODS Retrospective cohort study, from the patient records of an adult ICU of a Brazilian teaching hospital for 12 months. Data were tabulated, and descriptive statistics and univariate and multivariate analyses were performed. RESULTS During the study period, 85 patients with acute neurologic diseases and suspected BD were admitted to the ICU and included for analysis. Of these, there were 9 organ donors (7 liver and 9 kidney donors); 77.7% were men, with a mean age of 39.6 years and admission Acute Physiology and Chronic Health Evaluation II of 25.5. Two-thirds of the patients were victims of trauma. The mean time between acute neurologic event and organ withdrawal was 269 hours. The main prognostic factors related to the success of organ donation were the maximum serum lactate and creatinine levels during ICU admission. CONCLUSIONS The main clinical factors correlated with nonevolution for organ donation among ICU patients with clinical suspicion of BD were related to patient severity and organic dysfunction: serum lactate and creatinine level. Clinical care and monitoring are emphasized to improve the efficiency of the donation process.
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Affiliation(s)
- M T Nakamura
- Hospital Universitário do Oeste do Paraná, Cascavel, Brazil
| | - G E Rodio
- Hospital Universitário do Oeste do Paraná, Cascavel, Brazil
| | - C Tchaicka
- General ICU, Hospital Universitário do Oeste do Paraná, Cascavel, Brazil.
| | - E F Padilha
- Transplantation and Organ Donation Committee, Hospital Universitário do Oeste do Paraná, Cascavel/PR, Brazil
| | - A C Jorge
- General ICU, Hospital Universitário do Oeste do Paraná, Cascavel, Brazil
| | - P A D Duarte
- General ICU, Hospital Universitário do Oeste do Paraná, Cascavel, Brazil
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The New Era of Transplant Oncology: Liver Transplantation for Nonresectable Colorectal Cancer Liver Metastases. Can J Gastroenterol Hepatol 2018; 2018:9531925. [PMID: 29623268 PMCID: PMC5829429 DOI: 10.1155/2018/9531925] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most incident cancer worldwide. Most of CRC patients will develop distant metastases, mainly to the liver, and liver resection is the only potential chance for cure. On the other hand, only a small proportion of patients with hepatic CRC metastasis are candidates for upfront liver resection. Liver transplantation (LT) is an attractive option for patients with nonresectable CRC liver metastases (NRCLM) without extrahepatic involvement. Initial experiences with LT for NRCLM achieved very poor outcomes, with a 5-year overall survival (OS) lower than 20%. However, these initial studies did not have a standardized patient selection or neoadjuvant or adjuvant therapies. With recent advances in the surgical and medical oncology fields, the landscape has changed. Recent studies from Norway have shown an encouraging 5-year OS of 50% when transplanting patients with NRCLM. Nevertheless, the main concern when expanding the indications for LT is organ shortage. To manage this organ shortage, strategies utilizing live donor liver transplantation are gaining favor. A few ongoing trials are assessing the impact of LT in NRCLM patient survival. Therefore, the aim of this paper is to review the current status of LT for NRCLM.
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Tardalkar K, Desai S, Adnaik A, Bohara R, Joshi M. Novel Approach Toward the Generation of Tissue Engineered Heart Valve by Using Combination of Antioxidant and Detergent: A Potential Therapy in Cardiovascular Tissue Engineering. Tissue Eng Regen Med 2017; 14:755-762. [PMID: 30603525 PMCID: PMC6171666 DOI: 10.1007/s13770-017-0070-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/21/2017] [Accepted: 07/11/2017] [Indexed: 11/25/2022] Open
Abstract
To develop decellularized heart valve scaffold from porcine for heart valve regeneration. Porcine heart valves were decellularized with unique optimized approach by using 1% sodium dodecyl sulfate solution and 5% dimethyl sulfoxide for the first time. Effect of decellularization process on scaffold were characterized by hematoxylin-eosin, 4',6-diamidino-2-phenylindole, Masson's trichrome, alcian blue staining and scanning electron microscopy for extracellular matrix (ECM) analysis in scaffold. The results showed that developed protocol for decellularization of heart valve scaffold shown complete removal of all cellular components, without changing the properties of ECM. The developed protocol was successfully used for heart valve ECM scaffolds development from porcine. The developed protocol seems to be promising solution for the heart valve tissue engineering application.
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Affiliation(s)
- Kishor Tardalkar
- Department of Stem Cells and Regenerative Medicine, D. Y. Patil University, D. Y. Patil Vidyanagar, Kasba Bawda, Kolhapur, Maharashtra 416006 India
| | - Shashikant Desai
- Stem Plus Biotech, SMK Commercial Complex, C/S No. 1317/2, Near Shivaji Maharaj Putla, Bus Stand Road, Gaon Bhag, Sangli, Maharashtra 416416 India
| | - Arjun Adnaik
- Department of Stem Cells and Regenerative Medicine, D. Y. Patil University, D. Y. Patil Vidyanagar, Kasba Bawda, Kolhapur, Maharashtra 416006 India
| | - Raghvendra Bohara
- Department of Stem Cells and Regenerative Medicine, D. Y. Patil University, D. Y. Patil Vidyanagar, Kasba Bawda, Kolhapur, Maharashtra 416006 India
| | - Meghnad Joshi
- Department of Stem Cells and Regenerative Medicine, D. Y. Patil University, D. Y. Patil Vidyanagar, Kasba Bawda, Kolhapur, Maharashtra 416006 India
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A Systematic Literature Review and Research Agenda for Organ Donation Decision Communication. Prog Transplant 2017; 27:309-320. [DOI: 10.1177/1526924817715459] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: This study systematically located and appraised peer-reviewed evidence for the efficacy of strategies to increase organ donation decision communication among adults including an assessment of study quality to guide future research in this field. There is little room to move in strengthening unanimously positive public attitudes toward organ donation. Consequently, researchers have called for a focus on organ donation decision communication to understand modifiable factors to increase organ donation rates. Methods: Multiple databases were searched during September 2015, and 44 studies were selected for inclusion. Data concerning participants, design, and outcomes were extracted. Studies were rated for quality and levels of evidence. Findings: Although not amenable to meta-analysis, the literature indicates that approximately 50% of adults who are willing to become an organ donor have discussed this decision with family. The majority of research was conducted in a Western context with an overrepresentation of students. Strategies to increase communication include education, motivation, input from lived experience, efforts to address salient audience beliefs, and scheduled reminders or prompts. Intentions and willingness to discuss organ donation were consistently positively related to discussion behavior; however, formative research and experimental studies testing theoretically driven interventions were scarce. Conclusions: There is mixed evidence for the role of demographic and attitudinal characteristics in the success of organ donation communication interventions. Additional theoretically based research is recommended to establish boundary conditions and validate strategies to increase organ donation decision communication among adults.
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Witjes M, Kotsopoulos A, Herold IHF, Otterspoor L, Simons KS, van Vliet J, de Blauw M, Festen B, Eijkenboom JJA, Jansen NE, van der Hoeven JG, Abdo WF. The Influence of End-of-Life Care on Organ Donor Potential. Am J Transplant 2017; 17:1922-1927. [PMID: 28371278 DOI: 10.1111/ajt.14286] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/16/2017] [Accepted: 03/18/2017] [Indexed: 01/25/2023]
Abstract
Many patients with acute devastating brain injury die outside intensive care units and could go unrecognized as potential organ donors. We conducted a prospective observational study in seven hospitals in the Netherlands to define the number of unrecognized potential organ donors outside intensive care units, and to identify the effect that end-of-life care has on organ donor potential. Records of all patients who died between January 2013 and March 2014 were reviewed. Patients were included if they died within 72 h after hospital admission outside the intensive care unit due to devastating brain injury, and fulfilled the criteria for organ donation. Physicians of included patients were interviewed using a standardized questionnaire regarding logistics and medical decisions related to end-of-life care. Of the 5170 patients screened, we found 72 additional potential organ donors outside intensive care units. Initiation of end-of-life care in acute settings and lack of knowledge and experience in organ donation practices outside intensive care units can result in under-recognition of potential donors equivalent to 11-34% of the total pool of organ donors. Collaboration with the intensive care unit and adjusting the end-of-life path in these patients is required to increase the likelihood of organ donation.
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Affiliation(s)
- M Witjes
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands.,Dutch Transplant Foundation, Leiden, The Netherlands
| | - A Kotsopoulos
- Department of Intensive Care, St. Elisabeth hospital, Tilburg, The Netherlands
| | - I H F Herold
- Department of Intensive Care, Catharina hospital, Eindhoven, The Netherlands
| | - L Otterspoor
- Department of Intensive Care, Catharina hospital, Eindhoven, The Netherlands
| | - K S Simons
- Department of Intensive Care, Jeroen Bosch hospital, Den Bosch, The Netherlands
| | - J van Vliet
- Department of Intensive Care, Rijnstate hospital, Arnhem, The Netherlands
| | - M de Blauw
- Department of Intensive Care, Rijnstate hospital, Arnhem, The Netherlands
| | - B Festen
- Department of Intensive Care, Gelderse Vallei hospital, Ede, The Netherlands
| | - J J A Eijkenboom
- Department of Intensive Care, Maxima medical center, Veldhoven, The Netherlands
| | - N E Jansen
- Dutch Transplant Foundation, Leiden, The Netherlands
| | - J G van der Hoeven
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - W F Abdo
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
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Affiliation(s)
- Chiara Robba
- Neurosciences Critical Care Unit, Addenbrooke's Hospital, Box 1, Cambridge University, Cambridge University Hospitals Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy
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Casadio MC, Coppo A, Vargiolu A, Villa J, Rota M, Avalli L, Citerio G. Organ donation in cardiac arrest patients treated with extracorporeal CPR: A single centre observational study. Resuscitation 2017; 118:133-139. [PMID: 28596083 DOI: 10.1016/j.resuscitation.2017.06.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 05/22/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
AIM OF THE STUDY In a consecutive cohort of cardiac arrest (CA) treated with extracorporeal cardiopulmonary resuscitation (eCPR), we describe the incidence of brain death (BD), the eligibility for organ donation and the short-term follow-up of the transplanted organs. METHODS All refractory in- and out-of-hospital CA admitted to our Cardiac Intensive Care Unit between January 2011 and September 2016 treated with eCPR were enrolled in the study. RESULTS 112 CA patients received eCPR. 82 (73.2%) died in hospital, 25 BD (22.3%) and 57 for other causes (50.9%). At the time of first neurological evaluation after rewarming, variables related to evolution to BD were a lower GCS (3 [3-3] vs. 8 [3-11], p<0.001), a higher level of neuron specific enolase (269.3±49.4 vs. 55.2±37.2ng/ml, p<0.001), a higher presence of EEG indices of poor outcome (84% vs. 15%, p<0.001), absence of brainstem reflexes (p<0.001), absence of bilateral N20 SSEPS waves (66.7% vs. 3.7%, p<0.001). None of BD patients present a normal CT scan (at 2.5±2days), with 85% prevalence of diffuse hypoxic injury and a mean grey/white matter ratio of 1.1±0.1. Rate of donation in BD patients was 56%, with 39 donated organs: 23 kidneys, 12 livers, and 4 lungs. 89.74% of the transplanted organs reached an early good functional recovery. CONCLUSION In refractory CA patients treated with eCPR, the prevalence of BD is high. This population has a high potential for considering organ donation. Donated organs have a good outcome.
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Affiliation(s)
| | - Anna Coppo
- Cardiac Intensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Italy
| | - Alessia Vargiolu
- Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Italy
| | - Jacopo Villa
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Matteo Rota
- Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Italy
| | - Leonello Avalli
- Cardiac Intensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy; Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Italy.
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