1
|
Savoye E, Martin-Lefèvre L, Dantal J, Dorez D, Gaudez F, Drouin S, Riou B, Strecker G, Thierry A, Legeai C, Bronchard R, Kerbaul F, Antoine C. Risk Factors for Adverse Outcomes in Kidney Transplants From Donors After Circulatory Death With Normothermic Regional Perfusion: A Systematic Analysis. Transplantation 2024:00007890-990000000-00791. [PMID: 38872246 DOI: 10.1097/tp.0000000000005102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
BACKGROUND This study examined 1071 adult primary kidney transplants from the French-controlled donation after the circulatory determination of death (cDCD) program, which uses normothermic regional perfusion (NRP), and involves short cold ischemia times (CIT) and constrained asystole times differing by donor age. METHODS Logistic regression identified risk factors for primary nonfunction (PNF), delayed graft function (DGF), and graft failure. RESULTS Risk factors for PNF included donor hypertension, admission for ischemic vascular stroke, and HLA DR mismatches. Risk factors for DGF included functional warm ischemia time >40 min, dialysis >2 y, recipient body mass index of 30 kg/m2 or higher, recipient diabetes, and CIT >10 h. Risk factors for 1-y graft failure included donor hypertension, donor lung recovery, ostial calcification, recipient cardiovascular comorbidities, and HLA DR mismatches. A high donor estimated glomerular filtration rate protected against DGF and graft failure at 1-y. After adjustment restricted to recipient and graft factors and donor age, the risks of PNF, DGF, and graft failure increased with donor age up to 65 y and then remained stable. CONCLUSIONS The study suggests that cDCD kidney transplants are highly successful, but also that its outcomes are influenced by lung recovery, poor HLA DR matching, and warm ischemia times differing with donor age. Our study identified several risk factors for kidney transplantation failure after cDCD with systematic use of NRP and some of them seem as modifiable variables associated with cDCD transplant outcome.
Collapse
Affiliation(s)
- Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, 93212 Saint-Denis-la-Plaine cedex, France
| | - Laurent Martin-Lefèvre
- Organ Donation Service, Service de Médecine Intensive Réanimation, La Roche-Sur-Yon, France
| | - Jacques Dantal
- Nephrology and Transplantation Department, Centre Hospitalier Universitaire, Nantes, France
| | - Didier Dorez
- Organ Donation Service, Centre Hospitalier Annecy-genevois, Epagny Metz-Tessy, France
| | - François Gaudez
- Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Drouin
- Kidney Transplantation, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Riou
- Sorbonne Université, UMR 1166, IHU ICAN, Organs and Tissues Harvesting Unit, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Antoine Thierry
- Department of Nephrology, University of Poitiers, Poitiers, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, 93212 Saint-Denis-la-Plaine cedex, France
| | - Régis Bronchard
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, 93212 Saint-Denis-la-Plaine cedex, France
| | - François Kerbaul
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, 93212 Saint-Denis-la-Plaine cedex, France
| | - Corinne Antoine
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, 93212 Saint-Denis-la-Plaine cedex, France
| |
Collapse
|
2
|
Renaudier M, Binois Y, Dumas F, Lamhaut L, Beganton F, Jost D, Charpentier J, Lesieur O, Marijon E, Jouven X, Cariou A, Bougouin W. Controlled donation after circulatory death in post-cardiac arrest patients: Estimates from a large registry. Resuscitation 2024; 199:110202. [PMID: 38582445 DOI: 10.1016/j.resuscitation.2024.110202] [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: 01/18/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Controlled donation after circulatory death (cDCD) in post-anoxic brain injury is a valuable source of organs that is still underused in some countries. We assessed the number of potential cDCD donors after out-of-hospital cardiac arrest (OHCA) in Paris and its suburbs and extrapolated the results to the French population. METHODS Using the large regional registry of the Great Paris area, we prospectively included all consecutive adults with OHCA with a stable return of spontaneous circulation (ROSC) who ultimately died in the intensive care unit (ICU) after withdrawal of life-sustaining treatments (WLST) due to post anoxic brain injury. The primary endpoint was potential for organ donation by cDCD in this population. The number of potential cDCD donors was calculated and extrapolated to the entire French population. RESULTS Between 2011 and 2018, 4638 patients with stable ROSC were admitted to ICUs after OHCA, and 3170 died in ICU, of which 1034 died after WLST due to post-anoxic brain injury. When considering French criteria, 421/1034 patients (41%) would have been potential cDCD donors (55 patients per year in a 4.67 million population). After standardization for age and sex, the potential for cDCD was 515 (95% CI 471-560) patients per year in France corresponding to an annual incidence of 1.18 per 100 000 inhabitants per year. CONCLUSIONS Organ donation by cDCD after cardiac arrest could provide a large pool of donors in France.
Collapse
Affiliation(s)
- Marie Renaudier
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Intensive Care Unit, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France.
| | - Yannick Binois
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France
| | - Florence Dumas
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Emergency Department, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France; Université Paris Cité, Paris, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Intensive Care Unit and SAMU 75, Necker Enfants-Malades Hospital, Paris, France
| | - Frankie Beganton
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Brigade des Sapeurs-Pompiers de Paris (BSPP), Paris, France
| | - Julien Charpentier
- Donor Coordinator Unit, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France; Intensive Care Unit, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France
| | - Olivier Lesieur
- Université Paris Cité, Paris, France; Intensive Care Unit, Saint Louis General Hospital, La Rochelle, France
| | - Eloi Marijon
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Cardiology Department, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Cardiology Department, European Georges Pompidou Hospital, AP-HP, Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Université Paris Cité, Paris, France; Intensive Care Unit, Cochin-Hotel-Dieu Hospital, AP-HP, Paris, France
| | - Wulfran Bougouin
- Paris Cardiovascular Research Centre (PARCC), INSERM Unit 970, Paris, France; Paris Sudden Death Expertise Centre, Paris, France; Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, France
| |
Collapse
|
3
|
Mohkam K, Nasralla D, Mergental H, Muller X, Butler A, Jassem W, Imber C, Monbaliu D, Perera MTPR, Laing RW, García‐Valdecasas JC, Paul A, Dondero F, Cauchy F, Savier E, Scatton O, Robin F, Sulpice L, Bucur P, Salamé E, Pittau G, Allard M, Pradat P, Rossignol G, Mabrut J, Ploeg RJ, Friend PJ, Mirza DF, Lesurtel M. In situ normothermic regional perfusion versus ex situ normothermic machine perfusion in liver transplantation from donation after circulatory death. Liver Transpl 2022; 28:1716-1725. [PMID: 35662403 PMCID: PMC9796010 DOI: 10.1002/lt.26522] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/14/2022] [Accepted: 03/19/2022] [Indexed: 12/30/2022]
Abstract
In situ normothermic regional perfusion (NRP) and ex situ normothermic machine perfusion (NMP) aim to improve the outcomes of liver transplantation (LT) using controlled donation after circulatory death (cDCD). NRP and NMP have not yet been compared directly. In this international observational study, outcomes of LT performed between 2015 and 2019 for organs procured from cDCD donors subjected to NRP or NMP commenced at the donor center were compared using propensity score matching (PSM). Of the 224 cDCD donations in the NRP cohort that proceeded to asystole, 193 livers were procured, resulting in 157 transplants. In the NMP cohort, perfusion was commenced in all 40 cases and resulted in 34 transplants (use rates: 70% vs. 85% [p = 0.052], respectively). After PSM, 34 NMP liver recipients were matched with 68 NRP liver recipients. The two cohorts were similar for donor functional warm ischemia time (21 min after NRP vs. 20 min after NMP; p = 0.17), UK-Donation After Circulatory Death risk score (5 vs. 5 points; p = 0.38), and laboratory Model for End-Stage Liver Disease scores (12 vs. 12 points; p = 0.83). The incidence of nonanastomotic biliary strictures (1.5% vs. 2.9%; p > 0.99), early allograft dysfunction (20.6% vs. 8.8%; p = 0.13), and 30-day graft loss (4.4% vs. 8.8%; p = 0.40) were similar, although peak posttransplant aspartate aminotransferase levels were higher in the NRP cohort (872 vs. 344 IU/L; p < 0.001). NRP livers were more frequently allocated to recipients suffering from hepatocellular carcinoma (HCC; 60.3% vs. 20.6%; p < 0.001). HCC-censored 2-year graft and patient survival rates were 91.5% versus 88.2% (p = 0.52) and 97.9% versus 94.1% (p = 0.25) after NRP and NMP, respectively. Both perfusion techniques achieved similar outcomes and appeared to match benchmarks expected for donation after brain death livers. This study may inform the design of a definitive trial.
Collapse
Affiliation(s)
- Kayvan Mohkam
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - David Nasralla
- Department of Hepatopancreatobiliary and Liver Transplant SurgeryRoyal Free HospitalLondonUK
| | - Hynek Mergental
- Liver Unit, Queen Elizabeth HospitalUniversity Hospitals BirminghamBirminghamUK
| | - Xavier Muller
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - Andrew Butler
- Department of Surgery, Addenbrooke's HospitalUniversity of CambridgeCambridgeUK
| | - Wayel Jassem
- Institute of Liver StudiesKing's College HospitalLondonUK
| | - Charles Imber
- Department of Hepatopancreatobiliary and Liver Transplant SurgeryRoyal Free HospitalLondonUK
| | - Diethard Monbaliu
- Abdominal Transplant Surgery Unit, Department of SurgeryUniversity Hospitals LeuvenLeuvenBelgium
| | | | - Richard W. Laing
- Liver Unit, Queen Elizabeth HospitalUniversity Hospitals BirminghamBirminghamUK
| | | | - Andreas Paul
- Department of General, Visceral and Transplantation SurgeryUniversity Hospital EssenEssenGermany
| | - Federica Dondero
- Department of Hepatobiliopancreatic SurgeryDepartment of Hepatopancreatobiliary Surgery and Liver TransplantationBeaujon Hospital, Assitance Publique‐Hôpitaux de Paris (AP‐HP), University Paris CitéClichyFrance
| | - François Cauchy
- Department of Hepatobiliopancreatic SurgeryDepartment of Hepatopancreatobiliary Surgery and Liver TransplantationBeaujon Hospital, Assitance Publique‐Hôpitaux de Paris (AP‐HP), University Paris CitéClichyFrance
| | - Eric Savier
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié‐Salpêtrière HospitalSorbonne UniversityParisFrance
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, Pitié‐Salpêtrière HospitalSorbonne UniversityParisFrance
| | - Fabien Robin
- Department of Hepatobiliary and Digestive SurgeryPontchaillou University HospitalRennesFrance
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive SurgeryPontchaillou University HospitalRennesFrance
| | - Petru Bucur
- Department of Digestive, Oncological, Endocrine, Hepato‐Biliary, Pancreatic and Liver Transplant SurgeryTrousseau HospitalToursFrance
| | - Ephrem Salamé
- Department of Digestive, Oncological, Endocrine, Hepato‐Biliary, Pancreatic and Liver Transplant SurgeryTrousseau HospitalToursFrance
| | - Gabriella Pittau
- Centre Hépato‐Biliaire, Hôpital Paul Brousse, Assistance Publique‐Hôpitaux de Paris (AP‐HP)Université Paris SudVillejuifFrance
| | - Marc‐Antoine Allard
- Centre Hépato‐Biliaire, Hôpital Paul Brousse, Assistance Publique‐Hôpitaux de Paris (AP‐HP)Université Paris SudVillejuifFrance
| | - Pierre Pradat
- Clinical Research Centre, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - Guillaume Rossignol
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - Jean‐Yves Mabrut
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | - Rutger J. Ploeg
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Peter J. Friend
- Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Darius F. Mirza
- Liver Unit, Queen Elizabeth HospitalUniversity Hospitals BirminghamBirminghamUK
| | - Mickaël Lesurtel
- Department of Digestive Surgery & Liver Transplantation, Croix‐Rousse Hospital, Hospices Civils de LyonClaude Bernard Lyon 1 UniversityLyonFrance
| | | |
Collapse
|
4
|
Horn MA, Dahlberg J. When is a person dead? TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2022; 142:22-0193. [PMID: 35510466 DOI: 10.4045/tidsskr.22.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
5
|
Le Dorze M, Martin-Lefèvre L, Santin G, Robert R, Audibert G, Megarbane B, Puybasset L, Dorez D, Veber B, Kerbaul F, Antoine C. Critical pathways for controlled donation after circulatory death in France. Anaesth Crit Care Pain Med 2022; 41:101029. [PMID: 35121185 DOI: 10.1016/j.accpm.2022.101029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/22/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In 2015, France authorised controlled donation after circulatory death (cDCD) according to a nationally approved protocol. The aim of this study is to provide an overview from the perspective of critical care specialists of cDCD. The primary objective is to assess how the organ donation procedure affects the withdrawal of life-sustaining therapies (WLST) process. The secondary objective is to assess the impact of cDCD donors' diagnoses on the whole process. MATERIAL AND METHODS This 2015-2019 prospective observational multicentre study evaluated the WLST process in all potential cDCD donors identified nationwide, comparing 2 different sets of subgroups: 1- those whose WLST began after organ donation was ruled out vs. while it was still under consideration; 2- those with a main diagnosis of post-anoxic brain injury (PABI) vs. primary brain injury (PBI) at the time of the WLST decision. RESULTS The study analysed 908 potential cDCD donors. Organ donation remained under consideration at WLST initiation for 54.5% of them with longer intervals between their WLST decision and its initiation (2 [1-4] vs. 1 [1-2] days, P < 0.01). Overall, 60% had post-anoxic brain injury. Time from ICU admission to WLST decision was longer for primary brain injury donors (10 [4-21] vs. 6 [4-9] days, P < 0.01). Median time to death (agonal phase) was 15 [15-20] minutes. CONCLUSIONS French cDCD donors are mostly related to post-anoxic brain injury. The organ donation process does not accelerate WLST decision but increases the interval between the WLST decision and its initiation.
Collapse
Affiliation(s)
- Matthieu Le Dorze
- Université de Paris, INSERM, U942 MASCOT, F-75006, paris, france, Department of Anaesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.
| | - Laurent Martin-Lefèvre
- Organ Donation Service, Service de Médecine Intensive Réanimation, boulevard Stéphane Moreau, 85000 La Roche-sur-Yon, France
| | - Gaëlle Santin
- Agence de la biomédecine, Medical and Scientific Department, 1, avenue du stade de France, 93212 Saint-Denis, France
| | - René Robert
- University of Poitiers, CHU de Poitiers, Service de Médecine Intensive Réanimation, CIC Inserm 1402, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Gérard Audibert
- University of Lorraine, Department of Anaesthesiology and Critical Care Medicine, Nancy University Hospital, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Bruno Megarbane
- University of Paris, INSERM UMRS-1144, Department of Medical and Toxicological Critical Care, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Louis Puybasset
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Didier Dorez
- Organ Donation Service, Centre Hospitalier Annecy-genevois, 1, avenue de l'Hôpital, 74370 Epagny Metz-Tessy, France
| | - Benoît Veber
- SFAR Ethics Committee, Surgical Intensive Care Unit, Rouen University Hospital, 37, boulevard Gambetta, 76000 Rouen, France
| | - François Kerbaul
- Agence de la biomédecine, Medical and Scientific Department, 1, avenue du stade de France, 93212 Saint-Denis, France
| | - Corinne Antoine
- Agence de la biomédecine, Medical and Scientific Department, 1, avenue du stade de France, 93212 Saint-Denis, France
| |
Collapse
|
6
|
Divard G, Goutaudier V. Global Perspective on Kidney Transplantation: France. KIDNEY360 2021; 2:1637-1640. [PMID: 35372987 PMCID: PMC8785777 DOI: 10.34067/kid.0002402021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/05/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Gillian Divard
- Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris Cardiovascular Research Center (PARCC), Paris Translational Research Centre for Organ Transplantation, Paris, France
| | | |
Collapse
|
7
|
Ex vivo perfusion of the donor heart: Preliminary experience in high-risk transplantations. Arch Cardiovasc Dis 2021; 114:715-726. [PMID: 34620574 DOI: 10.1016/j.acvd.2021.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The number of heart transplantations (HTs) has decreased in France since 2017 (-5%/year) despite a stable rate of patients referred on the waiting list. Ex vivo heart perfusion (EVHP) is an innovative approach for organ preservation, reducing graft ischaemic time and facilitating continuous organ monitoring before transplantation. AIM To report our preliminary experience of seven donor hearts preserved with EVHP, including the first heart resuscitated after circulatory-determined death in France. METHODS Seven hearts were procured from donation after brain death (DBD) for HT or donation after circulatory-determined death (DCD) for research purposes (Protocol PFS20-004, Agence de la Biomédecine, La Plaine Saint-Denis, France). All grafts were preserved using the Organ Care System® (TransMedics Inc., Andover, MA, USA) for normothermic EVHP. Perfusion parameters were adjusted to achieve stable or decreasing arterial lactate trend consistent with suitability for organ transplantation. RESULTS Indications for EVHP were assessment of a marginal graft in four cases, prolonged preservation in two cases (anticipated duration for retrieval of recipient's heart>3hours) and resuscitation after circulatory-determined death in one case. Median duration of EVHP was 270 (interquartile range 216-343) minutes. five were transplanted, with a median ex situ preservation time (ischaemic time+EVHP time) of 334 (interquartile range 326-444) minutes. The two other grafts were discarded for HT. Three recipients had extracorporeal life support after HT, and presented complete cardiac recovery within a week after HT. One patient died at day 11 because of septic shock. The 3-month survival rate was 75% among recipients. Three months after HT, the left ventricular ejection fraction was>60% in all cases. CONCLUSIONS EVHP enabled safe prolonged preservation and assessment of marginal grafts. This approach provides an opportunity to expand the donor pool by resuscitating grafts from donors with extended criteria, including controlled DCD.
Collapse
|
8
|
Savoye E, Legeai C, Branchereau J, Gay S, Riou B, Gaudez F, Veber B, Bruyere F, Cheisson G, Kerforne T, Badet L, Bastien O, Antoine C. Optimal donation of kidney transplants after controlled circulatory death. Am J Transplant 2021; 21:2424-2436. [PMID: 36576341 DOI: 10.1111/ajt.16425] [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] [Received: 07/07/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 01/25/2023]
Abstract
Controlled donation after circulatory death (cDCD) is used for "extended criteria" donors with poorer kidney transplant outcomes. The French cDCD program started in 2015 and is characterized by normothermic regional perfusion, hypothermic machine perfusion, and short cold ischemia time. We compared the outcomes of kidney transplantation from cDCD and brain-dead (DBD) donors, matching cDCD and DBD kidney transplants by propensity scoring for donor and recipient characteristics. The matching process retained 442 of 499 cDCD and 809 of 6185 DBD transplantations. The DGF rate was 20% in cDCD recipients compared with 28% in DBD recipients (adjusted relative risk [aRR], 1.43; 95% confidence interval [CI] 1.12-1.82). When DBD transplants were ranked by cold ischemia time and machine perfusion use and compared with cDCD transplants, the aRR of DGF was higher for DBD transplants without machine perfusion, regardless of the cold ischemia time (aRR with cold ischemia time <18 h, 1.57; 95% CI 1.20-2.03, vs aRR with cold ischemia time ≥18 h, 1.79; 95% CI 1.31-2.44). The 1-year graft survival rate was similar in both groups. Early outcome was better for kidney transplants from cDCD than from matched DBD transplants with this French protocol.
Collapse
Affiliation(s)
- Emilie Savoye
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Camille Legeai
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Julien Branchereau
- Department of Urology, Nantes University Hospital, University of Nantes, Nantes, France
| | - Samuel Gay
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France
| | - Bruno Riou
- Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Francois Gaudez
- Department of Urology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benoit Veber
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | | | - Gaelle Cheisson
- Department of Surgical Anesthesia and Intensive Care, South Paris University hospital, Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Thomas Kerforne
- Anesthesia and Intensive Care Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lionel Badet
- Groupement Hospitalier Edouard Herriot, Service d'urologie chirurgie de la Transplantation, Lyon, France
| | - Olivier Bastien
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | - Corinne Antoine
- Agence de la biomédecine, Direction Prélèvement Greffe Organes-Tissus, Saint-Denis La Plaine, France
| | | |
Collapse
|
9
|
Ehrsam JP, Benden C, Immer FF, Inci I. Current status and further potential of lung donation after circulatory death. Clin Transplant 2021; 35:e14335. [PMID: 33948997 DOI: 10.1111/ctr.14335] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 12/13/2022]
Abstract
Chronic organ shortage remains the most limiting factor in lung transplantation. To overcome this shortage, a minority of centers have started with efforts to reintroduce donation after circulatory death (DCD). This review aims to evaluate the experimental background, the current international clinical experience, and the further potential and challenges of the different DCD categories. Successful strategies have been implemented to reduce the problems of warm ischemic time, thrombosis after circulatory arrest, and difficulties in organ assessment, which come with DCD donation. From the currently reported results, controlled-DCD lungs are an effective and safe method with good mid-term and even long-term survival outcomes comparable to donation after brain death (DBD). Primary graft dysfunction and onset of chronic allograft dysfunction seem also comparable. Thus, controlled-DCD lungs should be ceased to be treated as marginal and instead be promoted as an equivalent alternative to DBD. A wide implementation of controlled-DCD-lung donation would significantly decrease the mortality on the waiting list. Therefore, further efforts in establishment of legislation and logistics are crucial. With regard to uncontrolled DCD, more data are needed analyzing long-term outcomes. To help with the detailed assessment and improvement of uncontrolled or otherwise questionable grafts after retrieval, ex-vivo lung perfusion is promising.
Collapse
Affiliation(s)
- Jonas P Ehrsam
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.,Department of Thoracic Surgery, Cantonal Hospital Aarau, Zurich, Switzerland
| | | | | | - Ilhan Inci
- Department of Thoracic Surgery, Cantonal Hospital Aarau, Zurich, Switzerland.,University of Zurich Faculty of Medicine, Zurich, Switzerland
| |
Collapse
|
10
|
Antoine C, Jasseron C, Dondero F, Savier E. Liver Transplantation From Controlled Donors After Circulatory Death Using Normothermic Regional Perfusion: An Initial French Experience. Liver Transpl 2020; 26:1516-1521. [PMID: 32531132 DOI: 10.1002/lt.25818] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/30/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023]
Abstract
A national program of controlled donation after circulatory death (cDCD) began in France in 2014 involving the use of a standardized national protocol that involves the systematic use of normothermic regional perfusion (NRP). In this article, we describe in detail the French cDCD program. Between January 1, 2015, and December 31, 2018, 225 livers were offered for donation, resulting in 123 cDCD liver transplantations (LTs). The overall 90-day graft survival rate was 93.1% (95% confidence interval [CI], 85.9%-96.6%). A total of 21 of 123 LTs (17%) did not adhere strictly to the national protocol. The 1-year graft survival was significantly lower in the group deviating from the national protocol compared with those patients following the national protocol: 68.4% (95% CI, 42.8%-84.4%) versus 94.8% (95% CI, 86.5%-98.0%; P < 0.01). There were 14 patients who died, including 2 after primary 2 after primary non function, and 10 related to liver cancer recurrence. Only 1 case of ischemic cholangiopathy was observed at month 18 in this series, and the patient underwent a successful retransplant. During the first 4 years, excellent LT results were observed where the national protocol was followed. Systematic use of NRP limits liver damage induced by warm ischemia and provides excellent cDCD organs for transplant.
Collapse
Affiliation(s)
- Corinne Antoine
- Direction Générale Médicale et Scientifique, Agence de la Biomédecine, Saint Denis, France
| | - Carine Jasseron
- Direction Générale Médicale et Scientifique, Agence de la Biomédecine, Saint Denis, France
| | - Federica Dondero
- Department of Hepatobiliopancreatic Surgery, Beaujon Hospital, Clichy, France
| | - Eric Savier
- Service de Chirurgie Digestive, Hépato-Bilio-Pancréatique et Transplantation Hépatique, Centre Hospitalier Universitaire Pitié-Salpetriere, Paris, France
| | | |
Collapse
|
11
|
Kidney Transplant From Uncontrolled Donation After Circulatory Death: Contribution of Normothermic Regional Perfusion. Transplantation 2020; 104:130-136. [PMID: 30985577 DOI: 10.1097/tp.0000000000002753] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The French uncontrolled donors after circulatory death (DCD) protocol restricts donor age to <55 years, no-flow time to <30 minutes, and functional warm ischemia time to <150 minutes. In situ kidney perfusion can be performed at either 4°C (in situ cooling [ISC]) or 33-36°C (normothermic regional perfusion [NRP]). Hypothermic machine perfusion is systematically used. Only nonimmunized first transplant recipients were eligible. To improve the management of uncontrolled DCD, we tried to identify factors predictive of outcome. METHODS We identified all kidney transplants from uncontrolled DCD between 2007 and 2014 from the French Transplant Registry. Risk factors for primary nonfunction (PNF; n = 37) and poor renal function (estimated glomerular filtration rate < 30 mL/min or graft loss at 1 y, n = 66) were analyzed by using a multivariate logistic model. RESULTS This study analyzed 499 kidney transplantations, 50% of which were performed with NRP. Mean functional warm ischemia time was 135 minutes. Mean cold ischemia time was 14 hours. The principal PNF risk factor was young donor age (odds ratio [OR] = 0.95; P = 0.002). A sensitivity analysis showed a higher risk of PNF with ISC than with NRP (OR = 4.5; P = 0.015). Risk factors for poor renal function were donor body mass index (OR = 1.2; P < 0.001) and ISC versus NRP. Univariate analysis of uncontrolled DCD-specific risk factors showed no-flow time, functional warm time, and cold ischemia time did not affect the risk of PNF or poor renal function. CONCLUSIONS Uncontrolled DCD kidneys are an additional source of valuable transplants. NRP appears to decrease graft failure by restoring oxygenated blood as the first step of preconditioning.
Collapse
|
12
|
Chen L, Shi B. Reply to Sharif et al. Transpl Int 2020; 33:821-823. [PMID: 32342536 DOI: 10.1111/tri.13631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Liping Chen
- Kidney Transplant Quality Control Center of National Health Commission, The 8th Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Bingyi Shi
- Kidney Transplant Quality Control Center of National Health Commission, The 8th Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| |
Collapse
|
13
|
Kidney transplantation following uncontrolled donation after circulatory death. Curr Opin Organ Transplant 2020; 25:144-150. [DOI: 10.1097/mot.0000000000000742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
14
|
Cho WH. Organ donation in Korea in 2018 and an introduction of the Korea national organ donation system. KOREAN JOURNAL OF TRANSPLANTATION 2019; 33:83-97. [PMID: 35769975 PMCID: PMC9188944 DOI: 10.4285/jkstn.2019.33.4.83] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 11/10/2022] Open
Abstract
A total of 1,503 solid organs were procured from 449 deceased donors in 2018. Although the number of donors was down by 12.8% from the previous year (8.7 per million population), the number of organs procured per donor increased from 3.29 in 2017 to 3.35 in 2018. While the causes of brain death by cerebrovascular diseases and head trauma from traffic accidents have declined, brain damage from hypoxia has increased slightly. The most prominent change in the decline of organ donations was a decrease in family consent (36.5% in 2018 vs. 42.9% in 2017). The disagreement over organ donations by other family members even extended beyond the next of kin, and the restriction of organ donations in connection with the suspension of end-of-life care partly affected the consent rate, making this a controversial social issue. An accurate analysis regarding the factors causing the decline of familial consent rates is required, and related organizations along with the government should make a unified concerted effort to resolve this issue. To help achieve this goal, this manuscript describes the transplantation process and briefly explains the Korean domestic organ donation system.
Collapse
|
15
|
Ghimessy ÁK, Farkas A, Gieszer B, Radeczky P, Csende K, Mészáros L, Török K, Fazekas L, Agócs L, Kocsis Á, Bartók T, Dancs T, Tóth KK, Schönauer N, Madurka I, Elek J, Döme B, Rényi-Vámos F, Lang G, Taghavi S, Hötzenecker K, Klepetko W, Bogyó L. Donation After Cardiac Death, a Possibility to Expand the Donor Pool: Review and the Hungarian Experience. Transplant Proc 2019; 51:1276-1280. [DOI: 10.1016/j.transproceed.2019.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
16
|
Critical Appraisal of International Clinical Practice Guidelines in Kidney Transplantation Using the Appraisal of Guidelines for Research and Education II Tool: A Systematic Review. Transplantation 2019; 102:1419-1439. [PMID: 30124634 DOI: 10.1097/tp.0000000000002255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although clinical practice guidelines (CPGs) are used for the development of local protocols in kidney transplantation (Ktx), the quality of their methodology is variable. This systematic review aimed to critically appraise international CPGs in all aspects of Ktx using the Appraisal of Guidelines for Research and Evaluation II tool. METHODS Clinical Practice Guidelines in Ktx and donation published between 2010 and 2017 were identified from MEDLINE, Embase, National Guideline Clearinghouse, National Health Service and National Institute for Health and Care Excellence Evidence Searches, and the websites of transplant societies. Using Appraisal of Guidelines for Research and Evaluation II, 3 appraisers assessed the quality of CPGs. Interrater reliability was measured using the intraclass correlation coefficient (ICC). RESULTS Searches identified 3168 records, and 115 CPGs were included. The highest scoring Appraisal of Guidelines for Research and Evaluation II domain was "scope and purpose" (80%; range, 30%-100%), followed by "clarity of presentation" (77%; range, 43%-98%), "editorial independence" (52%; range, 0%-94%), "rigor of development" (47%; range 6%-97%) and "stakeholder involvement" (41%; range, 11%-85%). The poorest scoring domain was "applicability" (31%; range, 3%-74%). Most CPGs were recommended for future use either with (63%) or without (18%) modifications. A small number (14%) were not recommended for future use or reviewers (5%) did not agree on recommending the CPG. The overall mean CPG quality score was 4 of 7 (range, 2-7). The mean ICC of 0.74 indicated substantial agreement between reviewers. CONCLUSIONS The quality of international CPGs in Ktx was variable, and most CPGs lacked key aspects of methodological robustness and transparency. Improvements in methodology, patient involvement, and strategies for implementation are required.
Collapse
|
17
|
Gay S, Levrat A, Dorez D. Controlled donation after circulatory death in France: first results of a nonuniversity pilot centre. Transpl Int 2018; 31:1178-1180. [PMID: 29931694 DOI: 10.1111/tri.13309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Samuel Gay
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France
| | - Albrice Levrat
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France
| | - Didier Dorez
- Intensive Care Unit, Centre Hospitalier Annecy-genevois, Annecy, France.,Organ Donation Team, Centre Hospitalier Annecy-genevois, Annecy, France
| |
Collapse
|
18
|
Lesieur O, Genteuil L, Leloup M. A few realistic questions raised by organ retrieval in the intensive care unit. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:S44. [PMID: 29302600 DOI: 10.21037/atm.2017.05.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Organ transplantation saves the lives of many persons who would otherwise die from end-stage organ disease. The increasing demand for donated organs has led to a renewed interest in donation after circulatory determination of death (CDD). In many countries (including France), terminally ill patients who die of circulatory arrest after a planned withdrawal of life support may be considered as organ donors under certain conditions. While having equal responsibility towards the potential donor and the persons awaiting a transplant, caregivers may experience an ethical dilemma between the responsibility to deliver the best care to the dying, and the need to retrieve the organs. Once it has been established that the patient wishes to be a donor, we assume that end-of-life care and organ donation may have convergent goals when they contribute to transforming a comfortable death into a chance of life for others in need.
Collapse
Affiliation(s)
- Olivier Lesieur
- Intensive Care Unit, Saint Louis Hospital, La Rochelle, France
| | - Liliane Genteuil
- Organ Procurement Organization, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Maxime Leloup
- Intensive Care Unit, Saint Louis Hospital, La Rochelle, France
| |
Collapse
|
19
|
Murphy P, Boffa C, Manara A, Ysebaert D, de Jongh W. In-hospital logistics: what are the key aspects for succeeding in each of the steps of the process of controlled donation after circulatory death? Transpl Int 2017; 29:760-70. [PMID: 26497951 DOI: 10.1111/tri.12708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/19/2015] [Accepted: 10/19/2015] [Indexed: 02/04/2023]
Abstract
Donation after circulatory death (DCD) donors are becoming an increasingly important population of organ donors in Europe and worldwide. We report the state of the art regarding controlled DCD donation describing the organizational and technical aspects of establishing a controlled DCD programme and provide recommendations regarding the introduction and development of this type of programme.
Collapse
Affiliation(s)
- Paul Murphy
- National Clinical Lead for Organ Donation, NHS Blood and Transplant, Bristol, UK
| | - Catherine Boffa
- Oxford Transplant Centre, Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Alex Manara
- Consultant in Anaesthesia and Critical Care, Frenchay Hospital, North Bristol NHS Trust, Bristol, UK
| | - Dirk Ysebaert
- Professor of Surgery, University Hospital, Antwerp, Belgium
| | - Wim de Jongh
- Transplant Coordinator, Maastricht, The Netherlands
| |
Collapse
|
20
|
|
21
|
[Ethical concerns around donors after cessation of active treatment]. SOINS; LA REVUE DE RÉFÉRENCE INFIRMIÈRE 2016; 61:36-9. [PMID: 27596498 DOI: 10.1016/j.soin.2016.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The cessation of treatment in intensive care leads to death through circulatory arrest. In these circumstances there is an opportunity to remove organs, if that was the wish of the patient. This raises legitimate ethical questions. A French national protocol defines the conditions of this donation and ensures a harmonisation of practices as well as an overall improvement in end-of-life support in intensive care. These donors represent an opportunity to increase the number of organs available for transplant.
Collapse
|
22
|
Ex vivo lung graft perfusion. Anaesth Crit Care Pain Med 2016; 35:123-31. [DOI: 10.1016/j.accpm.2015.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/25/2015] [Indexed: 01/08/2023]
|
23
|
Portolés Pérez J, Lafuente O, Sánchez-Sobrino B, Pérez Sáez M, Fernández García A, Llamas F, López-Sánchez P, Rodriguez-Ferrero M, Zarraga S, Ramos A, Pascual J. Kidney Transplantation With Organs From Donors After Circulatory Death Type 3: A Prospective Multicentric Spanish Study (GEODAS 3). Transplant Proc 2015; 47:27-9. [DOI: 10.1016/j.transproceed.2014.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Lemoine L, Neron L, Hamidi A, Leon A, Graftieaux JP. [Organ procurement under Maastricht 3 condition: the unknowable sets the limits in ethics]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2014; 33:704-705. [PMID: 25458449 DOI: 10.1016/j.annfar.2014.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- L Lemoine
- Département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - L Neron
- Département d'anesthésie-réanimation, CHU de Reims, 51092 Reims cedex, France
| | - A Hamidi
- Département d'anesthésie-réanimation, CHU de Reims, 51092 Reims cedex, France
| | - A Leon
- Département d'anesthésie-réanimation, CHU de Reims, 51092 Reims cedex, France
| | - J-P Graftieaux
- Département d'anesthésie-réanimation, CHU de Reims, 51092 Reims cedex, France.
| |
Collapse
|
25
|
Brocas E, Rolando S, Bronchard R, Fender F, Guérineau C, Bruyère M. [Eligibility to a Maastricht III - type organ donation according to the protocol proposed by the French organ procurement organization (Agence de la biomedicine) among patients in a medico surgical intensive care unit]. ACTA ACUST UNITED AC 2014; 33:631-7. [PMID: 25464912 DOI: 10.1016/j.annfar.2014.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 10/20/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Because of graft shortages, an experimental programme of organ donation after Maastricht 3-type circulatory death (M3) has been proposed by the French organ procurement organization (Agence de la biomedicine: ABM). The aim of the study was to estimate how many potential patients were eligible for an M3-type organ donation, amongst deceased patients who have had life-support withdrawn. PATIENTS AND METHODS We conducted a retrospective study looking at the notes of deceased patients in a French general intensive care unit (ICU), where organ donation is arranged in DBD donors. RESULTS Over the year 2013, 1475 patients were admitted in ICU and 215 died. One hundred and one patients were brain-injured and 26 of them died following a decision to withdrawn life-support and without contraindication to organ donation. Among them, 2 patients (8%) met the criteria for the French M3-type organ donation protocol. A 12.5% increase in organ donation activity of our team and five organ transplantations could have been considered. CONCLUSION If M3 organ donation is considered, a significant increase in transplantation would be expected.
Collapse
Affiliation(s)
- E Brocas
- Coordination des dons d'organes et de tissus, centre hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France.
| | - S Rolando
- Coordination des dons d'organes et de tissus, centre hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - R Bronchard
- Service de régulation et d'appui Île-de-France, agence de la biomédecine, centre Antilles-Guyane, 1-3, rue Eugène-Varlin, 92240 Malakoff, France
| | - F Fender
- Coordination des dons d'organes et de tissus, centre hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - C Guérineau
- Coordination des dons d'organes et de tissus, centre hospitalier Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - M Bruyère
- Departments of Anaesthesia and Critical Care, Edinburgh Royal Infirmary, Edinburgh EH16 4SA, Royaume-Uni
| |
Collapse
|
26
|
Lesieur O, Leloup M, Gonzalez F, Mamzer MF. Eligibility for organ donation following end-of-life decisions: a study performed in 43 French intensive care units. Intensive Care Med 2014; 40:1323-31. [DOI: 10.1007/s00134-014-3409-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/15/2014] [Indexed: 01/15/2023]
|
27
|
Puybasset L, Stevens RD. 35th Congress of the French association of neuro-anesthesiology and critical care. ACTA ACUST UNITED AC 2014; 33:63-4. [PMID: 24440735 DOI: 10.1016/j.annfar.2013.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- L Puybasset
- Neuro-réanimation chirurgicale Babinski, département d'anesthésie-réanimation, groupe hospitalier Pitié-Salpêtrière, université Pierre-et-Marie-Curie, Paris 6, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - R D Stevens
- Johns Hopkins university school of medicine, division of neuroscience critical care, Meyer 8-140, 600N Wolfe St, MD 21287 Baltimore, United States
| |
Collapse
|