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Vail EA, Tam VW, Sonnenberg EM, Lavu NR, Reese PP, Abt PL, Martin ND, Hasz RD, Olthoff KM, Kerlin MP, Christie JD, Neuman MD, Potluri VS. Characterizing proximity and transfers of deceased organ donors to donor care units in the United States. Am J Transplant 2024; 24:983-992. [PMID: 38346499 PMCID: PMC11144555 DOI: 10.1016/j.ajt.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/15/2024]
Abstract
Some United States organ procurement organizations transfer deceased organ donors to donor care units (DCUs) for recovery procedures. We used Organ Procurement and Transplantation Network data, from April 2017 to June 2021, to describe the proximity of adult deceased donors after brain death to DCUs and understand the impact of donor service area (DSA) boundaries on transfer efficiency. Among 19 109 donors (56.1% of the cohort) in 25 DSAs with DCUs, a majority (14 593 [76.4%]) were in hospitals within a 2-hour drive. In areas with DCUs detectable in the study data set, a minority of donors (3582 of 11 532 [31.1%]) were transferred to a DCU; transfer rates varied between DSAs (median, 27.7%, range, 4.0%-96.5%). Median hospital-to-DCU driving times were not meaningfully shorter among transferred donors (50 vs 51 minutes for not transferred, P < .001). When DSA boundaries were ignored, 3241 cohort donors (9.5%) without current DCU access were managed in hospitals within 2 hours of a DCU and thus potentially eligible for transfer. In summary, approximately half of United States deceased donors after brain death are managed in hospitals in DSAs with a DCU. Transfer of donors between DSAs may increase DCU utilization and improve system efficiency.
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Affiliation(s)
- Emily A Vail
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Vicky W Tam
- Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | - Peter P Reese
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Renal-Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Niels D Martin
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Richard D Hasz
- Gift of Life Donor Program, Philadelphia, Pennsylvania, USA
| | - Kim M Olthoff
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Meeta P Kerlin
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason D Christie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark D Neuman
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vishnu S Potluri
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Renal-Electrolyte and Hypertension Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Pérez-Blanco A, Acevedo M, Padilla M, Gómez A, Zapata L, Barber M, Martínez A, Calleja V, Rivero MC, Fernández E, Velasco J, Flores EM, Quindós B, Rodríguez ST, Virgós B, Robles JC, Nebra AC, Moya J, Trenado J, García N, Vallejo A, Herrero E, García Á, Rodríguez ML, García F, Lara R, Lage L, Gil FJ, Guerrero FJ, Meilán Á, Del Prado N, Fernández C, Coll E, Domínguez-Gil B. Assessing Outcomes of Patients Subject to Intensive Care to Facilitate Organ Donation: A Spanish Multicenter Prospective Study. Transpl Int 2024; 37:12791. [PMID: 38681973 PMCID: PMC11046399 DOI: 10.3389/ti.2024.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
Intensive Care to facilitate Organ Donation (ICOD) consists of the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom curative treatment is deemed futile and death by neurological criteria (DNC) is foreseen, to incorporate organ donation into their end-of-life plans. In this study we evaluate the outcomes of patients subject to ICOD and identify radiological and clinical factors associated with progression to DNC. In this first prospective multicenter study we tested by multivariate regression the association of clinical and radiological severity features with progression to DNC. Of the 194 patients, 144 (74.2%) patients fulfilled DNC after a median of 25 h (95% IQR: 17-44) from ICOD onset. Two patients (1%) shifted from ICOD to curative treatment, both were alive at discharge. Factors associated with progression to DNC included: age below 70 years, clinical score consistent with severe brain injury, instability, intracranial hemorrhage, midline shift ≥5 mm and certain types of brain herniation. Overall 151 (77.8%) patients progressed to organ donation. Based on these results, we conclude that ICOD is a beneficial and efficient practice that can contribute to the pool of deceased donors.
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Affiliation(s)
| | - María Acevedo
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Aroa Gómez
- Hospital Universitario Vall d’Hebrón, Barcelona, Spain
| | - Luis Zapata
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Barber
- Hospital Universitario de Navarra, Pamplona, Spain
| | | | | | - María C. Rivero
- Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Julio Velasco
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | - Sergio T. Rodríguez
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Beatriz Virgós
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - José Moya
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Josep Trenado
- Hospital Universitario Mútua Terrasa, Barcelona, Spain
| | | | - Ana Vallejo
- Hospital Universitario de Araba, Vitoria-Gasteiz, Spain
| | | | - Álvaro García
- Complejo Asistencial Universitario, Salamanca, Spain
| | | | | | - Ramón Lara
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | | | - Ángela Meilán
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Cristina Fernández
- Hospital Clínico Universitario de Santiago, Instituto de Investigaciones Sanitarias de Santiago, Santiago, Spain
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Deniz İ, Ayhan H. The effectiveness of video training in improving intensive care nurses' knowledge about brain death identification. Nurs Crit Care 2024; 29:80-89. [PMID: 36414015 DOI: 10.1111/nicc.12863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Because patients diagnosed with brain death in intensive care units constitute a potential cadaveric donor group for organ transplantation, intensive care units are potential donor sources. Nurses who closely monitor the patient collaborate with medical personnel in the recognition and early diagnosis of brain death. Nurses also have an important role in supporting the patient's family. Therefore, it is very important for nurses to know the diagnostic criteria for brain death. AIM The aim of this study was to compare the effectiveness of theoretical education and video-assisted education in equipping intensive care nurses to recognize brain death. STUDY DESIGN A randomized, experimental study was conducted between February and May 2020 with a total of 50 intensive care nurses, split into 25 in the video-assisted training group and 25 in the theoretical training group. In study, intensive care nurses were given a theoretical training and video-assisted training on brain death criteria. One group was trained theoretically and the other group used a video showing criteria for brainstem reflexes (pupil assessment, spontaneous breathing, corneal reflex, retching and coughing assessments) and deep tendon reflexes in a simulated patient, supported by animation. The data were collected before, immediately after and 3 months after the training using the Brain Death Criteria Knowledge Test, the Brain Death Case Test, and the Training Effectiveness Evaluation Form. The independent samples t-test, Mann-Whitney U test, Friedman test, Wilcoxon test, and Chi-square test were used for statistical analysis of data. RESULTS It was found that the knowledge scores of both groups immediately after training and 3 months after training were higher than before the training (p < .001). However, the post-training knowledge scores of the video-assisted training group were significantly higher than those of the theoretical training group (p = .011). CONCLUSIONS To enable intensive care nurses to identify brain death, video-assisted training with a simulated patient is recommended, as is repeating the training at regular intervals. RELEVANCE TO CLINICAL PRACTICE The simulated patient video-assisted training method can be used for in-service training to provide intensive care nurses with the ability to identify brain death. The training may be repeated at regular intervals (e.g., every 3 months) to increase nurse recall.
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Affiliation(s)
- İsmail Deniz
- Dialysis Department, Hakkari University Vocational School of Health Services, Hakkari, Turkey
| | - Hatice Ayhan
- Department of Surgical Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
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Nejatollahi SMR, Abdolmohammadi Y, Ahmadi S, Hasanzade A, Hosseini F, Mohseni A, Shafaghi S, Dezfuli MM, Ghorbani F. Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study. KOREAN JOURNAL OF TRANSPLANTATION 2023; 37:241-249. [PMID: 37997212 PMCID: PMC10772271 DOI: 10.4285/kjt.23.0049] [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: 09/04/2023] [Revised: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 11/25/2023] Open
Abstract
Background Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors. Methods In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals. Results A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals. Conclusions This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.
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Affiliation(s)
- Seyed Mohammad Reza Nejatollahi
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yazdan Abdolmohammadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Ahmadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Hasanzade
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseini
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arshia Mohseni
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mojtaba Mokhber Dezfuli
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Schoene D, Freigang N, Trabitzsch A, Pleul K, Kaiser DPO, Roessler M, Winzer S, Hugo C, Günther A, Puetz V, Barlinn K. Identification of patients at high risk for brain death using an automated digital screening tool: a prospective diagnostic accuracy study. J Neurol 2023; 270:5935-5944. [PMID: 37626244 PMCID: PMC10632197 DOI: 10.1007/s00415-023-11938-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND An automated digital screening tool (DETECT) has been developed to aid in the early identification of patients who are at risk of developing brain death during critical care. METHODS This prospective diagnostic accuracy study included consecutive patients ≥ 18 years admitted to neurocritical care for primary or secondary acute brain injury. The DETECT screening tool searched routinely monitored patient data in the electronic medical records every 12 h for a combination of coma and absence of bilateral pupillary light reflexes. In parallel, daily neurological assessment was performed by expert neurointensivists in all patients blinded to the index test results. The primary target condition was the eventual diagnosis of brain death. Estimates of diagnostic accuracy along with their 95%-confidence intervals were calculated to assess the screening performance of DETECT. RESULTS During the 12-month study period, 414 patients underwent neurological assessment, with 8 (1.9%) confirmed cases of brain death. DETECT identified 54 positive patients and sent 281 notifications including 227 repeat notifications. The screening tool had a sensitivity of 100% (95% CI 63.1-100%) in identifying patients who eventually developed brain death, with no false negatives. The mean time from notification to confirmed diagnosis of brain death was 3.6 ± 3.2 days. Specificity was 88.7% (95% CI 85.2-91.6%), with 46 false positives. The overall accuracy of DETECT for confirmed brain death was 88.9% (95% CI 85.5-91.8%). CONCLUSIONS Our findings suggest that an automated digital screening tool that utilizes routinely monitored clinical data may aid in the early identification of patients at risk of developing brain death.
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Affiliation(s)
- Daniela Schoene
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Norman Freigang
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Anne Trabitzsch
- Department of Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Konrad Pleul
- Deutsche Stiftung Organtransplantation (DSO), Frankfurt am Main, Germany
| | - Daniel P O Kaiser
- Institute of Neuroradiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Roessler
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- BARMER Institute for Health Care System Research (Bifg), Berlin, Germany
| | - Simon Winzer
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Christian Hugo
- Division of Nephrology, Department of Internal Medicine III, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Albrecht Günther
- Department of Neurology, University Hospital Jena, Jena, Germany
| | - Volker Puetz
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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Kitlen E, Kim N, Rubenstein A, Keenan C, Garcia G, Khosla A, Johnson J, Miller PE, Wira C, Greer D, Gilmore EJ, Beekman R. Development and validation of a novel score to predict brain death after out-of-hospital cardiac arrest. Resuscitation 2023; 192:109955. [PMID: 37661012 DOI: 10.1016/j.resuscitation.2023.109955] [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: 07/18/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Brain death (BD) occurs in 9-24% of successfully resuscitated out-of-hospital cardiac arrests (OHCA). To predict BD after OHCA, we developed a novel brain death risk (BDR) score. METHODS We identified independent predictors of BD after OHCA in a retrospective, single academic center cohort between 2011 and 2021. The BDR score ranges from 0 to 7 points and includes: non-shockable rhythm (1 point), drug overdose as etiology of arrest (1 point), evidence of grey-white differentiation loss or sulcal effacement on head computed tomography (CT) radiology report within 24 hours of arrest (2 points), Full-Outline-Of-UnResponsiveness (FOUR) score of 0 (2 points), FOUR score 1-5 (1 point), and age <45 years (1 point). We internally validated the BDR score using k-fold cross validation (k = 8) and externally validated the score at an independent academic center. The main outcome was BD. RESULTS The development cohort included 362OHCA patients, of whom 18% (N = 58) experienced BD. Internal validation provided an area under the receiving operator characteristic curve (AUC) (95% CI) of 0.931 (0.905-0.957). In the validation cohort, 19.8% (N = 17) experienced BD. The AUC (95% CI) was 0.849 (0.765-0.933). In both cohorts, a BDR score >4 was the optimal cut off (sensitivity 0.903 and 0.882, specificity 0.830 and 0.652, in the development and validation cohorts respectively). DISCUSSION The BDR score identifies those at highest risk for BD after OHCA. Our data suggest that a BDR score >4 is the optimal cut off.
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Affiliation(s)
- Eva Kitlen
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Noah Kim
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Alexandra Rubenstein
- Department of Neurology, Boston University Medical Center, Boston, MA, United States
| | - Caitlyn Keenan
- Department of Neurology, Boston University Medical Center, Boston, MA, United States
| | - Gabriella Garcia
- Department of Neurology, University of Pennsylvania, PA, United States
| | - Akhil Khosla
- Department of Pulmonary Critical Care, Yale School of Medicine, New Haven, CT, United States
| | | | - P Elliott Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Charles Wira
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - David Greer
- Department of Neurology, Boston University Medical Center, Boston, MA, United States
| | - Emily J Gilmore
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States
| | - Rachel Beekman
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States.
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de Oliveira Restier RB, Knihs NDS, Salum NC, Pontes DO, Magalhães ALP, Dos Santos EG, Walendowsky ASSDR, Pessoa JLE, Roza BDA, Ramos SF. Interventions to Improve the Quality in the Organ and Tissue Donation Process. Transplant Proc 2023; 55:1346-1351. [PMID: 37537077 DOI: 10.1016/j.transproceed.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/19/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Map Interventions is capable of supporting the multidisciplinary team that works in organ and tissue donation to disseminate quality in this process. METHODS A scoping review study that was conducted through the steps proposed by the Joanna Briggs Institute. RESULTS Fifty-six studies made up the sample. 2018 (no. 07, 12.5%) had the highest number of publications. The country that published the most was the United States (no. 16, 28.56%). The database with the most publications was the Cumulative Index to Nursing and Allied Health Literature - CINAHL (no. 15, 26.78%). The most used interventions, which had the most significant impact on the improvement of results and quality, were the use of indicators in all stages of the organ and tissue donation process; the use of real goals that can be achieved; frequent audits, validation of instruments to track opportunities for improvement; as well as methodologies to implement quality and education among professionals who work in this process. Such interventions reveal important changes in the organ donation process, especially in the notification of potential and effective donors, as well as providing an opportunity for safety in the stages of the organ and tissue donation process. CONCLUSION The interventions tracked suggest the implementation of a set of actions formed by the continuous use of auditing, indicators, continuing education with the team that works in the process of organ and tissue donation, combined with the management of the results obtained through the indicators, where it is generated from these data, actions that have a direct impact on the weaknesses identified.
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Affiliation(s)
| | | | | | | | | | | | | | - João Luis Erbs Pessoa
- State Transplant Center; Secretary of Health of the state of São Paulo, São Paulo, Brazil
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Tannous LA, Westphal GA, Ioshii SO, de Lima Alves GN, Pigatto RN, Pinto RL, de Carvalho KAT, Francisco JC, Guarita-Souza LC. Histological, Laboratorial, and Clinical Benefits of an Optimized Maintenance Strategy of a Potential Organ Donor-A Rabbit Experimental Model. Life (Basel) 2023; 13:1439. [PMID: 37511814 PMCID: PMC10381703 DOI: 10.3390/life13071439] [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: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Most transplanted organs are obtained from brain-dead donors. Inflammation results in a higher rate of rejection. Objectives: The objective of this animal model of brain death (BD) was to evaluate the effect of the progressive institution of volume expansion, norepinephrine, and combined hormone therapy on clinical, laboratory, and histological aspects. Methods: Twenty rabbits were divided: A (control), B (induction of BD + infusion of crystalloid), C (BD + infusion of crystalloid and noradrenaline (NA)), and D (BD + infusion of crystalloid + vasopressin + levothyroxine + methylprednisolone + NA). The animals were monitored for four hours with consecutives analysis of vital signs and blood samples. The organs were evaluated by a pathologist. Results: In Group D, we observed fewer number and lesser volume of infusions (p = 0.032/0.014) when compared with groups B and C. Mean arterial pressure levels were higher in group D when compared with group B (p = 0.008). Group D had better glycemic control when compared with group C (p = 0.016). Sodium values were elevated in group B in relation to groups C and D (p = 0.021). In Group D, the organ perfusion was better. Conclusion: The optimized strategy of management of BD animals is associated with better hemodynamic, glycemic, and natremia control, besides reducing early signs of ischemia.
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Affiliation(s)
- Luana Alves Tannous
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba 80215-901, Paraná, Brazil
| | | | - Sergio Ossamu Ioshii
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba 80215-901, Paraná, Brazil
| | | | - Raul Nishi Pigatto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba 80215-901, Paraná, Brazil
| | - Rafael Luiz Pinto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba 80215-901, Paraná, Brazil
| | | | | | - Luiz César Guarita-Souza
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba 80215-901, Paraná, Brazil
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Zirpe KG, Tiwari AM, Pandit RA, Govil D, Mishra RC, Samavedam S, Gopal PB, Kulkarni AP, Swaminathan S, Dixit SB, Kar A, Pande RK, Chaudhry D. Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM. Indian J Crit Care Med 2022; 26:S43-S50. [PMID: 36896361 PMCID: PMC9989874 DOI: 10.5005/jp-journals-10071-24190] [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: 02/10/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022] Open
Abstract
There is a wide gap between patients who need transplants and the organs that are available in India. Extending the standard donation criterion is certainly important to address the scarcity of organs for transplantation. Intensivists play a major role in the success of deceased donor organ transplants. Recommendations for deceased donor organ evaluation are not discussed in most intensive care guidelines. The purpose of this position statement is to establish current evidence-based recommendations for multiprofessional critical care staff in the evaluation, assessment, and selection of potential organ donors. These recommendations will give "real-world" criteria that are acceptable in the Indian context. The aim of this set of recommendations is to both increase the number and enhance the quality of transplantable organs. How to cite this article Zirpe KG, Tiwari AM, Pandit RA, Govil D, Mishra RC, Samavedam S, et al. Recommendations for Evaluation and Selection of Deceased Organ Donor: Position Statement of ISCCM. Indian J Crit Care Med 2022;26(S2):S43-S50.
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Affiliation(s)
- Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Anand M Tiwari
- Department of Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Rahul A Pandit
- Department of Critical Care Medicine, Fortis Hospital, Mumbai, Maharashtra, India
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurugram, Haryana, India
| | - Rajesh C Mishra
- Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
| | | | - Atul P Kulkarni
- Division of Critical Care Medicine, Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Arindam Kar
- Calcutta Medical Research Institute, Kolkata, West Bengal, India
| | - Rajesh K Pande
- Department of Critical Care, BLK Superspeciality Hospital, New Delhi, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
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Successful liver and kidneys transplant following aortic dissection and subclavian artery rupture: A case report. Int J Surg Case Rep 2022; 98:107526. [PMID: 35988503 PMCID: PMC9420505 DOI: 10.1016/j.ijscr.2022.107526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 11/22/2022] Open
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11
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Quality Improvement Tools to Manage Deceased Organ Donation Processes: A Scoping Review Protocol. Nurse Educ Pract 2022; 61:103322. [DOI: 10.1016/j.nepr.2022.103322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 11/19/2022]
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Lazzeri C, Bonizzoli M, Guetti C, Fulceri GE, Peris A. Hemodynamic management in brain dead donors. World J Transplant 2021; 11:410-420. [PMID: 34722170 PMCID: PMC8529942 DOI: 10.5500/wjt.v11.i10.410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/22/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
Donor management is the key in the complex donation process, since up to 20% of organs of brain death donors (DBD) are lost due to hemodynamic instability. This challenge is made more difficult due to the lack of strong recommendations on therapies for hemodynamic management in DBDs and more importantly to the epidemiologic changes in these donors who are becoming older and with more comorbidities (marginal donors). In the present manuscript we aimed at summarizing the available evidence on therapeutic strategies for hemodynamic management (focusing on vasoactive drugs) and monitoring (therapeutic goals). Evidence on management in elderly DBDs is also summarized. Donor management continues critical care but with different and specific therapeutic goals since the number of donor goals met is related to the number of organs retrieved and transplanted. Careful monitoring of selected parameters (possibly including serial echocardiography) is the clinical tool able to guarantee the achievement and maintaining of therapeutic goals. Despide worldwide differences, norepinephrine is the vasoactive of choice in most countries but, whenever higher doses (> 0.2 mcg/kg/min) are needed, a second vasoactive drug (vasopressin) is advisable. Hormonal therapy (desmopressin, corticosteroid and thyroid hormone) are suggested in all DBDs independently of hemodynamic instability. In the single patient, therapeutic regimen (imprimis vasoactive drugs) should be chosen also according to the potential organs retrievable (i.e. heart vs liver and kidneys).
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Affiliation(s)
- Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero Universitaria Careggi, Florence 50134, Italy
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero Universitaria Careggi, Florence 50134, Italy
| | - Cristiana Guetti
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero Universitaria Careggi, Florence 50134, Italy
| | - Giorgio Enzo Fulceri
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero Universitaria Careggi, Florence 50134, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero Universitaria Careggi, Florence 50134, Italy
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Lücking KM, Söffker G. [Organ donation: A treatment option in end-of life intensive care?]. Dtsch Med Wochenschr 2021; 146:1077-1084. [PMID: 34416776 DOI: 10.1055/a-1004-6781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A newly issued policy statement of the German Medical Association considers organ donation as an integral part of end-of-life intensive care in patients with devastating brain afflictions. Hence, patients' wishes towards organ donation and medical suitability should be evaluated when prognosis is considered futile and goals of treatment need to be reconsidered. Continuation of intensive care treatment towards the (mandatory) diagnosis of "brain death" and subsequently towards organ donation has to be legitimatized by patients' explicit wishes (organ donor card, advanced directive) or by surrogate decisions makers. Intensive care facilitating organ donation should be goal-directed and follow established guidelines. Thus, a potential recovery of transplantable organs is supported by appropriate intensive care treatment. Decisions to employ extended intensive care options (like extracorporeal circulatory support or cardiopulmonary resuscitation) in potential organ donors should be carefully outbalanced with patients' wishes, organ donation being considered an achievable goal and even potential frictions in medical teams.
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Wagner LS, Souza RLD, Magajewski FRL. New procedures for the confirmation of brain death in Brazil: results from the Central Estadual de Transplantes de Santa Catarina. Rev Bras Ter Intensiva 2021; 33:290-297. [PMID: 34231810 PMCID: PMC8275083 DOI: 10.5935/0103-507x.20210037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/12/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To analyze the impact of Resolution 2.173/2017 of the Federal Council of Medicine on results from the Central Estadual de Transplantes de Santa Catarina. Methods This was a cross-sectional observational study of medical records of all patients (1,605) with suspected brain death notified to the Central Estadual de Transplantes de Santa Catarina; for this study, procedures to confirm this diagnosis were initiated between July 2016 and December 2017 and between January 2018 and June 2019. The median duration of the protocol in each period was considered for the comparison between the intervals. The collected data were transformed into rates (per million population). The mean rates for the periods before and after the implementation of the protocol were analyzed by Student’s t-test, and qualitative variables were analyzed by Pearson’s chi-squared test. Results The mean duration of brain death confirmation procedures decreased more than 1 hour in the second period compared to the first period, with statistical significance (p = 0.001). The rates of harvested livers and transplanted pancreas, the number of notifications by hospital size and the rate of cardiac arrest in the macro-region of the Itajaí Valley were significantly different between the two periods. Conclusion In the period after the new resolution on brain death, there was a reduction in the duration for diagnosis. However, other indicators did not change significantly, providing evidence for the multidimensional nature of the organ transplantation process in Santa Catarina and the need for further studies to better understand and optimize the process.
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Affiliation(s)
- Letícia Silva Wagner
- Universidade do Sul de Santa Catarina, Campus Pedra Branca - Palhoça (SC), Brasil
| | - Rafael Lisboa de Souza
- Central Estadual de Transplantes de Santa Catarina, Secretaria de Estado da Saúde de Santa Catarina - Florianópolis (SC), Brasil
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15
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Bacterial Pneumonia in Brain-Dead Patients: Clinical Features and Impact on Lung Suitability for Donation. Crit Care Med 2021; 48:1760-1770. [PMID: 33009101 DOI: 10.1097/ccm.0000000000004631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To appraise the epidemiological features of bacterial pneumonia and its impact on lung suitability for donation in brain-dead patients managed with protective ventilatory settings. DESIGN Retrospective observational study. SETTING Six ICUs from two university-affiliated hospitals. PATIENTS Brain-dead adult patients managed in the participating ICUs over a 4-year period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among the 231 included patients, 145 (62.8%) were classified as ideal or extended-criteria potential lung donors at ICU admission and the remaining 86 patients having baseline contraindication for donation. Culture-proven aspiration pneumonia and early-onset ventilator-associated pneumonia occurred in 54 patients (23.4%) and 15 patients (6.5%), respectively (overall pneumonia incidence, 29.9%). Staphylococcus aureus and Enterobacterales were the most common pathogens. Using mixed-effects Cox proportional hazard models, age (adjusted hazard ratio, 0.98; 95% CI [0.96-0.99]), anoxic brain injury (3.55 [1.2-10.5]), aspiration (2.29 [1.22-4.29]), and not receiving antimicrobial agents at day 1 (3.56 [1.94-6.53]) were identified as independent predictors of pneumonia occurrence in the whole study population. Analyses restricted to potential lung donors yielded similar results. Pneumonia was associated with a postadmission decrease in the PaO2/FIO2 ratio and lower values at brain death, in the whole study population (estimated marginal mean, 294 [264-323] vs 365 [346-385] mm Hg in uninfected patients; p = 0.0005) as in potential lung donors (299 [248-350] vs 379 [350-408] mm Hg; p = 0.04; linear mixed models). Lungs were eventually retrieved in 31 patients (34.4%) among the 90 potential lung donors with at least one other organ harvested (pneumonia prevalence in lung donors (9.7%) vs nondonors (49.2%); p = 0.0002). CONCLUSIONS Pneumonia occurs in one-third of brain-dead patients and appears as the main reason for lung nonharvesting in those presenting as potential lung donors. The initiation of antimicrobial prophylaxis upon the first day of the ICU stay in comatose patients with severe brain injury could enlarge the pool of actual lung donors.
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Chen P, Shih Y, Chiu C, Huang S, Hsu H. Unexpected cardio-circulatory arrest during a brain-dead donor organ retrieval. Respirol Case Rep 2021; 9:e00752. [PMID: 33959298 PMCID: PMC8080290 DOI: 10.1002/rcr2.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022] Open
Abstract
According to the Maastricht classification category of donation after circulatory death (DCD), type IV DCD refers to brain-dead donors who are re-categorized after unexpected circulatory arrest before donor organ retrieval. Clinical management is challenging, even in intensive care units, where most of this type of organ donation occurs. We report a case of the first successful lung transplantation (LTx) using type IV DCD organ in Taiwan. The recipient's recovery was satisfactory, without acute or chronic organ dysfunction. When unexpected events made the brain-dead donors suffer from sudden onset of cardiac arrest before or during organ donation surgery, immediately switching the retrieval protocol from donation after brain death (DBD) to DCD could expand the donor pool and increase organ supply. The well-prepared and experienced transplant team and prompt protocol switch made this transplant surgery possible.
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Affiliation(s)
- Pei‐Hsing Chen
- Division of Thoracic Surgery, Department of SurgeryNational Taiwan University Hospital Yun‐Lin BranchYun‐LinTaiwan
| | - Yu‐Shan Shih
- National Taiwan University College of MedicineTaipeiTaiwan
| | - Ching‐Tang Chiu
- Department of AnesthesiologyNational Taiwan University HospitalTaipeiTaiwan
| | - Shu‐Chien Huang
- National Taiwan University College of MedicineTaipeiTaiwan
- Division of Cardiovascular Surgery, Department of SurgeryNational Taiwan University HospitalTaipeiTaiwan
| | - Hsao‐Hsun Hsu
- National Taiwan University College of MedicineTaipeiTaiwan
- Division of Thoracic Surgery, Department of SurgeryNational Taiwan University HospitalTaipeiTaiwan
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Silva E Silva V, Schirmer J, Roza BD, de Oliveira PC, Dhanani S, Almost J, Schafer M, Tranmer J. Defining Quality Criteria for Success in Organ Donation Programs: A Scoping Review. Can J Kidney Health Dis 2021; 8:2054358121992921. [PMID: 33680483 PMCID: PMC7897821 DOI: 10.1177/2054358121992921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background Well-established performance measures for organ donation programs do not fully address the complexity and multifactorial nature of organ donation programs such as the influence of relationships and organizational attributes. Objective To synthesize the current evidence on key organizational attributes and processes of international organ donation programs associated with successful outcomes and to generate a framework to categorize those attributes. Design Scoping Review using a mixed methods approach for data extraction. Setting Databases included PubMed, CINAHL, Embase, LILACS, ABI Business ProQuest, Business Source Premier, and gray literature (organ donation association websites, Google Scholar-first 8 pages), and searches for gray literature were performed, and relevant websites were perused. Sample Organ donation programs or processes. Methods We systematically searched the literature to identify any research design, including text and opinion papers and unpublished material (research data, reports, institutional protocols, government documents, etc). Searches were completed on January 2018, updated it in May 2019, and lastly in March 2020. Title, abstracts, and full texts were screened independently by 2 reviewers with disagreements resolved by a third. Data extraction followed a mixed method approach in which we extracted specific details about study characteristics such as type of research, year of publication, origin/country of study, type of journal published, and key findings. Studies included considered definitions and descriptions of success in organ donation programs in any country by considering studies that described (1) attributes associated with success or effectiveness, (2) organ donation processes, (3) quality improvement initiatives, (4) definitions of organ donation program effectiveness, (5) evidence-based practices in organ donation, and (6) improvements or success in such programs. We tabulated the type and frequency of the presence or absence of reported improvement quality indicators and used a qualitative thematic analysis approach to synthesize results. Results A total of 84 articles were included. Quantitative analysis identified that most of the included articles originated from the United States (n = 32, 38%), used quantitative approaches (n = 46, 55%), and were published in transplant journals (n = 34, 40.5%). Qualitative analysis revealed 16 categories that were described as positively influencing success/effectiveness of organ donation programs. Our thematic analysis identified 16 attributes across the 84 articles, which were grouped into 3 categories influencing organ donation programs' success: context (n = 39, 46%), process (n = 48, 57%), and structural (n = 59, 70%). Limitations Consistent with scoping review methodology, the methodological quality of included studies was not assessed. Conclusions This scoping review identified a number of factors that led to successful outcomes. However, those factors were rarely studied in combination representing a gap in the literature. Therefore, we suggest the development and reporting of primary research investigating and measuring those attributes associated with the performance of organ donation programs holistically. Trial Registration Not applicable.
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Affiliation(s)
| | | | | | | | - Sonny Dhanani
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Joan Almost
- School of Nursing, Queen's University, Kingston, ON, Canada
| | - Markus Schafer
- Department of Sociology, University of Toronto, ON, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, ON, Canada
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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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Tong L, Hu XG, Huang F, Huang SW, Li LF, Tang ZX, Yao JY, Xu JH, Zhu YP, Chen YH, He XS, Guan XD, Cai C. Clinical Impacts and Outcomes With Possible Donor-Derived Infection in Infected Donor Liver Transplantation: A Single-Center Retrospective Study in China. J Infect Dis 2021; 221:S164-S173. [PMID: 32176783 DOI: 10.1093/infdis/jiz591] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Information on possible donor-derived transmission events in China is limited. We evaluated the impacts of liver transplantation from infected deceased-donors, analyzed possible donor-derived bacterial or fungal infection events in recipients, and evaluated the etiologic agents' characteristics and cases outcomes. METHODS A single-center observational study was performed from January 2015 to March 2017 to retrospectively collect data from deceased-donors diagnosed with infection. Clinical data were recorded for each culture-positive donor and the matched liver recipient. The microorganisms were isolated and identified, and antibiotic sensitivity testing was performed. The pathogens distribution and incidence of possible donor-derived infection (P-DDI) events were analyzed and evaluated. RESULTS Information from 211 donors was collected. Of these, 82 donors were infected and classified as the donation after brain death category. Overall, 149 and 138 pathogens were isolated from 82 infected donors and 82 matched liver recipients, respectively. Gram-positive bacteria, Gram-negative bacteria, and fungi accounted for 42.3% (63 of 149), 46.3% (69 of 149), and 11.4% (17 of 149) of pathogens in infected donors. The incidence of multidrug-resistant bacteria was high and Acinetobacter baumannii was the most concerning species. Infections occurred within the first 2 weeks after liver transplantation with an organ from an infected donor. Compared with the noninfection recipient group, the infection recipient group experienced a longer mechanical ventilation time (P = .004) and intensive care unit stay (P = .003), a higher incidence of renal dysfunction (P = .026) and renal replacement therapy (P = .001), and higher hospital mortality (P = .015). Possible donor-derived infection was observed in 14.6% of cases. Recipients with acute-on-chronic liver failure were more prone to have P-DDI than recipients with other diseases (P = .007; odds ratio = 0.114; 95% confidence interval, .025-.529). CONCLUSIONS When a liver recipient receives a graft from an infected deceased-donor, the postoperative incidence of infection is high and the infection interval is short. In addition, when a possible donor-derived, drug-resistant bacterial infection occurs, recipients may have serious complications and poor outcomes.
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Affiliation(s)
- Li Tong
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Guang Hu
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fa Huang
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shun-Wei Huang
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li-Fen Li
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhao-Xia Tang
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ji-You Yao
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing-Hong Xu
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan-Ping Zhu
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yin-Hua Chen
- The Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Shun He
- The Department of Organ Transplantation, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiang-Dong Guan
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - ChangJie Cai
- The Second Department of Critical Care Medicine, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Organ donation in the US and Europe: The supply vs demand imbalance. Transplant Rev (Orlando) 2020; 35:100585. [PMID: 33071161 DOI: 10.1016/j.trre.2020.100585] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
Organ donation and transplantation remain the best and most cost-effective clinical solution for end-stage organ failure. Several agencies across the US and Europe provide legislative, regulatory, and humanitarian services to generate smoother applications in all transplantation processes and donor-recipient relationships. US and European statistics present nine types of grafts, with kidneys being the most transplanted organ worldwide. However, organ shortage, religion, underrepresented minority groups, difficulties in obtaining consent, lack of understanding, and general ethical concerns present challenging barriers to organ donation, reflecting the complexity of graft procurement and allocation. Breaking down these barriers to reduce the organ-supply imbalance requires an appropriate multifaceted approach. Some of the key areas include increasing the potential donor pool and consent rates, apt organ allocation, and improving organ health. Additionally, suitable policies and standardized guidelines for both donors and recipients, alongside educational initiatives, are needed to ensure patient safety and global awareness. Looking forward, novel and effective research plans and initiatives are needed if we are to avoid a colossal supply-demand gap.
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D'Aragon F, Lamontagne F, Cook D, Dhanani S, Keenan S, Chassé M, English S, Burns KEA, Frenette AJ, Ball I, Boyd JG, Masse MH, Breau R, Akhtar A, Kramer A, Rochwerg B, Lauzier F, Kutsogiannis DJ, Ibrahim Q, Hand L, Zhou Q, Meade MO. Variability in deceased donor care in Canada: a report of the Canada-DONATE cohort study. Can J Anaesth 2020; 67:992-1004. [PMID: 32385825 DOI: 10.1007/s12630-020-01692-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Canadian donor management practices have not been reported. Our aim was to inform clinicians and other stakeholders about the range of current practices. METHODS This prospective observational cohort study enrolled consecutive, newly consented organ donors from August 1 2015 to July 31 2018 at 27 academic and five community adult intensive care units in British Columbia, Alberta, Ontario, and Quebec. Research staff prospectively recorded donor management data. Provincial organ donation organizations verified the organs donated. We formally compared practices across provinces. RESULTS Over a median collection period of eight months, 622 potential donors were classified at baseline as having neurologic determination of death (NDD donors; n = 403) or circulatory death (DCD donors; n = 219). Among NDD donors, 85.6% underwent apnea testing (rarely with carbon dioxide insufflation), 33.2% underwent ancillary testing, and subsequent therapeutic hypothermia (34-35°C) was rare. Neurologic determination of death donors were more hemodynamically unstable with most having received vasopressin and norepinephrine infusions, with a large majority having received high-dose corticosteroids and intravenous thyroxine. Among DCD donors, 61.6% received corticosteroids, and 8.9% received thyroxine. Most donors did not receive lung-protective ventilation strategies. Invasive procedures after donation consent included bronchoscopy (71.7%), cardiac catheterization (NDD donors only; 21.3%), and blood transfusions (19.3%). Physicians ordered intravenous antemortem heparin for 94.8% of DCD donors. The cohort donated 1,629 organs resulting in 1,532 transplants. Case selection, death determinations, and hormone, nutrition and heparin practices all varied across provinces. CONCLUSION These study findings highlight areas for knowledge translation and further clinical research. Interprovincial discrepancies will likely pose unique challenges to national randomized trials. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03114436); registered 10 April, 2017.
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Affiliation(s)
- Frédérick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, 2001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada.
| | - Francois Lamontagne
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Deborah Cook
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Sonny Dhanani
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Eastern, Ontario University of Ottawa, Ottawa, ON, Canada
| | - Sean Keenan
- Department of Critical Care, University of British Columbia, Vancouver, BC, Canada
- BC Transplant, Vancouver, BC, Canada
| | - Michaël Chassé
- Department of Medicine (Critical Care), Université de Montreal, Montreal, QC, Canada
| | - Shane English
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Anne Julie Frenette
- Pharmacy faculty, Université de Montreal, Montreal, QC, Canada
- Hôpital Sacre-Coeur de Montreal, Montreal, QC, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - John Gordon Boyd
- Department of Medicine (Neurology), Queen's University, Kingston, ON, Canada
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - Marie-Hélène Masse
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Ruth Breau
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Aemal Akhtar
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Andreas Kramer
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - François Lauzier
- Population Health and Optimal Health Practice Research Unit, CHU de Québec-Université Laval Research Center, Quebec City, QC, Canada
- Departments of Medicine, Université Laval, Quebec City, QC, Canada
| | | | - Quazi Ibrahim
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Lori Hand
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Qi Zhou
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
| | - Maureen O Meade
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
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23
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Ningning NMD, Ying TMD, Jingwen ZMD. Real-Time Tissue Elastography: A Noninvasive Technique to Evaluate Liver Damage after Brain Death in Animal Mode. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.190028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, Malhotra R. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020; 24:804-808. [PMID: 33132564 PMCID: PMC7584817 DOI: 10.5005/jp-journals-10071-23578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Transplantation of Human Organ Act was passed in India in 1994 to streamline organ donation and transplantation activities. It is time to retrospect ourselves and analyze the method to increase organ donation. Type of study Retrospective observational analysis. Objectives To evaluate the change in organ donation rate and reasons for changes in rates. Subjects Brainstem dead declared patients whose family consented for organ donations in the last 23 years (1997–2019) at Ruby Hall Clinic, Pune, India. Materials and methods Retrospectively demographic data of the brainstem dead declared donors, the primary diagnoses, comorbidities, and the complete data of their management till organ retrieval was assessed. Results One hundred cases in the age group 15–75 years (mean 41.6 ± 15.3 years) of brainstem death consented for organ donation were retrospectively studied. The period was divided into two groups, group I and group II included study duration from 1997 to 2013 and from 2013 to 2019 respectively. During the entire period, though the major cause of donor death remained road traffic accidents (RTA) in both the groups (84.21% till 2013 vs 48.15% after 2013), the proportion of donors declared brain dead due to RTA dipped significantly after 2013 (p = 0.004) and the non-RTA causes of brain dead contributed more than RTA causes (51.85% non-RTA vs 48.15% RTA). The major contributor among non-RTA causes was intracranial bleeds (5.26% before 2013 vs 33.33% after 2013, p = 0.014). Compared to the previous 17 years (from 1997) there were more than fourfold rise in the rate of transplantation in the last 6 years (2014–2019) at our institute. Kidneys were retrieved from 90% donors followed by cornea 84%, liver 65%, heart 22%, skin 7%, lungs 6%, and pancreas 5%. Conclusion We have observed that the cadaveric organ donation rate significantly improved after 2013. Reasons might be widening of the donor pool by the selection of more of non-RTA brain death donors over RTA, acceptability of elderly population donor (>60 years) by our transplant teams, early identification of potential organ donor, and better protocol-based management of the cadaver organ donor. How to cite this article Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, et al. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020;24(9):804–808.
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Affiliation(s)
- Kapil G Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Sushma Gurav
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Abhijeet Deshmukh
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Prajakta Pote
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Amit Tungenwar
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Ria Malhotra
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
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Changing the Position: Iterative Improvements in the Chain of Lung Transplantation. Crit Care Med 2019; 47:1154-1156. [PMID: 31305301 DOI: 10.1097/ccm.0000000000003860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Zirpe K, Gurav S. Brain Death and Management of Potential Organ Donor: An Indian Perspective. Indian J Crit Care Med 2019; 23:S151-S156. [PMID: 31485125 PMCID: PMC6707496 DOI: 10.5005/jp-journals-10071-23194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
How to cite this article: Zirpe K, Gurav S. Brain Death and Management of Potential Organ Donor: An Indian Perspective. Indian J Crit Care Med 2019;23(Suppl 2):S151-S156.
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Affiliation(s)
- Kapil Zirpe
- Department of Neurotrauma, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sushma Gurav
- Department of Neurotrauma, Ruby Hall Clinic, Pune, Maharashtra, India
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