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Mali VP, Aw M, Ng KH, Karthik SV, Tan M, Teo S, Lau PYW, Nyo YL, Loh DSKL, Tiong HY, Quak SH, Yap HK. Paediatric living-donor liver and kidney transplantation during COVID-19. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:119-121. [PMID: 35224610 DOI: 10.47102/annals-acadmedsg.2021272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Vidyadhar Padmakar Mali
- Department of Paediatric Surgery, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
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Ho AFW, Tan TXZ, Latiff E, Shahidah N, Ng YY, Leong BSH, Lim SL, Pek PP, Gan HN, Mao DR, Chia MYC, Cheah SO, Tham LP, Ong MEH. Assessing unrealised potential for organ donation after out-of-hospital cardiac arrest. Scand J Trauma Resusc Emerg Med 2021; 29:105. [PMID: 34321054 PMCID: PMC8317313 DOI: 10.1186/s13049-021-00924-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 07/17/2021] [Indexed: 01/13/2023] Open
Abstract
Background Organ donation after brain death is the standard practice in many countries. Rates are low globally. This study explores the potential national number of candidates for uncontrolled donations after cardiac death (uDCD) amongst out-of-hospital cardiac arrest (OHCA) patients and the influence of extracorporeal cardiopulmonary resuscitation (ECPR) on the candidacy of these potential organ donors using Singapore as a case study. Methods Using Singapore data from the Pan-Asian Resuscitation Outcomes Study, we identified all non-traumatic OHCA cases from 2010 to 2016. Four established criteria for identifying uDCD candidates (Madrid, San Carlos Madrid, Maastricht and Paris) were retrospectively applied onto the population. Within these four groups, a condensed ECPR eligibility criteria was employed and thereafter, an estimated ECPR survival rate was applied, extrapolating for possible neurologically intact survivors had ECPR been administered. Results 12,546 OHCA cases (64.8% male, mean age 65.2 years old) qualified for analysis. The estimated number of OHCA patients who were eligible for uDCD ranged from 4.3 to 19.6%. The final projected percentage of potential uDCD donors readjusted for ECPR survivors was 4.2% (Paris criteria worst-case scenario, n = 532) to 19.4% of all OHCA cases (Maastricht criteria best-case scenario, n = 2428), for an estimated 14.3 to 65.4 uDCD donors per million population per year (pmp/year). Conclusions In Singapore case study, we demonstrated the potential numbers of candidates for uDCD among resuscitated OHCA cases. This sizeable pool of potential donors demonstrates the potential for an uDCD program to expand the organ donor pool. A small proportion of these patients might however survive had they been administered ECPR. Further research into the factors influencing local organ and patient outcomes following uDCD and ECPR is indicated.
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Affiliation(s)
- Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore. .,Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore, Singapore.
| | | | - Ejaz Latiff
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yih Yng Ng
- Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore, Singapore.,Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Pre-hospital and Emergency Research Center, Duke-NUS Medical School, Singapore, Singapore.,Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Han Nee Gan
- Accident & Emergency, Changi General Hospital, Singapore, Singapore
| | - Desmond Renhao Mao
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Si Oon Cheah
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Lai Peng Tham
- Children's Emergency, KK Women's and Children's Hospital, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore.,Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Thong WY, Chong PH, Koh PL, Loh WNH, Tay SKH. First pediatric organ donation after circulatory determination of death in Singapore: Facing challenges in the absence of a local practice guideline. Pediatr Transplant 2020; 24:e13740. [PMID: 32447823 DOI: 10.1111/petr.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/06/2020] [Accepted: 04/15/2020] [Indexed: 11/29/2022]
Abstract
Pediatric organ donation represents only a low proportion of overall organ donation in many parts of world, unable to match the needs for pediatric organ transplantation. Pediatric organ donation after circulatory determination of death (DCD) is increasingly explored in pediatric transplantation, as it increases the availability of organ grafts. A 6-year-old Caucasian boy with a history of arteriovenous malformation presented with a catastrophic intracranial bleed, resulting in severe brainstem dysfunction despite maximal medical and surgical measures. He did not fulfill the criteria for brain death, which must be met for pediatric organ donation in Singapore. Due to parental request, his organs were donated after withdrawal of life support and determination of death by circulatory criteria. Pediatric organ DCD poses many challenges in the pediatric population, especially in the absence of a local practice guideline. We present the first case of a pediatric organ DCD that has occurred in Singapore. Further work is needed, particularly in establishing a national policy for pediatric organ DCD and increasing overall awareness and acceptance toward pediatric organ donations.
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Affiliation(s)
- Wen Yi Thong
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Pei Lin Koh
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Will Ne-Hooi Loh
- Department of Anesthesia, National University Health System, Singapore, Singapore
| | - Stacey Kiat-Hong Tay
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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