1
|
Molina M, Fernández-Ruiz M, Gonzalez E, Cabrera J, Praga M, Rodriguez A, Tejido-Sánchez A, Medina-Polo J, Mateos A, Rubio-Chacón C, Sanchez A, Pla A, Andrés A. Prophylactic Anticoagulation Reduces the Risk of Kidney Graft Venous Thrombosis in Recipients From Uncontrolled Donation After Circulatory Death Donors With High Renal Resistive Index. Transplant Direct 2024; 10:e1649. [PMID: 38817627 PMCID: PMC11139466 DOI: 10.1097/txd.0000000000001649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/13/2024] [Accepted: 03/21/2024] [Indexed: 06/01/2024] Open
Abstract
Background Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplantation (KT) at the expense of a higher risk of primary graft nonfunction (PNF). At least half of the cases of PNF are secondary to graft venous thrombosis. The potential benefit from prophylactic anticoagulation in this scenario remains unclear. Methods In this single-center retrospective study we compared 2 consecutive cohorts of KT from uDCD with increased (≥0.8) renal resistive index (RRI) in the Doppler ultrasound examination performed within the first 24-72 h after transplantation: 36 patients did not receive anticoagulation ("nonanticoagulation group") and 71 patients underwent prophylactic anticoagulation until normalization of RRI in follow-up Doppler examinations ("anticoagulation group"). Results Anticoagulation was initiated at a median of 2 d (interquartile range, 2-3) after transplantation and maintained for a median of 12 d (interquartile range, 7-18). In 4 patients (5.6%), anticoagulation had to be prematurely stopped because of the development of a hemorrhagic complication. In comparison with the nonanticoagulation group, recipients in the anticoagulation group had a lower 2-wk cumulative incidence of graft venous thrombosis (19.4% versus 0.0%; P < 0.001) and PNF (19.4% versus 2.8%; P = 0.006). The competing risk analysis with nonthrombotic causes of PNF as the competitive event confirmed the higher risk of graft thrombosis in the nonanticoagulation group (P = 0.0001). The anticoagulation group had a higher incidence of macroscopic hematuria (21.1% versus 5.6%; P = 0.049) and blood transfusion requirements (39.4% versus 19.4%; P = 0.050) compared with the nonanticoagulation group. No graft losses or deaths were attributable to complications potentially associated with anticoagulation. Conclusions Early initiation of prophylactic anticoagulation in selected KT recipients from uDCD with an early Doppler ultrasound RRI of ≥0.8 within the first 24-72 h may reduce the incidence of graft venous thrombosis as a cause of PNF.
Collapse
Affiliation(s)
- Maria Molina
- Department of Nephrology, Hospital Universitario “12 de Octubre”, Madrid, Spain
- Department of Nephrology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- REMAR-IGTP Group, Germans Trias i Pujol Research Institute (IGTP), Can Ruti Campus, Badalona, Spain
- Department of Medicine, School of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
- RICORS2040 (Kidney Disease), Badalona, Barcelona, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Esther Gonzalez
- Department of Nephrology, Hospital Universitario “12 de Octubre”, Madrid, Spain
- Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Jimena Cabrera
- Programa de Prevención y Tratamiento de las Glomerulopatías, Centro de Nefrología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
- Department of Nephrology, Hospital Evangelico, Montevideo, Uruguay
| | - Manuel Praga
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Alfredo Rodriguez
- Department of Urology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Angel Tejido-Sánchez
- Department of Urology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Jose Medina-Polo
- Department of Urology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Alonso Mateos
- Servicio de Urgencia Médica de la Comunidad de Madrid, SUMMA 112
- Facultad de medicina, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Angel Sanchez
- Department of Interventional Radiology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Ana Pla
- Department of Interventional Radiology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| | - Amado Andrés
- Department of Nephrology, Hospital Universitario “12 de Octubre”, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Hospital “12 de Octubre” (imas12), Madrid, Spain
| |
Collapse
|
2
|
Karataş H. Beyond Death: Exploring Cultural Perceptions in Cadaveric Organ Donation. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241236982. [PMID: 38419299 DOI: 10.1177/00302228241236982] [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: 03/02/2024]
Abstract
Advancements in medicine introduced a relatively invented death into our lives: Brain Death. It intermingles with our perceptions of classical death due to knowing the heart is beating, the color of the skin is pink, and the body's temperature is warm. Hence, accepting brain death as death might get complicated in terms of relatives of the brain-dead person. The interviews revealed that the reluctance to cadaveric organ donations is highly connected to the cultural perception of death. Furthermore, folklore interferes with altruistic cadaveric donations, particularly folk beliefs, rituals, social norms, and oral traditions.
Collapse
Affiliation(s)
- Hicran Karataş
- Department of Sociology, Bartın University, Bartın, Turkiye
| |
Collapse
|
3
|
Lim WH, Dominguez-Gil B. Ethical Issues Related to Donation and Transplantation of Donation After Circulatory Determination of Death Donors. Semin Nephrol 2022; 42:151269. [PMID: 36577644 DOI: 10.1016/j.semnephrol.2022.07.003] [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] [Indexed: 12/28/2022]
Abstract
With the continuing disparity between organ supply to match the increasing demand for kidney transplants in patients with renal failure, donation after the circulatory determination of death (DCDD) has become an important and increasing global source of kidneys for clinical use. The concern that the outcomes of controlled DCDD donor kidney transplants were inferior to those obtained from donors declared dead by neurologic criteria has largely diminished because large-scale registry and single-center reports consistently have reported favorable outcomes. For uncontrolled DCDD kidney transplants, outcomes are correspondingly acceptable, although there is a greater risk of primary nonfunction. The potential of DCDD remains unrealized in many countries because of the ethical concerns and resource implications in the utilization of these donor kidneys for transplantation. In this review, we discuss the origin and definitions of DCDD donors, and examine the long-term outcomes of transplants from DCDD donor kidneys. We discuss the controversies, challenges, and ethical and legal barriers in the acceptance of DCDD, including the complexities of implementing and sustaining controlled and uncontrolled DCDD donor programs. The lessons learned from global leaders will assist a wider international recognition, acceptance, and development of DCDD transplant programs that will noticeably facilitate and address the global shortages of kidneys for transplantation, and ensure the opportunity for people who had indicated their desires to become organ donors fulfill their final wishes.
Collapse
Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Internal Medicine, University of Western Australia Medical School, Perth, Australia.
| | | |
Collapse
|
4
|
Viñuela-Prieto JM, Escarpa Falcón MC, Candel FJ, Mateos Rodríguez A, Torres González JI, Del Río Gallegos F. Family Refusal to Consent Donation: Retrospective Quantitative Analysis of Its Increasing Tendency and the Associated Factors Over the Last Decade at a Spanish Hospital. Transplant Proc 2021; 53:2112-2121. [PMID: 34419253 DOI: 10.1016/j.transproceed.2021.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Organ and tissue recovery remains limited by several factors. This study retrospectively analyzes the factors associated with family refusal to consent to donation at a high-donor-volume Spanish hospital. METHODS Data regarding the annual number of potential donors and family refusal rates at hospital and regional levels were retrieved from 2008 to 2017. Descriptive, bivariate, and multivariate analyses were performed to detect those factors independently associated with family refusal. Results were cross-validated using the data from years 2018 and 2019 as the validation group. To explore potential inter-relations between factors a Multiple Correspondence Analysis was performed. RESULTS A total of 601 family interviews for petition of consent were conducted between 2008 and 2017, 531 (88.4%) resulted in acceptance and 70 (11.6%) resulted in refusal of the donation. Lesser experience of the interviewers (odds ratio [OR], 2.980; P = .001), donation after brain death (OR, 2.485; P = .013), number of interviews conducted per family (OR, 1.892; P < .001), age of the main decision maker (OR, 1.025; P = .045), and high or middle attributed cultural levels (OR, 0.142; P < .001 and OR, 0.199; P < .001 respectively) were observed to be independently associated with the family final decision. The logistic regression model displayed good predictive power for both derivation and validation cohorts, with an overall predictive accuracy of 80.9% (95% confidence interval, 0.747-0.870; P < .001) and 74.4% (95% confidence interval, 0.635-0.854; P = .001), respectively. CONCLUSIONS Transplant coordination team members having a thorough knowledge of the family decision mechanisms may be a key factor in donation process optimization.
Collapse
Affiliation(s)
- José Manuel Viñuela-Prieto
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; Neurosurgery Department, University Hospital La Paz, Madrid, Spain.
| | | | - Francisco Javier Candel
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; Health Research Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Alonso Mateos Rodríguez
- Regional Organization for Transplant Coordination (ORCT), Community of Madrid Health Service (SERMAS), Madrid, Spain; School of Medicine, Francisco de Vitoria University, Madrid, Spain
| | - Juan Ignacio Torres González
- Regional Organization for Transplant Coordination (ORCT), Community of Madrid Health Service (SERMAS), Madrid, Spain; Nursing, Physiotherapy and Podiatry School, Complutense University, Madrid, Spain
| | - Francisco Del Río Gallegos
- Transplant Coordination Department, Hospital Clínico San Carlos, Madrid, Spain; Regional Organization for Transplant Coordination (ORCT), Community of Madrid Health Service (SERMAS), Madrid, Spain
| |
Collapse
|
5
|
Ruta F, Gallo G, Ferrara P, Terzoni S, Monica AD, Dal Mas F, Cobianchi L. Translating Knowledge About Organ and Tissue Donation Using Webinars: An Exploratory Study In Italy. Transplant Proc 2021; 53:1792-1797. [PMID: 34275598 DOI: 10.1016/j.transproceed.2021.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Organ transplant is considered a life-saving treatment for patients with end-stage diseases. The knowledge of the population and their opinions can influence the willingness of family members and patients to consent to organ and tissue donation. This work aims to evaluate the effectiveness of a webinar intervention as a knowledge translation tool on the Italian population's knowledge and attitudes related to organ and tissue donation. METHODS The study used an interventional methodology, analyzing the results of a webinar event lasting 120 minutes organized and managed by 4 experienced professionals in collaboration with the National Association of Donors. Evaluation of customer satisfaction at the end of the webinar was assessed, along with the impact of the event on the participants' perceived knowledge and attitudes. RESULTS The overall evaluation of the webinar can be considered satisfactory, and the webinar stood as a valid knowledge translation tool. The intervention significantly improved perceived knowledge, attitudes, and propensity to donate. The analysis showed that the difference between brain death and coma was still doubtful. CONCLUSIONS A short webinar course was effective and appreciated by the participants, representing a valid knowledge translation tool and an alternative to in-presence training on specific topics that require the creation of a real "culture of donation."
Collapse
Affiliation(s)
- Federico Ruta
- Department of Donation and Transplantation, L. Bonomo-Hospital Andria, Barletta, Italy.
| | | | - Paolo Ferrara
- San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital, Milan, Italy
| | - Stefani Terzoni
- San Paolo Bachelor School of Nursing, San Paolo Teaching Hospital, Milan, Italy
| | | | - Francesca Dal Mas
- Department of Management, Lincoln International Business School, Lincoln, United Kingdom
| | - Lorenzo Cobianchi
- General Surgery, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
6
|
Prevalence and Potential Correlates of Family Refusal to Organ Donation for Brain-Dead Declared Patients: A 12-Year Retrospective Screening Study. Transplant Proc 2020; 53:548-554. [PMID: 32943213 DOI: 10.1016/j.transproceed.2020.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/08/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study was designed to determine prevalence and potential correlates of family refusal to organ donation for patients declared brain dead thorough a 12-year retrospective data analysis. METHODS Of 111 cases declared brain dead by our hospital within a 12-year period between 2008 and 2019, a total of 82 potentially brain-dead organ donors were included in this retrospective study. Data on sociodemographic characteristics, length of intensive care unit stay, cause of death, decedent's wishes, interview time, family decision, and reasons for refusal were recorded. RESULTS The rate of family refusal to organ donation was 51.2% and because of religious concerns (64.3%) in most of cases. The likelihood of family consent to organ donation was significantly higher for an adult vs a child (60.0% vs 25.9%, P = .004) and for a schooler and adolescent age vs a younger child (55.6 vs 22.5%, P = .004). Patients who were declared brain dead after nontraumatic intracranial hemorrhage (60.4%) vs encephalitis (18.2%) had higher rates of family consent to organ donation (P = .023). CONCLUSIONS In conclusion, our findings revealed family refusal to organ donation in at least half of cases and higher likelihood of family consent to organ donation depending on age of patient (adult vs children) and cause of death (brain injury vs encephalitis). The religious concerns and distrust in the health care system were the 2 major causes of family refusal, whereas no significant difference was noted across different family refusal reasons in terms of sociodemographic factors, length of intensive care unit stay, awareness of decedent's wishes, or time of family interview.
Collapse
|
7
|
Coll E, Miñambres E, Sánchez-Fructuoso A, Fondevila C, Campo-Cañaveral de la Cruz JL, Domínguez-Gil B. Uncontrolled Donation After Circulatory Death: A Unique Opportunity. Transplantation 2020; 104:1542-1552. [PMID: 32732830 DOI: 10.1097/tp.0000000000003139] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Uncontrolled donation after circulatory death (uDCD) refers to donation from persons who die following an unexpected and unsuccessfully resuscitated cardiac arrest. Despite the large potential for uDCD, programs of this kind only exist in a reduced number of countries with a limited activity. Barriers to uDCD are of a logistical and ethical-legal nature, as well as arising from the lack of confidence in the results of transplants from uDCD donors. The procedure needs to be designed to reduce and limit the impact of the prolonged warm ischemia inherent to the uDCD process, and to deal with the ethical issues that this practice poses: termination of advanced cardiopulmonary resuscitation, extension of advanced cardiopulmonary resuscitation beyond futility for organ preservation, moment to approach families to discuss donation opportunities, criteria for the determination of death, or the use of normothermic regional perfusion for the in situ preservation of organs. Although the incidence of primary nonfunction and delayed graft function is higher with organs obtained from uDCD donors, overall patient and graft survival is acceptable in kidney, liver, and lung transplantation, with a proper selection and management of both donors and recipients. Normothermic regional perfusion has shown to be critical to achieve optimal outcomes in uDCD kidney and liver transplantation. However, the role of ex situ preservation with machine perfusion is still to be elucidated. uDCD is a unique opportunity to improve patient access to transplantation therapies and to offer more patients the chance to donate organs after death, if this is consistent with their wishes and values.
Collapse
Affiliation(s)
| | - Eduardo Miñambres
- Intensive Care Unit and Donor Coordination Unit, Hospital Universitario Marqués de Valdecilla-IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Ana Sánchez-Fructuoso
- Nephrology Department, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | | | | |
Collapse
|
8
|
Reed MJ, Currie I, Forsythe J, Young I, Stirling J, Logan L, Clegg GR, Oniscu GC. Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK. Emerg Med J 2019; 37:155-161. [PMID: 31757833 DOI: 10.1136/emermed-2019-208650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 11/03/2022]
Abstract
Worldwide there is a shortage of available organs for patients requiring transplants. However, some countries such as France, Italy and Spain have had greater success by allowing donations from patients with unexpected and unrecoverable circulatory arrest who arrive in the ED. Significant advances in the surgical approach to organ recovery from donation after circulatory death (DCD) led to the establishment of a pilot programme for uncontrolled DCD in the ED of the Royal Infirmary of Edinburgh. This paper describes the programme and discusses the lessons learnt.
Collapse
Affiliation(s)
- Matthew James Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Ian Currie
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John Forsythe
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- NHS Blood and Transplant, The Courtyard Callendar Business Park, Falkirk, UK
| | - Irene Young
- NHS Blood and Transplant, The Courtyard Callendar Business Park, Falkirk, UK
| | - John Stirling
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Lesley Logan
- NHS Blood and Transplant, The Courtyard Callendar Business Park, Falkirk, UK
| | - Gareth R Clegg
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Gabriel C Oniscu
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| |
Collapse
|
9
|
Molina M, Domínguez-Gil B, Pérez-Villares JM, Andrés A. Uncontrolled donation after circulatory death: ethics of implementation. Curr Opin Organ Transplant 2019; 24:358-363. [PMID: 31090649 DOI: 10.1097/mot.0000000000000648] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Despite its potential to increase the donor pool, uncontrolled donation after circulatory death (uDCD) is available in a limited number of countries. Ethical concerns may preclude the expansion of this program. This article addresses the ethical concerns that arise in the implementation of uDCD. RECENT FINDINGS The first ethical concern is that associated with the determination of an irreversible cardiac arrest. Professionals must strictly adhere to local protocols and international standards on advanced cardiopulmonary resuscitation, independent of their participation in an uDCD program. Cardiac compression and mechanical ventilation are extended beyond futility during the transportation of potential uDCD donors to the hospital with the sole purpose of preserving organs. Importantly, potential donors remain monitored while being transferred to the hospital, which allows the identification of any return of spontaneous circulation. Moreover, this procedure allows the determination of death to be undertaken in the hospital by an independent health care provider who reassesses that no other therapeutic interventions are indicated and observes a period of the complete absence of circulation and respiration. Extracorporeal-assisted cardiopulmonary resuscitation programs can successfully coexist with uDCD programs. The use of normothermic regional perfusion with ECMO devices for the in-situ preservation of organs is considered appropriate in a setting in which the brain is subject to profound and prolonged ischemic damage. Finally, communication with relatives must be transparent and accurate, and the information should be provided respecting the time imposed by the family's needs and emotions. SUMMARY uDCD can help increase the availability of organs for transplantation while giving more patients the opportunity to donate organs after death. The procedures should be designed to confront the ethical challenges that this practice poses and respect the values of all those involved.
Collapse
Affiliation(s)
- María Molina
- Department of Nephrology, Hospital Universitario '12 de Octubre'
- Department of Nephrology, Hospital Universitario Arnau de Vilanova
- Institut de Recerca Biomèdica, Lleida
| | | | - José M Pérez-Villares
- Coordinación Sectorial de Trasplantes de Granada, Servicio de Medicina Intensiva Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Amado Andrés
- Department of Nephrology, Hospital Universitario '12 de Octubre'
- Instituto de Investigación Hospital '12 de Octubre' (imas12), Madrid
| |
Collapse
|
10
|
Potential organ donors after Out-of-Hospital Cardiac Arrest during a ten-year period in Stockholm, Sweden. Resuscitation 2019; 137:215-220. [DOI: 10.1016/j.resuscitation.2019.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/29/2018] [Accepted: 01/02/2019] [Indexed: 12/24/2022]
|
11
|
Molina M, Guerrero-Ramos F, Fernández-Ruiz M, González E, Cabrera J, Morales E, Gutierrez E, Hernández E, Polanco N, Hernández A, Praga M, Rodriguez-Antolín A, Pamplona M, de la Rosa F, Cavero T, Chico M, Villar A, Justo I, Andrés A. Kidney transplant from uncontrolled donation after circulatory death donors maintained by nECMO has long-term outcomes comparable to standard criteria donation after brain death. Am J Transplant 2019; 19:434-447. [PMID: 29947163 DOI: 10.1111/ajt.14991] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 01/25/2023]
Abstract
Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplant (KT) with short-term outcomes similar to those obtained from donation after brain death (DBD) donors. However, heterogeneous results in the long term have been reported. We compared 10-year outcomes between 237 KT recipients from uDCD donors maintained by normothermic extracorporeal membrane oxygenation (nECMO) and 237 patients undergoing KT from standard criteria DBD donors during the same period at our institution. We further analyzed risk factors for death-censored graft survival in the uDCD group. Delayed graft function (DGF) was more common in the uDCD group (73.4% vs 46.4%; P < .01), although glomerular filtration rates at the end of follow-up were similar in the 2 groups. uDCD and DBD groups had similar rates for 10-year death-censored graft (82.1% vs 80.4%; P = .623) and recipient survival (86.2% vs 87.6%; P = .454). Donor age >50 years was associated with graft loss in the uDCD group (hazard ratio: 1.91; P = .058), whereas the occurrence of DGF showed no significant effect. uDCD KT under nECMO support resulted in similar graft function and long-term outcomes compared with KT from standard criteria DBD donors. Increased donor age could negatively affect graft survival after uDCD donation.
Collapse
Affiliation(s)
- María Molina
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Félix Guerrero-Ramos
- Department of Urology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Esther González
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Jimena Cabrera
- Programa de Prevención y Tratamiento de las Glomerulopatías, Centro de Nefrología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.,Department of Nephrology, Hospital Evangelico, Montevideo, Uruguay
| | - Enrique Morales
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Eduardo Gutierrez
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Eduardo Hernández
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Natalia Polanco
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Ana Hernández
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Manuel Praga
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| | - Alfredo Rodriguez-Antolín
- Department of Urology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Manuel Pamplona
- Department of Urology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Federico de la Rosa
- Department of Urology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Teresa Cavero
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Mario Chico
- Department of Intensive Care Medicine, Hospital Universitario "12 de Octubre", Madrid, Spain
| | | | - Iago Justo
- Department of Abdominal Organ Transplantation and General and Digestive Surgery, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Amado Andrés
- Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Madrid, Spain.,School of Medicine, Universidad Complutense, Madrid, Spain
| |
Collapse
|
12
|
Pabisiak K, Krejczy A, Bohatyrewicz R, Ciechanowski K. Underestimated Role in the Organ Donation Pathway—Paramedics' Attitudes and Knowledge About Donation After Circulatory Death. Transplant Proc 2018; 50:1953-1956. [DOI: 10.1016/j.transproceed.2018.02.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/06/2018] [Indexed: 11/16/2022]
|
13
|
López JS, Soria-Oliver M, Aramayona B, García-Sánchez R, Martínez JM, Martín MJ. An Integrated Psychosocial Model of Relatives' Decision About Deceased Organ Donation (IMROD): Joining Pieces of the Puzzle. Front Psychol 2018; 9:408. [PMID: 29692744 PMCID: PMC5902731 DOI: 10.3389/fpsyg.2018.00408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
Organ transplantation remains currently limited because the demand for organs far exceeds the supply. Though organ procurement is a complex process involving social, organizational, and clinical factors, one of the most relevant limitations of organ availability is family refusal to donate organs of a deceased relative. In the past decades, a remarkable corpus of evidence about the factors conditioning relatives' consent has been generated. However, research in the field has been carried out mainly by means of merely empirical approaches, and only partial attempts have been made to integrate the existing empirical evidence within conceptual and theoretically based frameworks. Accordingly, this work articulates the proposal of an Integrated Psychosocial Model of Relatives' Organ Donation (IMROD) which offers a systematic view of the factors and psychosocial processes involved in family decision and their interrelations. Relatives' experience is conceptualized as a decision process about the possibility of vicariously performing an altruistic behavior that takes place under one of the most stressful experiences of one's lifetime and in the context of interaction with different healthcare professionals. Drawing on this, in the proposed model, the influence of the implied factors and their interrelations/interactions are structured and interpreted according to their theoretically based relation with processes like rational/heuristic decision-making, uncertainty, stress, bereavement, emotional reactions, sense of reciprocity, sense of freedom to decide, and attitudes/intentions toward one's own and the deceased's organ donation. Our model also develops a processual perspective and suggests different decisional scenarios that may be reached as a result of the combinations of the considered factors. Each of these scenarios may imply different balances between factors that enhance or hinder donation, such as different levels of uncertainty and potential decisional conflict. Throughout our work, current controversial or inconsistent results are discussed and interpreted on the basis of the relationships that are posited in the proposed model. Finally, we suggest that the structure of the relationships and interactions contained in our model can be used by future research to guide the formulation of hypotheses and the interpretation of results. In this sense, specific guidelines and research questions are also proposed.
Collapse
Affiliation(s)
- Jorge S López
- Departamento de Psicología y Pedagogía, Universidad Pública de Navarra, Pamplona, Spain.,Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Soria-Oliver
- Facultad de Ciencias de la Salud, UNIR-Universidad Internacional de la Rioja, Logroño, Spain
| | - Begoña Aramayona
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rubén García-Sánchez
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - José M Martínez
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - María J Martín
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
14
|
Syversen TB, Sørensen DW, Foss S, Andersen MH. Donation after circulatory death - an expanded opportunity for donation appreciated by families. J Crit Care 2017; 43:306-311. [PMID: 28968526 DOI: 10.1016/j.jcrc.2017.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Torgunn Bø Syversen
- Division of Emergencies and Critical Care, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Dag Wendelbo Sørensen
- Division of Emergencies and Critical Care, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Stein Foss
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Marit Helen Andersen
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| |
Collapse
|
15
|
Abstract
End-organ failure is associated with high mortality and morbidity, in addition to increased health care costs. Organ transplantation is the only definitive treatment that can improve survival and quality of life in such patients; however, due to the persistent mismatch between organ supply and demand, waiting lists continue to grow across the world. Careful intensive care management of the potential organ donor with goal-directed therapy has the potential to optimize organ function and improve donation yield.
Collapse
|
16
|
Abstract
Organ transplantation improves survival and quality of life in patients with end-organ failure. Waiting lists continue to grow across the world despite remarkable advances in the transplantation process, from the creation of public engagement campaigns to the development of critical pathways for the timely identification, referral, approach, and treatment of the potential organ donor. The pathophysiology of dying triggers systemic changes that are intimately related to organ viability. The intensive care management of the potential organ donor optimizes organ function and improves the donation yield, representing a significant step in reducing the mismatch between organ supply and demand. Different beliefs and cultures reflect diverse legislations and donation practices amongst different countries, creating a challenge to standardized practices. Maintaining public trust is necessary for continued progress in organ donation and transplantation, hence the urge for a joint effort in creating uniform protocols that ensure transparent practices within the medical community.
Collapse
Affiliation(s)
- C B Maciel
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - D Y Hwang
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - D M Greer
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
17
|
Thuret R, Timsit MO, Kleinclauss F. [Chronic kidney disease and kidney transplantation]. Prog Urol 2016; 26:882-908. [PMID: 27727091 DOI: 10.1016/j.purol.2016.09.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To report epidemiology and characteristics of end-stage renal disease (ESRD) patients and renal transplant candidates, and to evaluate access to waiting list and results of renal transplantation. MATERIAL AND METHODS An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: "chronic kidney disease, epidemiology, kidney transplantation, cost, survival, graft, brain death, cardiac arrest, access, allocation". French legal documents have been reviewed using the government portal (http://www.legifrance.gouv.fr). Articles were selected according to methods, language of publication and relevance. The reference lists were used to identify additional historical studies of interest. Both prospective and retrospective series, in French and English, as well as review articles and recommendations were selected. In addition, French national transplant and health agencies (http://www.agence-biomedecine.fr and http://www.has-sante.fr) databases were screened using identical keywords. A total of 3234 articles, 6 official reports and 3 newspaper articles were identified; after careful selection 99 publications were eligible for our review. RESULTS The increasing prevalence of chronic kidney disease (CKD) leads to worsen organ shortage. Renal transplantation remains the best treatment option for ESRD, providing recipients with an increased survival and quality of life, at lower costs than other renal replacement therapies. The never-ending lengthening of the waiting list raises issues regarding treatment strategies and candidates' selection, and underlines the limits of organ sharing without additional source of kidneys available for transplantation. CONCLUSION Allocation policies aim to reduce medical or geographical disparities regarding enrollment on a waiting list or access to an allotransplant.
Collapse
Affiliation(s)
- R Thuret
- Service d'urologie et transplantation rénale, CHU de Montpellier, 34090 Montpellier, France; Université de Montpellier, 34090 Montpellier, France.
| | - M O Timsit
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - F Kleinclauss
- Service d'urologie et transplantation rénale, CHRU de Besançon, 25030 Besançon, France; Université de Franche-Comté, 25030 Besançon, France; Inserm UMR 1098, 25030 Besançon, France
| |
Collapse
|
18
|
Shah SK, Kasper K, Miller FG. A narrative review of the empirical evidence on public attitudes on brain death and vital organ transplantation: the need for better data to inform policy. JOURNAL OF MEDICAL ETHICS 2015; 41:291-6. [PMID: 24769621 DOI: 10.1136/medethics-2013-101930] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Vital organ transplantation is premised on 'the dead donor rule': donors must be declared dead according to medical and legal criteria prior to donation. However, it is controversial whether individuals diagnosed as 'brain dead' are really dead in accordance with the established biological conception of death-the irreversible cessation of the functioning of the organism as a whole. A basic understanding of brain death is also relevant for giving valid, informed consent to serve as an organ donor. There is therefore a need for reliable empirical data on public understanding of brain death and vital organ transplantation. We conducted a review of the empirical literature that identified 43 articles with approximately 18,603 study participants. These data demonstrate that participants generally do not understand three key issues: (1) uncontested biological facts about brain death, (2) the legal status of brain death and (3) that organs are procured from brain dead patients while their hearts are still beating and before their removal from ventilators. These data suggest that, despite scholarly claims of widespread public support for organ donation from brain dead patients, the existing data on public attitudes regarding brain death and organ transplantation reflect substantial public confusion. Our review raises questions about the validity of consent for vital organ transplantation and suggests that existing data are of little assistance in developing policy proposals for organ transplantation from brain dead patients. New approaches to rigorous empirical research with educational components and evaluations of understanding are urgently needed.
Collapse
Affiliation(s)
- Seema K Shah
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Kenneth Kasper
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Franklin G Miller
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| |
Collapse
|
19
|
Matesanz R. When health care priorities are unclear: do we obtain organs or try to save lives? Am J Emerg Med 2013; 31:411-3. [DOI: 10.1016/j.ajem.2012.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 07/28/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022] Open
|
20
|
Miranda-Utrera N, Medina-Polo J, Pamplona M, de la Rosa F, Rodríguez A, Duarte JM, Passas JB, Mateos-Rodríguez A, Díaz R, Andrés A. Donation after cardiac death: results of the SUMMA 112 - Hospital 12 de Octubre Program. Clin Transplant 2013; 27:283-8. [DOI: 10.1111/ctr.12071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 11/29/2022]
Affiliation(s)
| | - José Medina-Polo
- Department of Urology; Hospital Universitario 12 de Octubre; Madrid; Spain
| | - Manuel Pamplona
- Department of Urology; Hospital Universitario 12 de Octubre; Madrid; Spain
| | | | - Alfredo Rodríguez
- Department of Urology; Hospital Universitario 12 de Octubre; Madrid; Spain
| | - José M. Duarte
- Department of Urology; Hospital Universitario 12 de Octubre; Madrid; Spain
| | - Juan B. Passas
- Department of Urology; Hospital Universitario 12 de Octubre; Madrid; Spain
| | | | - Rafael Díaz
- Department of Urology; Hospital Universitario 12 de Octubre; Madrid; Spain
| | - Amado Andrés
- Department ofDepartment of Nephrology; Hospital Universitario 12 de Octubre; Madrid; Spain
| |
Collapse
|
21
|
Mateos-Rodríguez AA, Navalpotro-Pascual JM, Del Rio Gallegos F, Andrés-Belmonte A. Out-hospital donors after cardiac death in Madrid, Spain: a 5-year review. ACTA ACUST UNITED AC 2012; 15:164-9. [PMID: 22947689 DOI: 10.1016/j.aenj.2012.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The Medical Emergencies Service of Madrid (Spain) (Servicio de Urgencias Medicas de Madrid), SUMMA112, forms part of an organ donor program involving patients who have suffered out-hospital cardiac arrest and fail to respond to advanced cardiopulmonary resuscitation maneuvers. Subjects meeting the inclusion criteria are moved to a transplant unit under sustained resuscitation maneuvering in order to harvest the organs. This paper presents compliance with the timelines of the program, the proportion of donors, the characteristics of donors and non-donors, and the number of organs obtained. MATERIAL A retrospective descriptive study was made based on the review of case histories. The SPSS(©) version 16.0 statistical package was used for data analysis. RESULTS A total of 214 cases were recorded, of which 84% were males. The mean age was 40 years. The mean time to arrival on scene was 13 min and 34 s. The mean time to arrival in hospital was 88 min and 10 s. A total of 522 organs and tissues were harvested (250 kidneys, 33 livers, 123 corneas, 97 bone tissues and 19 lungs), corresponding to 3.2 organs/tissues per patient on average. A total of 21.7% of the patients were not valid. There were no differences between the valid and non-valid patients in terms of age and gender. The causes of non-donation included extracorporeal circuit failure (6.3%), family refusal (15.6%), patient refusal expressed in life (4.7%), legal denial (1.6%), biological causes (51.6%), and others (20.3%). Cardiac compressors were used in 85 cases, yielding 92 kidneys, 41 corneas, 30 bone tissues, 19 livers and 9 lungs, corresponding to 2.1 organs/tissues per patient on average. CONCLUSION This program affords a very important number of organs for transplantation. Further studies are needed to assess the efficacy of mechanical cardiac compressor use in generating more organs.
Collapse
|
22
|
|
23
|
de Groot YJ, Lingsma HF, van der Jagt M, Bakker J, Ijzermans JNM, Kompanje EJO. Remarkable changes in the choice of timing to discuss organ donation with the relatives of a patient: a study in 228 organ donations in 20 years. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R235. [PMID: 21982557 PMCID: PMC3334786 DOI: 10.1186/cc10481] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/06/2011] [Accepted: 10/07/2011] [Indexed: 11/10/2022]
Abstract
Introduction We studied whether the choice of timing of discussing organ donation for the first time with the relatives of a patient with catastrophic brain injury in The Netherlands has changed over time and explored its possible consequences. Second, we investigated how thorough the process of brain death determination was over time by studying the number of medical specialists involved. And we studied the possible influence of the Donor Register on the consent rate. Methods We performed a retrospective chart review of all effectuated brain dead organ donors between 1987 and 2009 in one Dutch university hospital with a large neurosurgical serving area. Results A total of 271 medical charts were collected, of which 228 brain dead patients were included. In the first period, organ donation was discussed for the first time after brain death determination (87%). In 13% of the cases, the issue of organ donation was raised before the first EEG. After 1998, we observed a shift in this practice. Discussing organ donation for the first time after brain death determination occurred in only 18% of the cases. In 58% of the cases, the issue of organ donation was discussed before the first EEG but after confirming the absence of all brain stem reflexes, and in 24% of the cases, the issue of organ donation was discussed after the prognosis was deemed catastrophic but before a neurologist or neurosurgeon assessed and determined the absence of all brain stem reflexes as required by the Dutch brain death determination protocol. Conclusions The phases in the process of brain death determination and the time at which organ donation is first discussed with relatives have changed over time. Possible causes of this change are the introduction of the Donor Register, the reintroduction of donation after circulatory death and other logistical factors. It is unclear whether the observed shift contributed to the high refusal rate in The Netherlands and the increase in family refusal in our hospital in the second studied period. Taking published literature on this subject into account, it is possible that this may have a counterproductive effect.
Collapse
Affiliation(s)
- Yorick J de Groot
- Department of Intensive Care, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
24
|
Ghorbani F, Khoddami-Vishteh HR, Ghobadi O, Shafaghi S, Louyeh AR, Najafizadeh K. Causes of family refusal for organ donation. Transplant Proc 2011; 43:405-6. [PMID: 21440717 DOI: 10.1016/j.transproceed.2011.01.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Family refusal represents a barrier for organ donation together with other cultural and religious factors possible ignorance and clinical obstacles. METHODS We performed this retrospective study by phone employing our organ procurement unit database, using a list of families of potential organ donors who had refused organ donation. RESULTS In 2009, 146 potential organ donor families refused donation. We contacted 81 families. The main reason expressed by there families to justify the refusal to donate the deceased's organs was denial and rejection of brain-death criteria (44.4%). Other causes were believing in a miracle (13.6%); fear about organ trade and unknown organ destination (9.9%); religious beliefs (8.6%); insecutrity about the brain-death diagnosis (6.2%); unstable family mood (6.2%); unknown donor wishes about donation (4.9%); belief in body integrity after death (3.7%); and fear of objection by other family members (2.5%). CONCLUSION Our findings showed several reasons for family refusal for organ donation; among the main cause is poor acceptance of brain death. It seems that increasing the knowledge of people about brain death and organizing strategies to confirm brain death for families are necessary to meet the organ shortage.
Collapse
Affiliation(s)
- F Ghorbani
- Lung Transplantation Research Center, National Research Institute of TB and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | |
Collapse
|
25
|
|
26
|
Abstract
This mini-review on European experiences with tackling the problem of organ shortage for transplantation was based on a literature review of predominantly European publications dealing with the issue of organ donation from deceased donors. The authors tried to identify the most significant factors that have demonstrated to impact on donation rates from deceased donors and subsequent transplant successes. These factors include legislative measures (national laws and European Directives), optimization of the donation process, use of expanded criteria donors, innovative preservation and surgical techniques, organizational efforts, and improved allocation algorithms.
Collapse
Affiliation(s)
- Leo Roels
- Donor Action Foundation, Linden, Belgium
| | | |
Collapse
|
27
|
Kidney transplant function using organs from non-heart-beating donors maintained by mechanical chest compressions. Resuscitation 2010; 81:904-7. [PMID: 20579532 DOI: 10.1016/j.resuscitation.2010.04.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2010] [Revised: 04/12/2010] [Accepted: 04/28/2010] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aims to determine the failure rate of transplanted kidney grafts in recipients of organs from non-heart beating donors (NHBDs) who have had mechanical chest compressions to maintain a circulation before organ retrieval. METHODS A retrospective observational study based on review of the emergency medical service database and case histories of NHBDs, and information periodically sent by transplant units about donors and organs. The following variables were studied: age, sex, transfer hospital, time to arrival on the scene of cardiopulmonary arrest, time to arrival in hospital, number and type of organs retrieved, use of mechanical chest compression devices, and kidney function in graft recipients. The study covered the period between January 2008 and November 2009. During 2008 standard manual chest compressions were used and during 2009 mechanical chest compression devices were used. RESULTS In 39 transplanted kidneys from donors receiving mechanical chest compressions primary failure was documented in recipients on two occasions (5.1%). Kidneys transplanted from donors who had manual chest compressions resulted in three primary failures in recipients (9.1%). The difference between the two groups was not significant (p=0.5). Three patients achieved successful return of spontaneous circulation in the mechanical chest compression group after initiation of the NHBD donor protocol. CONCLUSION We have described our experience and protocol for non-heart beating donation using victims of out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation has been unsuccessful as donors. Primary kidney graft failure rates in organs from non-heart beating donors is similar when manual or mechanical chest compression devices are used during cardiopulmonary resuscitation.
Collapse
|