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Gallegos EM, Reed T, Deville P, Platt B, Leonardi C, Bellfi L, Dufrene J, Chaudhary S, Hunt J, Stuke L, Greiffenstein P, Schoen J, Marr A, Paramesh A, Smith AA. Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant. World J Transplant 2024; 14:89825. [PMID: 38947973 PMCID: PMC11212584 DOI: 10.5500/wjt.v14.i2.89825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/16/2024] [Accepted: 04/16/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND With an ongoing demand for transplantable organs, optimization of donor management protocols, specifically in trauma populations, is important for obtaining a high yield of viable organs per patient. Endocrine management of brain-dead potential organ donors (BPODs) is controversial, leading to heterogeneous clinical management approaches. Previous studies have shown that when levothyroxine was combined with other treatments, including steroids, vasopressin, and insulin, BPODs had better organ recovery and survival outcomes were increased for transplant recipients. AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients. METHODS A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed. Exclusion criteria included patients who were not solid organ donors, patients who were not declared brain dead (donation after circulatory death), and patients who did not receive steroids in their hospital course. Levothyroxine and steroid administration, the number of organs donated, the types of organs donated, and demographic information were recorded. Univariate analyses were performed with P < 0.05 considered to be statistically significant. RESULTS A total of 88 patients met inclusion criteria, 69 (78%) of whom received levothyroxine and steroids (ST/LT group) vs 19 (22%) receiving steroids without levothyroxine (ST group). No differences were observed between the groups for gender, race, pertinent injury factors, age, or other hormone therapies used (P > 0.05). In the ST/LT group, 68.1% (n = 47) donated a high yield (3-5) of organ types per donor compared to 42.1% (n = 8) in the ST group (P = 0.038). There was no difference in the total number of organ types donated between the groups (P = 0.068). CONCLUSION This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population. Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria. This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.
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Affiliation(s)
- Eden M Gallegos
- Department of Physiology, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70124, United States
| | - Tanner Reed
- Department of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Paige Deville
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Blake Platt
- Department of Trauma Surgery, Tacoma General Hospital, Tacoma 98405, United States
| | - Claudia Leonardi
- Department of Public Health, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Lillian Bellfi
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Jessica Dufrene
- Department of Donation Services, Louisiana Organ Procurement Agency, Covington, LA 70433, United States
| | - Saad Chaudhary
- Department of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - John Hunt
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Lance Stuke
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Patrick Greiffenstein
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Jonathan Schoen
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Alan Marr
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
| | - Anil Paramesh
- Department of Surgery, Tulane Transplant Institute, Tulane University School of Medicine, New Orleans, LA 70112, United States
| | - Alison A Smith
- Department of Surgery, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA 70112, United States
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Menna Barreto LN, Cabral ÉM, Buffon MR, Mauro JEP, Pruinelli L, de Abreu Almeida M. Nursing Diagnosis for Potential Organ Donors: Accuracy Study. Clin Nurs Res 2021; 31:60-68. [PMID: 34180268 DOI: 10.1177/10547738211019435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective was to analyze the diagnostic accuracy of Impaired physiological balance syndrome in potential brain-dead organ donors. It is a study of diagnostic accuracy. Data was retrospectively collected from 145 medical records through the filling out of an instrument containing 25 indicators of the nursing diagnosis (ND). Descriptive and inferential statistics were used. The prevalence of the ND was 77 (53.1%). The indicator with the best measures of accuracy was altered heart rate. Therefore, it has the best predictive capacity for determining the ND. It was identified that the absence of the indicators altered heart rate, hyperglycemia, and altered blood pressure is associated with the absence of the ND, while the presence of the indicators hyperthermia, hypothermia, and altered heart rhythm is associated with the presence of the ND. Accurate indicators will assist in diagnostic inference and the interventions and results will have greater chances of targeting and effectiveness.
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Paixão JTC, Nascimento VHND, Alves MC, Rodrigues MDFA, Sousa EDJSD, Santos-Lobato BLD. Analysis of brain death declaration process and its impact on organ donation in a reference trauma center. EINSTEIN-SAO PAULO 2020; 18:eAO5448. [PMID: 32965298 PMCID: PMC9586427 DOI: 10.31744/einstein_journal/2020ao5448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/16/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To characterize the processes of brain death diagnosis and organ donation in a reference trauma center. Methods Observational and cross-sectional study with patients notified with brain death at a reference trauma center. Data were obtained through the collection of medical records and brain death declaration forms. Results One hundred fity-nine patients were notified with brain death, mostly male (82.6%), young adults (97.61%) and victims of brain traumatic injury (93.7%). Median of the total time interval for the diagnosis of brain death was 20.75 hours, with no difference between organ donors and non-donors. We had excessive time intervals on brain death declaration, but without statistical effect on organ donation numbers. Conclusion We had low efficacy in brain death declaration based on longer time intervals, with no impact on organ donation.
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Barreto LNM, Cabral ÉM, Chies N, Almeida MDA. Indicadores clínicos para o diagnóstico de enfermagem Síndrome do equilíbrio fisiológico prejudicado para doadores de órgãos. ESCOLA ANNA NERY 2020. [DOI: 10.1590/2177-9465-ean-2019-0341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo Selecionar indicadores clínicos para o diagnóstico de enfermagem em desenvolvimento Síndrome do equilíbrio fisiológico prejudicado para potenciais doadores de órgãos em morte encefálica. Método Estudo de consenso de especialistas, realizado através da técnica Delphi, dos indicadores clínicos de um diagnóstico de enfermagem em desenvolvimento. A amostra do estudo foi intencional mediante convite e constituída por 37 enfermeiros que atenderam a critérios de inclusão. Os indicadores que obtiveram um consenso igual ou maior que 70% foram considerados validados. Resultados Especialistas recomendaram 25 dos 44 indicadores avaliados, dos quais oito pertenciam ao grupo Alterações endócrino-metabólicas, sete ao grupo Alterações hemodinâmicas e/ou cardiovasculares, cinco ao grupo Alterações ventilatórias, dois ao grupo Alterações nutricionais e três ao grupo Alterações de coagulação, inflamatórias e/ou imunológicas. Conclusão e implicações para a prática Esse novo diagnóstico de enfermagem pode colaborar com o desenvolvimento de conhecimento da enfermagem na área de doação de órgãos, contribuindo para o ensino e pesquisa, além de acarretar implicações para a prática, proporcionando acurácia diagnóstica e embasando a implementação e a avaliação de intervenções que impactam na melhora da manutenção do potencial doador.
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Affiliation(s)
| | - Éder Marques Cabral
- Hospital São Camilo, Brasil; Universidade Federal do Rio Grande do Sul, Brasil
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Halawa AA, El-Adl MA, Marghani BH. Postmortem Heat Stress upregulates Thanatotranscriptome of Genes encode Inflammation, Apoptosis and Neuronal Stress in Brain of Rats at Short Postmortem Intervals. AUST J FORENSIC SCI 2019. [DOI: 10.1080/00450618.2019.1682669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Amal A. Halawa
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed A. El-Adl
- Department of Biochemistry, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
| | - Basma H. Marghani
- Department of Physiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt
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Anwar ASMT, Lee JM. Medical Management of Brain-Dead Organ Donors. Acute Crit Care 2019; 34:14-29. [PMID: 31723901 PMCID: PMC6849043 DOI: 10.4266/acc.2019.00430] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 11/30/2022] Open
Abstract
With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, brain-dead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. Some transplant centers follow their own treatment protocols, whereas other countries, such as Bangladesh, do not have any protocols for potential organ donor care. In this review, we discuss how to identify brain-dead donors and describe the physiological changes that occur following brain death. We then summarize the management of brain-dead organ donors and, on the basis of a review of the literature, we propose recommendations for a treatment protocol to be developed in the future.
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Affiliation(s)
- A S M Tanim Anwar
- Department of Nephrology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Jae-Myeong Lee
- Department of Acute Care Surgery, Korea University Anam Hospital, Seoul, Korea
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Victorino JP, Mendes KDS, Westin ÚM, Magro JTJ, Corsi CAC, Ventura CAA. Perspectives toward brain death diagnosis and management of the potential organ donor. Nurs Ethics 2018; 26:1886-1896. [PMID: 30134745 DOI: 10.1177/0969733018791335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Organ donation and transplantation represent one of the most important scientific advances over the last decades. Due to the complexity of these procedures and related ethical-legal aspects, however, there are a lot of doubts and uncertainty about the brain death diagnosis and the maintenance of potential organ donor. AIM To identify and discuss the different meanings and experiences of registered nurses and physicians from an adult intensive care unit in relation to the diagnosis of brain death and the maintenance of potential organ donors for transplantation purposes. STUDY DESIGN Participants were registered nurses and physicians from an adult intensive care unit at a University Hospital from Brazil. Data were collected through semi-structured interviews and analyzed using content analysis. ETHICAL CONSIDERATIONS This study was approved by the University of São Paulo at Ribeirão Preto College of Nursing Research Ethics Committee. RESULTS Two main categories emerged from the analysis: (1) brain death diagnosis and its implications and (2) maintenance of the potential organ donor and its repercussion in the donation-transplantation process. Six subcategories were also identified: (1.1) understanding the brain death diagnosis as a tool to aid decision-making; (1.2) diagnosis as guarantee of rights; (1.3) difficulties encountered to establish the diagnosis; (1.4) clinical criteria adopted in Brazil and related ethical-legal aspects; (2.1) specificities of care to the brain dead person and outcomes; and (2.2) nurse's duties toward the brain dead person. CONCLUSION Although the brain death diagnosis is scientifically and legally defined in Brazil and the maintenance of the potential organ donor for transplantation purposes has been addressed during the last years, there are still some doubts about the subject, as its understanding varies according to the personal beliefs, culture, and educational background of individuals, including those who work in this scenario.
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Pozhitkov AE, Noble PA. Gene expression in the twilight of death: The increase of thousands of transcripts has implications to transplantation, cancer, and forensic research. Bioessays 2017; 39. [PMID: 28787088 DOI: 10.1002/bies.201700066] [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] [Indexed: 11/07/2022]
Abstract
After a vertebrate dies, many of its organ systems, tissues, and cells remain functional while its body no longer works as a whole. We define this state as the "twilight of death" - the transition from a living body to a decomposed corpse. We claim that the study of the twilight of death is important to ethical, legal and medical science. We examined gene expression at the twilight of death in the zebrafish and mouse reaching the conclusion that apparently thousands of transcripts significantly increase in abundance from life to several hours/days postmortem relative to live controls. Transcript dynamics of different genes provided "proof-of-principle" that models accurately predict an individual's elapsed-time-of-death (i.e. postmortem interval). While many transcripts were associated with survival and stress compensation, others were associated with epigenetic factors, developmental control, and cancer. Future studies are needed to determine whether the high incidence of cancer in transplant recipients is due to the postmortem processes in donor organs.
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Affiliation(s)
| | - Peter A Noble
- Department of Periodontics, University of Washington, Seattle, WA, USA
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Kuhn SO, Hahnenkamp K. [Therapy escalation for the potential organ donor : Are all intensive care measures also ethically justifiable?]. Med Klin Intensivmed Notfmed 2017; 114:240-245. [PMID: 28748278 DOI: 10.1007/s00063-017-0320-y] [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: 05/04/2017] [Revised: 05/31/2017] [Accepted: 06/11/2017] [Indexed: 12/14/2022]
Abstract
The gap between the number of organs needed and the number available has dramatically increased in Germany in the last decade-for intensivists and transplantation specialists, it is challenging to cover the demand responsibly. It is therefore increasingly important to identify potential organ donors in order to realize organ donation. An escalation of intensive care measures is often required, which raises critical ethical questions. In Germany, organ donation is only allowed after brain death with prior informed consent from the deceased or his/her relatives. Determining the willingness of the potential organ donor and adapting the subsequent intensive care to it requires experience and empathy. Therapy escalation for the realization of organ donation is not opposed to the basic ethical principles of medicine, but remains an individual decision. A time limitation of this last intensive therapy phase to achieve optimal conditions for transplantation should be discussed with the relatives and adapted to the medical requirements. This article would like to highlight ethical questions that are relevant in the context of therapy escalation of potential organ donors and, thus, support the decision-making process.
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Affiliation(s)
- S-O Kuhn
- Klinik für Anästhesiologie, Anästhesie, Intensiv‑, Notfall-, und Schmerzmedizin, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch Str., 17475, Greifswald, Deutschland.
| | - K Hahnenkamp
- Klinik für Anästhesiologie, Anästhesie, Intensiv‑, Notfall-, und Schmerzmedizin, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch Str., 17475, Greifswald, Deutschland
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Akca O. Managing potential brain dead organ donor - Guidelines and more…. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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