The Continued Need for Clinical Trials in Deceased Organ Donor Management

The potential use of non-fungible tokens (NFTs) in healthcare and medical research

Non-fungible tokens (NFTs) are cryptographic assets recorded on the blockchain that can certify authenticity and ownership, and they can be used to monetize health data, optimize the process of receiving a hematopoietic stem cell transplant, and improve the distribution of solid organs for transplantation. Blockchain technology, including NFTs, provides equitable access to wealth, increases transparency, eliminates personal or institutional biases of intermediaries, reduces inefficiencies, and ensures accountability. Blockchain architecture is ideal for ensuring security and privacy while granting individuals jurisdiction over their own information, making it a unique solution to the current limitations of existing health information systems. NFTs can be used to give patients the option to monetize their health data and provide valuable data to researchers. Wearable technology companies can also give their customers the option to monetize their data while providing data necessary to improve their products. Additionally, the process of receiving a hematopoietic stem cell transplant and the distribution of solid organs for transplantation could benefit from the integration of NFTs into the allocation process. However, there are limitations to the technology, including high energy consumption and the need for regulatory guidance. Further research is necessary to fully understand the potential of NFTs in healthcare and how it can be integrated with existing health information technology. Overall, NFTs have the potential to revolutionize the healthcare sector, providing benefits such as improved access to health information and increased efficiency in the distribution of organs for transplantation.

S-Nitrosylated hemoglobin predicts organ yield in neurologically-deceased human donors

Current human donor care protocols following death by neurologic criteria (DNC) can stabilize macro-hemodynamic parameters but have minimal ability to preserve systemic blood flow and microvascular oxygen delivery. S-nitrosylated hemoglobin (SNO-Hb) within red blood cells (RBCs) is the main regulator of tissue oxygenation (StO₂). Based on various pre-clinical studies, we hypothesized that brain death (BD) would decrease post-mortem SNO-Hb levels to negatively-impact StO₂ and reduce organ yields. We tracked SNO-Hb and tissue oxygen in 61 DNC donors. After BD, SNO-Hb levels were determined to be significantly decreased compared to healthy humans (p = 0·003) and remained reduced for the duration of the monitoring period. There was a positive correlation between SNO-Hb and StO₂ (p < 0.001). Furthermore, SNO-Hb levels correlated with and were prognostic for the number of organs transplanted (p < 0.001). These clinical findings provide additional support for the concept that BD induces a systemic impairment of S-nitrosylation that negatively impacts StO₂ and reduces organ yield from DNC human donors. Exogenous S-nitrosylating agents are in various stages of clinical development. The results presented here suggest including one or more of these agents in donor support regimens could increase the number and quality of organs available for transplant.

Therapeutic Hypothermia in Organ Donors: Follow-up and Safety Analysis

BACKGROUND

In a recent trial, targeted mild hypothermia in brain-dead organ donors significantly reduced the incidence of delayed graft function after kidney transplantation. This trial was stopped early for efficacy. Here, we report long-term graft survival for all organs along with donor critical care end points.

METHODS

We assessed graft survival through 1 year of all solid organs transplanted from 370 donors who had been randomly assigned to hypothermia (34-35°C) or normothermia (36.5-37.5°C) before donation. Additionally, changes in standardized critical care end points were compared between donors in each group.

RESULTS

Mild hypothermia was associated with a nonsignificant improvement in 1-year kidney transplant survival (95% versus 92%; hazard ratio, 0.61 [0.31-1.20]; P = 0.15). Mild hypothermia was associated with higher 1-year graft survival in the subgroup of standard criteria donors (97% versus 93%; hazard ratio, 0.39 [0.15 to -1.00]; P = 0.05). There were no significant differences in graft survival of extrarenal organs. There were no differences in critical care end points between groups.

CONCLUSIONS

Mild hypothermia in the donor safely reduced the rate of delayed graft function in kidney transplant recipients without adversely affecting donor physiology or extrarenal graft survival. Kidneys from standard criteria donors who received targeted mild hypothermia had improved 1-year graft survival.

Management of donation after brain death (DBD) in the ICU: the potential donor is identified, what's next?

The success of any donation process requires that potential brain-dead donors (PBDD) are detected and referred early to professionals responsible for their evaluation and conversion to actual donors. The intensivist plays a crucial role in organ donation. However, identification and referral of PBDDs may be suboptimal in the critical care environment. Factors influencing lower rates of detection and referral include the lack of specific training and the need to provide concomitant urgent care to other critically ill patients. Excellent communication between the ICU staff and the procurement organization is necessary to ensure the optimization of both the number and quality of organs transplanted. The organ donation process has been improved over the last two decades with the involvement and commitment of many healthcare professionals. Clinical protocols have been developed and implemented to better organize the multidisciplinary approach to organ donation. In this manuscript, we aim to highlight the main steps of organ donation, taking into account the following: early identification and evaluation of the PBDD with the use of checklists; donor management, including clinical maintenance of the PBDD with high-quality intensive care to prevent graft failure in recipients and strategies for optimizing donated organs by simplified care standards, clinical guidelines and alert tools; the key role of the intensivist in the donation process with the interaction between ICU professionals and transplant coordinators, nurse protocol managers, and communication skills training; and a final remark on the importance of the development of research with further insight into brain death pathophysiology and reversible organ damage.