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D’Costa RL, Radford S, Opdam HI, McDonald M, McEvoy L, Bellomo R. Expedited organ donation in Victoria, Australia: donor characteristics and donation outcomes. CRIT CARE RESUSC 2020; 22:303-311. [PMID: 38046868 PMCID: PMC10692516 DOI: 10.51893/2020.4.oa2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Deceased organ donation work-up typically takes 24 hours or more. Clinicians may thus discount the possibility of donation when the potential donor is physiologically unstable or family requirements do not allow this length of time. This may lead to loss of transplantable organs. In 2015, we introduced an expedited work-up guideline with the aim of facilitating donation in these circumstances and maximising donation potential. Objective: To determine the number of expedited work-up (consent to retrieval procedure of 6 hours or less) donors from 2015 to 2018, compare their clinical and demographic characteristics with standard donors, and assess the outcome of transplanted organs and organ recipients. Design: We performed a retrospective audit of the electronic database for all Victorian donors from 2015 to 2018. We obtained transplant outcome data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). Results: Overall, 38 expedited pathway donors donated 78 organs for transplantation (70 kidneys, four lungs, three livers, one pancreas). Of these, 55 retrieved kidneys were successfully transplanted. The lungs, livers and pancreas retrieved were all transplanted. For the kidney recipients, early graft dysfunction requiring dialysis was more common than with organs from the standard pathway (71% v 38%; P < 0.0001); however, short and medium term graft and patient survival were similar. Three recipients from the expedited pool experienced graft failure and two subsequently died. Of the two lung recipients, one died at day 622 of chronic rejection. Conclusions: Expedited pathway donation is feasible with acceptable donation outcomes. Clinicians should consider donation even when physiological instability or family requirements preclude standard organ donation work-up times.
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Affiliation(s)
- Rohit L. D’Costa
- DonateLife Victoria, Melbourne, VIC, Australia
- Melbourne Health, Melbourne, VIC, Australia
| | - Samuel Radford
- DonateLife Victoria, Melbourne, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia.ia
| | - Helen I. Opdam
- Austin Health, Melbourne, VIC, Australia
- Organ and Tissue Authority, Canberra, ACT, Australia
| | - Mark McDonald
- Organ and Tissue Authority, Canberra, ACT, Australia
| | | | - Rinaldo Bellomo
- Melbourne Health, Melbourne, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia.ia
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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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