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Pérez-Blanco A, Acevedo M, Padilla M, Gómez A, Zapata L, Barber M, Martínez A, Calleja V, Rivero MC, Fernández E, Velasco J, Flores EM, Quindós B, Rodríguez ST, Virgós B, Robles JC, Nebra AC, Moya J, Trenado J, García N, Vallejo A, Herrero E, García Á, Rodríguez ML, García F, Lara R, Lage L, Gil FJ, Guerrero FJ, Meilán Á, Del Prado N, Fernández C, Coll E, Domínguez-Gil B. Assessing Outcomes of Patients Subject to Intensive Care to Facilitate Organ Donation: A Spanish Multicenter Prospective Study. Transpl Int 2024; 37:12791. [PMID: 38681973 PMCID: PMC11046399 DOI: 10.3389/ti.2024.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
Intensive Care to facilitate Organ Donation (ICOD) consists of the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom curative treatment is deemed futile and death by neurological criteria (DNC) is foreseen, to incorporate organ donation into their end-of-life plans. In this study we evaluate the outcomes of patients subject to ICOD and identify radiological and clinical factors associated with progression to DNC. In this first prospective multicenter study we tested by multivariate regression the association of clinical and radiological severity features with progression to DNC. Of the 194 patients, 144 (74.2%) patients fulfilled DNC after a median of 25 h (95% IQR: 17-44) from ICOD onset. Two patients (1%) shifted from ICOD to curative treatment, both were alive at discharge. Factors associated with progression to DNC included: age below 70 years, clinical score consistent with severe brain injury, instability, intracranial hemorrhage, midline shift ≥5 mm and certain types of brain herniation. Overall 151 (77.8%) patients progressed to organ donation. Based on these results, we conclude that ICOD is a beneficial and efficient practice that can contribute to the pool of deceased donors.
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Affiliation(s)
| | - María Acevedo
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Aroa Gómez
- Hospital Universitario Vall d’Hebrón, Barcelona, Spain
| | - Luis Zapata
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Barber
- Hospital Universitario de Navarra, Pamplona, Spain
| | | | | | - María C. Rivero
- Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Julio Velasco
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | - Sergio T. Rodríguez
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Beatriz Virgós
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - José Moya
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Josep Trenado
- Hospital Universitario Mútua Terrasa, Barcelona, Spain
| | | | - Ana Vallejo
- Hospital Universitario de Araba, Vitoria-Gasteiz, Spain
| | | | - Álvaro García
- Complejo Asistencial Universitario, Salamanca, Spain
| | | | | | - Ramón Lara
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | | | - Ángela Meilán
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Cristina Fernández
- Hospital Clínico Universitario de Santiago, Instituto de Investigaciones Sanitarias de Santiago, Santiago, Spain
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Silva E Silva V, Schirmer J, de Aguiar Roza B, Sarti A, Hickey M, Dhanani S, Almost J, Schafer M, Tranmer J. Understanding organ donation processes and structures in ontario: A social network analysis approach. Soc Sci Med 2022; 310:115243. [PMID: 36027760 DOI: 10.1016/j.socscimed.2022.115243] [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: 01/23/2022] [Revised: 06/17/2022] [Accepted: 07/23/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transplant rates in Ontario rose steeply in the decade prior to the COVID-19 pandemic. Reasons for that increase remain unclear, but the inter-organizational arrangement of organ donation programs may have contributed. However, there is a paucity of literature investigating these inter-organizational arrangements, with a limited understanding of how communication facilitates organ donation. Understanding these arrangements may help to re-establish rising organ donation rates post-pandemic. OBJECTIVE To describe interprofessional interactions of Organ and Tissue Donation Coordinators (OTDCs) during organ donation cases, within organ donation programs in Ontario, from an organizational perspective (describing structure, context, process). METHODS Mixed-method social network analysis (SNA) approach analyzing 14 organ donation cases just before the COVID-19 pandemic. RESULTS Structure: Social network graphs depict the joint work performed by hospital staff and OTDCs, with a great part of the communication being processed through the OTDC. CONTEXT Network density ranged from 0.05 to 0.24 across cases, and health care professionals perceived an atmosphere of shared vision and trust among team members. PROCESS Most networks had a degree centralization <0.50 suggesting a decentralized information flow, and participants perceived decisions being jointly made. The characteristic path length of cases ranged from 1.6 to 3.2, suggesting potential for rapid information diffusion. Overall, data reinforced the OTDC role of intermediator within the communication process, and hospital staff perceived OTDCs as central players. Hospital staff and OTDCs reported frustration with some aspects of the flow of information during the organ allocation processes. CONCLUSION Findings from this study provide a network map of communications within organ donation cases and reinforce the importance of the OTDC role. Opportunities for quality improvement within these processes are identified.
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Affiliation(s)
- Vanessa Silva E Silva
- Brock University, Department of Nursing, 1812 ir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada; Queen's Univeristy, School of Nursing, 92 Barrie Street Kingston, Ontario, K7L 3N6, Canada.
| | | | | | - Aimee Sarti
- University of Ottawa, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Michael Hickey
- University of Ottawa, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Sonny Dhanani
- University of Ottawa, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Joan Almost
- Queen's Univeristy, School of Nursing, 92 Barrie Street Kingston, Ontario, K7L 3N6, Canada
| | - Markus Schafer
- Department of Sociology, Baylor University, Waco, TX, United States
| | - Joan Tranmer
- Queen's Univeristy, School of Nursing, 92 Barrie Street Kingston, Ontario, K7L 3N6, Canada
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Krampe N, Nebra Puertas A, Povar Echeverría M, Elmer J, Povar Marco J. Comparing demographics of organ donor referrals from the Intensive Care Unit and Outside Units. Transpl Int 2021; 34:2146-2153. [PMID: 34338368 DOI: 10.1111/tri.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 07/19/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Spanish organ donation system is a world leader in organ recovery. One of Spain's strategies is identification of organ donor referrals outside of the intensive care unit (ICU) for intensive care to facilitate organ donation (ICOD). There is limited data comparing the profiles of ICU-based and non-ICU ICOD referrals. METHODS This single-center retrospective chart review analyzed organ donor referrals of ICU and non-ICU patients to better understand the demographic and clinical differences between cohorts. The primary outcome was to understand if organ donation conversion rates were similar between ICU and non-ICU referrals. RESULTS We collected data from 745 organ donor referral candidates, 235 (32%) of whom entered ICOD protocols. Out of this cohort, 144 (61%) became an actual organ donor, 37 of whom (26%) were referred from non-ICU units. The ICU had the highest organ donor conversion rate (66% of ICU ICOD patients became actual organ donors) whereas non-ICU referrals had a 51% conversion rate. Non-ICU unit donors contributed to 21% and 26% of all kidney and liver donations, respectively. CONCLUSION Though organ referral candidates from non-ICU units contribute to a small proportion of actual donors, their donated organs are important to sustaining organ donation and transplant activity.
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Affiliation(s)
- Noah Krampe
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine
| | | | | | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, School of Medicine
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Qu Z, Oedingen C, Bartling T, Beneke J, Zink M, Krauth C, Schrem H. Systematic review on potential brain dead donor estimations and conversion rates to actually realized organ donations. Transplant Rev (Orlando) 2021; 35:100638. [PMID: 34246111 DOI: 10.1016/j.trre.2021.100638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Accurate estimations of potential organ donors (POTDs) are required to improve transplant systems. This systematic review analyses current studies on national estimations of potential donors for transplantation as well as the practical and policy implications of detected differences. METHOD A systematic review of literature published between 01.01.2010 and 01.04.2020 in PubMed was conducted. Data was extracted into a self-developed matrix, and further data retrieved on national population sizes, waiting lists and transplant activities. RESULTS Six studies were included. Investigated populations, underlying data collections and eligibility criteria for POTDs varied widely. Estimated POTDs per million population (p.m.p.) ranged from 25.8 to 333.6, conversion rates from 3.2% to 47.5% leading to 41.2 to 86.4 transplanted organs p.m.p.. Patients on the waiting lists varied from 66.7 to 338.9 p.m.p., defining gaps between organ supply and demand in countries. Not all studies adhered to the definitions and processes of the critical pathway for deceased donation which is the latest international consensus statement on deceased organ donation. CONCLUSION Differences in estimated POTDs and differences in supply and demand of donor organs between countries cannot be satisfactorily explained yet due to an obvious lack of evidence, consistent methodology, international consensus and robust underlying datasets. Future studies should be based on robust underlying data sets and aim for potential donor estimations that allow national comparisons due to the adherence to the international consensus on definitions, processes and methodology.
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Affiliation(s)
- Zhi Qu
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; Transplant Center, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
| | - Carina Oedingen
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Tim Bartling
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Jan Beneke
- Transplant Center, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Michael Zink
- Department of Anaesthesiology and Intensive Care Medicine, General Public Hospital Brothers of Saint John of God, Spitalgasse 26, A-9300 St. Veit/Glan, Austria; Head of the Austrian Transplantation Advisory Board, General Public Hospital of the Order of Saint Elisabeth in Klagenfurt, Völkermarkter Straße 15-19, A-9020 Klagenfurt am Wörthersee, Austria
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - Harald Schrem
- Center for Health Economics Research Hannover (CHERH), Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; General, Visceral and Transplant Surgery, Medical University Graz, Auenbrugger Platz 5/5, A-8036 Graz, Austria; Transplant Center Graz, Medical University Graz, Auenbrugger Platz 5/5, A-8036 Graz, Austria
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Silva E Silva V, Schirmer J, Roza BD, de Oliveira PC, Dhanani S, Almost J, Schafer M, Tranmer J. Defining Quality Criteria for Success in Organ Donation Programs: A Scoping Review. Can J Kidney Health Dis 2021; 8:2054358121992921. [PMID: 33680483 PMCID: PMC7897821 DOI: 10.1177/2054358121992921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background Well-established performance measures for organ donation programs do not fully address the complexity and multifactorial nature of organ donation programs such as the influence of relationships and organizational attributes. Objective To synthesize the current evidence on key organizational attributes and processes of international organ donation programs associated with successful outcomes and to generate a framework to categorize those attributes. Design Scoping Review using a mixed methods approach for data extraction. Setting Databases included PubMed, CINAHL, Embase, LILACS, ABI Business ProQuest, Business Source Premier, and gray literature (organ donation association websites, Google Scholar-first 8 pages), and searches for gray literature were performed, and relevant websites were perused. Sample Organ donation programs or processes. Methods We systematically searched the literature to identify any research design, including text and opinion papers and unpublished material (research data, reports, institutional protocols, government documents, etc). Searches were completed on January 2018, updated it in May 2019, and lastly in March 2020. Title, abstracts, and full texts were screened independently by 2 reviewers with disagreements resolved by a third. Data extraction followed a mixed method approach in which we extracted specific details about study characteristics such as type of research, year of publication, origin/country of study, type of journal published, and key findings. Studies included considered definitions and descriptions of success in organ donation programs in any country by considering studies that described (1) attributes associated with success or effectiveness, (2) organ donation processes, (3) quality improvement initiatives, (4) definitions of organ donation program effectiveness, (5) evidence-based practices in organ donation, and (6) improvements or success in such programs. We tabulated the type and frequency of the presence or absence of reported improvement quality indicators and used a qualitative thematic analysis approach to synthesize results. Results A total of 84 articles were included. Quantitative analysis identified that most of the included articles originated from the United States (n = 32, 38%), used quantitative approaches (n = 46, 55%), and were published in transplant journals (n = 34, 40.5%). Qualitative analysis revealed 16 categories that were described as positively influencing success/effectiveness of organ donation programs. Our thematic analysis identified 16 attributes across the 84 articles, which were grouped into 3 categories influencing organ donation programs' success: context (n = 39, 46%), process (n = 48, 57%), and structural (n = 59, 70%). Limitations Consistent with scoping review methodology, the methodological quality of included studies was not assessed. Conclusions This scoping review identified a number of factors that led to successful outcomes. However, those factors were rarely studied in combination representing a gap in the literature. Therefore, we suggest the development and reporting of primary research investigating and measuring those attributes associated with the performance of organ donation programs holistically. Trial Registration Not applicable.
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Affiliation(s)
| | | | | | | | - Sonny Dhanani
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Joan Almost
- School of Nursing, Queen's University, Kingston, ON, Canada
| | - Markus Schafer
- Department of Sociology, University of Toronto, ON, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, ON, Canada
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The Implementation of a Multidisciplinary Approach for Potential Organ Donors in the Emergency Department. Transplantation 2020; 103:2359-2365. [PMID: 30893291 DOI: 10.1097/tp.0000000000002701] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the implementation process of a multidisciplinary approach for potential organ donors in the emergency department (ED) in order to incorporate organ donation into their end-of-life care plans. METHODS A new multidisciplinary approach was implemented in 6 hospitals in The Netherlands between January 2016 and January 2018. The approach was introduced during staff meetings in the ED, intensive care unit (ICU), and neurology department. When patients with a devastating brain injury had a futile prognosis in the ED, without contraindications for organ donation, an ICU admission was considered. Every ICU admission to incorporate organ donation into end-of-life care was systematically evaluated with the involved physicians using a standardized questionnaire. RESULTS In total, 55 potential organ donors were admitted to the ICU to incorporate organ donation into end-of-life care. Twenty-seven families consented to donation and 20 successful organ donations were performed. Twenty-nine percent of the total pool of organ donors in these hospitals were admitted to the ICU for organ donation. CONCLUSIONS Patients with a devastating brain injury and futile medical prognosis in the ED are an important proportion of the total number of donors. The implementation of a multidisciplinary approach is feasible and could lead to better identification of potential donors in the ED.
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Manara AR, Thomas I. Current status of organ donation after brain death in the UK. Anaesthesia 2020; 75:1205-1214. [DOI: 10.1111/anae.15038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2020] [Indexed: 01/07/2023]
Affiliation(s)
- A. R. Manara
- Department of Intensive Care Medicine and Anaesthesia Southmead Hospital Bristol UK
| | - I. Thomas
- Department of Intensive Care Medicine and Anaesthesia Southmead Hospital Bristol UK
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[Intensive care to facilitate organ donation. ONT-SEMICYUC recommendations]. Med Intensiva 2019; 45:234-242. [PMID: 31740045 DOI: 10.1016/j.medin.2019.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/20/2019] [Accepted: 09/28/2019] [Indexed: 11/22/2022]
Abstract
Intensive care to facilitate organ donation (ICOD) is defined as the initiation or continuation of life-sustaining measures, such as mechanical ventilation, in patients with a devastating brain injury with high probability of evolving to brain death and in whom curative treatment has been completely dismissed and considered futile. ICOD incorporates the option to organ donation allowing a holistic approach to end-of-life care, consistent with the patients wills and values. Should the patient not evolve to brain death, life-supportive treatment must be withdrawal and controlled asystolia donation could be evaluated. ICOD is a legitimate practice, within the ethical and legal regulations that contributes increasing the accessibility of patients to transplantation, promoting health by increasing deceased donation by 24%, and with a mean of 2.3 organs transplanted per donor, and collaborating with the sustainability of health-care system. This ONT-SEMICYUC recommendations provide a guide to facilitate an ICOD harmonized practice in spanish ICUs.
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Mazo C, Gómez A, Sandiumenge A, Baena J, Báguena M, Nuvials FX, Ferrer R, Boned S, Rubiera M, Pont T. Intensive Care to Facilitate Organ Donation: A Report on the 4-Year Experience of a Spanish Center With a Multidisciplinary Model to Promote Referrals Out of the Intensive Care Unit. Transplant Proc 2019; 51:3018-3026. [DOI: 10.1016/j.transproceed.2019.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Witjes M, Jansen NE, van der Hoeven JG, Abdo WF. Interventions aimed at healthcare professionals to increase the number of organ donors: a systematic review. Crit Care 2019; 23:227. [PMID: 31221214 PMCID: PMC6587298 DOI: 10.1186/s13054-019-2509-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background The last decade, there have been many initiatives worldwide to increase the number of organ donors. However, it is not clear which initiatives are most effective. The aim of this study is to provide an overview of interventions aimed at healthcare professionals in order to increase the number of organ donors. Methods We systematically searched PubMed, EMBASE, CINAHL, PsycINFO, and the Cochrane Library for English language studies published until April 24, 2019. We included studies describing interventions in hospitals aimed at healthcare professionals who are involved in the identification, referral, and care of a family of potential organ donors. After the title abstract and full-text selection, two reviewers independently assessed each study’s quality and extracted data. Results From the 18,854 records initially extracted from five databases, we included 22 studies in our review. Of these 22 studies, 14 showed statistically significant effects on identification rate, family consent rate, and/or donation rate. Interventions that positively influenced one or more of these outcomes were training of emergency personnel in organ donation, an electronic support system to identify and/or refer potential donors, a collaborative care pathway, donation request by a trained professional, and additional family support in the ICU by a trained nurse. The methodological quality of the studies was relatively low, mainly because of the study designs. Conclusions Although there is paucity of data, collaborative care pathways, training of healthcare professionals and additional support for relatives of potential donors seem to be promising interventions to increase the number of organ donors. Trial registration PROSPERO, CRD42018068185 Electronic supplementary material The online version of this article (10.1186/s13054-019-2509-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marloes Witjes
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands.,Dutch Transplant Foundation, Leiden, The Netherlands
| | | | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands
| | - Wilson F Abdo
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands.
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