Organ donation protocols

Physiotherapy in Patients on the Organ Donation Pathway: A Survey of Current Practice

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.

History of first transplantations: Nothing is ever written. Part II

The history of the first transplants is an ideal model for analyzing the different stages of disruptive innovation in surgery. Pioneers have often taken paths that were strewn with pitfalls, mistakes or failures. Sometimes victory, brilliant or more modest, lies at the end of this path. We propose to re-explore the extraordinary pathways that led to the first transplantations of the kidney, liver, lung and heart. That these first transplants should one day become possible required the concurrence of several factors: basic research, laboratory work to perfect the surgical techniques, a favorable legislative and societal context, and, above all, pioneering surgeons who would dare to apply their expertise to human subjects. Initial failures were not technical but immunological. Not everything would be perfect, especially ethical questions in some cases. Furthermore, initial results often humbled the greatest surgeons. Even though the historical and legislative contexts have evolved considerably as have science, society and the organization of the health system, this analysis of the past is rich in lessons for the modern surgeon who wishes to embark today along innovative pathways in the face of a still unresolved problem. Because nothing is ever carved in stone.

Experimental Rat Model for Brain Death Induction and Kidney Transplantation

Background: Experimental animal research has been pivotal in developing clinical kidney transplantation (KTx). One donor-associated risk factor with negative affect of transplantation outcome is brain death (BD). Many rat models for BD and KTx have been developed in the last decade, but no surgical guidelines have been developed for these models. Here, we describe a surgical technique for BD induction and the cuff technique for experimental KTx in rats.Methods: After intubation and mechanically ventilation of sixteen healthy adult male Sprague-Dawley rats were induction of BD performed. Animals were kept hemodynamically stable for eight hours. Then, the kidney was prepared and perfused with standard histidine-tryptophan-ketoglutarate solution. After explantation, grafts were immediately implanted in recipients using the cuff technique and reperfused. After 2 h of observation, animals were sacrificed by intravenous administration of potassium chloride.Results: In the early phase of BD, heart rate increased and mean arterial pressure decreased. Partial variations were observed in O₂ partial pressure, O₂ saturation, and HCO₃. During the 2-h observation phase, all transplanted kidneys were sufficiently perfused macroscopically. There was no hyperacute rejection.Conclusions: It is feasible to observe BD for 8 h with maintained circulation in small experimental settings. The cuff technique for KTx is simple, the complication rate is low, and the warm ischemia time is short, therefore, this could be a suitable technique for KTx in the rat model.