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Zanatta P, Linassi F, Gasparetto N, Polesello L, Bussola M, Nascimben E, Minniti G, Cernetti C, Angelini M, Feltrin G, Romano M, Zanus G, Benazzi F, Gerosa G. Successful Recovery of Cardiac Function Following 20 min of a No-touch Period in a Donation After Circulatory Death: A Case Report. Transplantation 2024; 108:e106-e109. [PMID: 38750639 DOI: 10.1097/tp.0000000000004940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND Withdrawal of life-sustaining therapy (WLST) performed in the circulatory determination of death (DCD) donors leads to cardiac arrest, challenging the utilization of the myocardium for transplantation. The rapid initiation of normothermic regional perfusion or extracorporeal membrane oxygenation after death helps to optimize organs before implantation. However, additional strategies to mitigate the effects of stress response during WLST, hypoxic/ischemic injury, and reperfusion injury are required to allow myocardium recovery. METHODS To this aim, our team routinely used a preconditioning protocol for each DCD donation before and during the WLST and after normothermic regional perfusion/extracorporeal membrane oxygenation. The protocol includes pharmacological treatments combined to reduce oxidative stress (melatonin, N -acetylcysteine, and ascorbic acid), improve microcirculation (statins), and mitigate organ's ischemic injury (steroids) and organ ischemia/reperfusion injury (remifentanil and sevoflurane when the heart is available for transplantation). RESULTS This report presents the first case of recovery of cardiac function, with the only support of normothermic regional reperfusion, following 20 min of a no-touch period and 41 min of functional warm ischemic time in a DCD donor after the preconditioning protocol. CONCLUSIONS Our protocol seems to be effective in abolishing the stress response during WLST and, on the other hand, particularly organ protective (and heart protective), giving a chance to donate organs less impaired from ischemia/reperfusion injury.
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Affiliation(s)
- Paolo Zanatta
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Federico Linassi
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
- Department of Pharmaceutical and Pharmacological Sciences, Università degli Studi di Padova, Padova, Italy
| | - Nicola Gasparetto
- Division of Cardiology, Neuro-Cardio-Vascular Department, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Luigi Polesello
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Matteo Bussola
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Ennio Nascimben
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Giuseppe Minniti
- Division of Cardiac Surgery, Neuro-Cardio-Vascular Department, Treviso Regional Hospital AULSS 2 Marca Trevigiana Piazzale Ospedale 1, Treviso, Italy
| | - Carlo Cernetti
- Division of Cardiology, Neuro-Cardio-Vascular Department, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Matteo Angelini
- Department of Anesthesiology and Critical Care, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Giuseppe Feltrin
- Veneto Region Transplant Center Coordination, Veneto Region, Italy
| | - Maurizio Romano
- Division of Hepato-Pancreatic and Kidney Transplantation Surgery, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Giacomo Zanus
- Division of Hepato-Pancreatic and Kidney Transplantation Surgery, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Francesco Benazzi
- Department of Hospital Strategic Direction, Treviso Regional Hospital AULSS 2 Marca Trevigiana, Treviso, Italy
| | - Gino Gerosa
- Cardiac Surgery Clinic, Department of Cardiac, Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Eid R, Scemla A, Giral M, Arzouk N, Bertrand D, Peraldi MN, Mesnard L, Longuet H, Maanaoui M, Desbuissons G, Lefevre E, Snanoudj R. Use of a Belatacept-based Immunosuppression for Kidney Transplantation From Donors After Circulatory Death: A Paired Kidney Analysis. Transplant Direct 2024; 10:e1615. [PMID: 38617465 PMCID: PMC11013701 DOI: 10.1097/txd.0000000000001615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 04/16/2024] Open
Abstract
Background Efficacy and safety of belatacept have not been specifically reported for kidney transplantations from donors after circulatory death. Methods In this retrospective multicenter paired kidney study, we compared the outcome of kidney transplantations with a belatacept-based to a calcineurin inhibitor (CNI)-based immunosuppression. We included all kidney transplant recipients from donors after uncontrolled or controlled circulatory death performed in our center between February 2015 and October 2020 and treated with belatacept (n = 31). The control group included the recipients of the contralateral kidney that were treated with CNI in 8 other centers (tacrolimus n = 29, cyclosporine n = 2). Results There was no difference in the rate of delayed graft function. A higher incidence of biopsy-proven rejections was noted in the belatacept group (24 versus 6 episodes). Estimated glomerular filtration rate (eGFR) was significantly higher in the belatacept group at 3-, 12-, and 36-mo posttransplant, but the slope of eGFR was similar in the 2 groups. During a mean follow-up of 4.1 y, 12 patients discontinued belatacept and 2 patients were switched from CNI to belatacept. For patients who remained on belatacept, eGFR mean value and slope were significantly higher during the whole follow-up. At 5 y, eGFR was 80.7 ± 18.5 with belatacept versus 56.3 ± 22.0 mL/min/1.73 m2 with CNI (P = 0.003). No significant difference in graft and patient survival was observed. Conclusions The use of belatacept for kidney transplants from either uncontrolled or controlled donors after circulatory death resulted in a better medium-term renal function for patients remaining on belatacept despite similar rates of delayed graft function and higher rates of cellular rejection.
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Affiliation(s)
- Rita Eid
- Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Anne Scemla
- Department of Nephrology and Transplantation, Necker University Hospital for Sick Children, AP-HP, Paris, France
| | - Magali Giral
- Department of Nephrology and Transplantation, Nantes University Hospital Centre, Nantes, France
| | - Nadia Arzouk
- Department of Nephrology and Transplantation, Pitié Salpêtrière University Hospital, AP-HP, Paris, France
| | - Dominique Bertrand
- Department of Nephrology and Transplantation, Rouen University Hospital Centre, Rouen, France
| | - Marie-Noëlle Peraldi
- Department of Nephrology and Transplantation, Saint-Louis Hospital, AP-HP, Paris, France
| | - Laurent Mesnard
- Department of Nephrology and Transplantation, Tenon Hospital, AP-HP, Paris, France
| | - Helene Longuet
- Department of Nephrology and Transplantation, Tours University Hospital Centre, Tours, France
| | - Mehdi Maanaoui
- Department of Nephrology and Transplantation, Lille University Hospital Centre, Lille, France
| | - Geoffroy Desbuissons
- Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Edouard Lefevre
- Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | - Renaud Snanoudj
- Department of Nephrology and Transplantation, Bicêtre Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
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Febrero B, Almela-Baeza J, Ros-Madrid I, Iniesta M, Martínez-Alarcón L, Ramírez P. Attitude of the Older Population Toward Controlled Asystole Donation. Transplant Proc 2023; 55:2250-2252. [PMID: 37775403 DOI: 10.1016/j.transproceed.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Studies about the knowledge of and attitude toward new lines of organ donation in a group of older people are important due to the increase in older organ donors. OBJECTIVES To analyze the attitude of citizens over 65 years of age in southeastern Spain toward controlled asystole donation (CAD) and to determine the psycho-social profile that influences this attitude. METHODS The study population consisted of citizens over 65 years of age. A representative sample was obtained in southeastern Spain (N = 420). A questionnaire about attitudes toward CAD was used, detailing in the questionnaire that this is a type of donation from people who have died of circulatory and respiratory criteria after the limitation of life support treatment. Several psychosocial variables were also taken into account. Statistical analysis included the χ2 test and multivariate analysis. RESULTS The completion rate was 84% (n = 351). Favorable attitude toward organ donation and transplantation (ODT) was 98% (n = 344) overall, and CAD was viewed favorably by 45% (n = 158). The psychosocial variables that influenced attitude toward CAD were mainly having received a talk about ODT (odds ratio [OR] 5.6), knowing the opinion of one's partner (OR 7.95), acceptance of cremation (OR 1.09), and acceptance of autopsy (OR 3.002). CONCLUSIONS The attitude of older people toward CAD is unfavorable despite a willingness to support ODT in general. This attitude is influenced by variables of social and family dialogue about ODT, attitude to body manipulation, and having received information about ODT.
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Affiliation(s)
- Beatriz Febrero
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
| | - Javier Almela-Baeza
- Faculty of Communication and Documentation, University of Murcia, Murcia, Spain.
| | | | - María Iniesta
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
| | - Laura Martínez-Alarcón
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
| | - Pablo Ramírez
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
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Thiessen C, Wisel SA, Roll GR. Simultaneous thoracic and abdominal donation after circulatory death organ recovery: the abdominal surgeon's perspective. Curr Opin Organ Transplant 2023; 28:139-144. [PMID: 36603197 PMCID: PMC9994842 DOI: 10.1097/mot.0000000000001045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF THE REVIEW To summarize the international experience with heart-liver (joint) donation after circulatory death (DCD) procurements and to explore the technical challenges in joint abdominal and thoracic DCD procurement. RECENT FINDINGS Following completion of the Donors After Circulatory Death Heart Trial in the US, combined thoracic and abdominal DCD is poised to become the standard of care, expanding access to life-saving heart and lung allografts. DCD heart procurement relies on collection of donor blood for priming of the normothermic perfusion pump, which delays cooling of abdominal organs and increases risk of ischemic injury. We review the effect of donor ischemia time on abdominal organs, with several proposed technical solutions to optimize transplant outcomes for all organs. SUMMARY The strategies reviewed in this manuscript may inform clinical decision-making, preoperative coordination between thoracic and abdominal procurement teams, and surgical technique for joint DCD procurements. Several approaches to organ procurement organization (OPO) and national policy, as well as future areas of focus for research are proposed.
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Affiliation(s)
- Carrie Thiessen
- Division of Transplantation, University of Wisconsin, Madison, Wisconsin
| | - Steven A. Wisel
- Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles
| | - Garrett R. Roll
- Division of Transplantation, University of California, San Francisco, San Francisco, California, USA
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5
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Lung transplantation following donation after circulatory death. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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6
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Petit V, Lenain R, Debillon F, Hazzan M, Provot F. [Association between controlled circulatory death donor waitlisting and waiting time before kidney transplantation in a French center]. Nephrol Ther 2022; 18:604-610. [PMID: 36357263 DOI: 10.1016/j.nephro.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Transplantation from controlled donation after circulatory determination of death (cDCD) is a new practice in France. An additional specific consent is required for registration on the cDCD waiting list. The aim of this study is to evaluate the impact of cDCD acceptance on the waiting time for the registered patients on the transplant list. METHODS Patients registered on the kidney transplant waiting list for a Death Brain Donor (DBD) kidney transplant between 2018 and 2019 in our center were included. Patients who were candidates for a second kidney transplant or who had already received an organ transplant were not included. The cDCD waiting list registration was authorized by a signed consent of the patient on the day of DBD registration. The primary endpoint was time to renal transplantation. RESULTS Of the 315 patients eligible for a cDCD graft at transplant list registration, 152 were registered on the cDCD waiting list. Time to transplantation for these patients was multiplied by 1.42 (95%CI 1.07-1.87) compared with patients not registered for a cDCD graft. The time to transplantation was 2.59 months (95%CI 0.49-4.69) shorter for a 2-year follow-up for cDCD-listed patients. This represents one additional transplant at 6 months for every seven registered patients. CONCLUSION cDCD waiting list registration reduced the time to kidney transplantation in France.
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Affiliation(s)
- Vivien Petit
- Service de néphrologie, CHU de Lille, Lille, France; Service de néphrologie, centre hospitalier de Dunkerque, 59240 Dunkerque, France.
| | - Remi Lenain
- Service de néphrologie, CHU de Lille, Lille, France; Inserm UMR 1246 - SPHERE, université de Nantes, université de Tours, Nantes, France
| | | | - Marc Hazzan
- Service de néphrologie, CHU de Lille, Lille, France
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Arslan Z, Hennessy J, McCulloch MI, Dipchand AI, Lefkowitz DS, Marks SD. Experience of ethical dilemmas among professionals working in pediatric transplantation: An international survey. Pediatr Transplant 2022; 26:e14331. [PMID: 35851709 PMCID: PMC9787614 DOI: 10.1111/petr.14331] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/27/2022] [Accepted: 05/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Professionals working in pediatric transplantation commonly encounter complex ethical dilemmas. Most ethical research in transplantation is related to adult practice. We aimed to gain insight into ethical issues faced by transplant professionals when dealing with pediatric transplant recipients. METHODS A two-stage study was designed; the first part was a questionnaire completed by 190 (80%) members of the International Pediatric Transplant Association (IPTA) from over 30 different countries. This was followed by a multidisciplinary focus group that explored the preliminary data of the survey. RESULTS A total of 38% (56 of 149) respondents of the questionnaire had experienced an ethical issue between 2016 and 2018. Surgeons were more likely to have encountered an ethical issue as compared with physicians (60% vs. 35.7%, p = .035). Clinicians from Europe were more likely to have experienced an ethical issue in living organ donation compared with those from North America (78.9% vs. 52.5%, p = .005), with common ethical concerns being psychosocial evaluation and follow-up care of donors. The focus group highlighted the importance of a multidisciplinary approach to ethical issues. CONCLUSION The results of this study can direct future research into pediatric transplantation ethics with the aim of producing educational resources, policies, and ethical guidelines.
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Affiliation(s)
- Zainab Arslan
- Department of Paediatric NephrologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - Jack Hennessy
- NIHR Great Ormond Street Hospital Biomedical Research CentreUniversity College London Great Ormond Street Institute of Child HealthLondonUK
| | - Mignon I. McCulloch
- Children's Hospital of PhiladelphiaPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA,Department of Paediatric Nephrology, Red Cross War Memorial Children's HospitalUniveristy of Cape TownCape TownSouth Africa
| | - Anne I. Dipchand
- Department of Pediatrics, Labatt Family Heart Centre, Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | - Debra S. Lefkowitz
- Children's Hospital of PhiladelphiaPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Stephen D. Marks
- Department of Paediatric NephrologyGreat Ormond Street Hospital for ChildrenLondonUK,NIHR Great Ormond Street Hospital Biomedical Research CentreUniversity College London Great Ormond Street Institute of Child HealthLondonUK
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Leonova EI, Reshetnikov VV, Sopova JV. CRISPR/Cas-edited pigs for personalized medicine: more than preclinical test-system. RESEARCH RESULTS IN PHARMACOLOGY 2022. [DOI: 10.3897/rrpharmacology.8.83872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Novel CRISPR-Cas-based genome editing tools made it feasible to introduce a variety of precise genomic modifications in the pig genome, including introducing multiple edits simultaneously, inserting long DNA sequences into specifically targeted loci, and performing nucleotide transitions and transversions. Pigs serve as a vital agricultural resource and animal model in biomedical studies, given their advantages over the other models. Pigs share high similarities to humans regarding body/organ size, anatomy, physiology, and a metabolic profile. The pig genome can be modified to carry the same genetic mutations found in humans to replicate inherited diseases to provide preclinical trials of drugs. Moreover, CRISPR-based modification of pigs antigen profile makes it possible to offer porcine organs for xenotransplantation with minimal transplant rejection responses. This review summarizes recent advances in endonuclease-mediated genome editing tools and research progress of genome-edited pigs as personalized test-systems for preclinical trials and as donors of organs with human-fit antigen profile.
Graphical abstract:
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Mora V, Ballesteros MA, Naranjo S, Sánchez L, Suberviola B, Iturbe D, Cimadevilla B, Tello S, Alvarez C, Miñambres E. Lung transplantation from controlled donation after circulatory death using simultaneous abdominal normothermic regional perfusion: A single center experience. Am J Transplant 2022; 22:1852-1860. [PMID: 35390225 DOI: 10.1111/ajt.17057] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 01/25/2023]
Abstract
Despite the benefits of abdominal normothermic regional perfusion (A-NRP) for abdominal grafts in controlled donation after circulatory death (cDCD), there is limited information on the effect of A-NRP on the quality of the cDCD lungs. We aimed to study the effect of A-NRP in lungs obtained from cDCD and its impact on recipients´ outcomes. This is a study comparing outcomes of lung transplants (LT) from cDCD donors (September 2014 to December 2021) obtained using A-NRP as the abdominal preservation method. As controls, all lung recipients transplanted from donors after brain death (DBD) were considered. The primary outcomes were lung recipient 3-month, 1-year, and 5-year survival. A total of 269 LT were performed (60 cDCD and 209 DBD). There was no difference in survival at 3 months (98.3% cDCD vs. 93.7% DBD), 1 year (90.9% vs. 87.2%), and 5 years (68.7% vs. 69%). LT from the cDCD group had a higher rate of primary graft dysfunction grade 3 at 72 h (10% vs. 3.4%; p < .001). This is the largest experience ever reported with the use of A-NRP combined with lung retrieval in cDCD donors. This combined method is safe for lung grafts presenting short-term survival outcomes equivalent to those transplanted through DBD.
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Affiliation(s)
- Victor Mora
- Service of Neumology, Lung Transplantation Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Maria Angeles Ballesteros
- Transplant Coordination Unit & Service of Intensive Care, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Sara Naranjo
- Service of Thoracic Surgery, Lung Transplantation Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Laura Sánchez
- Service of Thoracic Surgery, Lung Transplantation Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Borja Suberviola
- Transplant Coordination Unit & Service of Intensive Care, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - David Iturbe
- Service of Neumology, Lung Transplantation Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Bonifacio Cimadevilla
- Service of Anesthesia, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Sandra Tello
- Service of Neumology, Lung Transplantation Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Carlos Alvarez
- Service of Thoracic Surgery, Lung Transplantation Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.,School of Medicine, University of Cantabria, Santander, Spain
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Pancreas Transplantation from Donors after Cardiac Death – The US Experience. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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11
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Seth AK, Mohanka R, Navin S, Gokhale AGK, Sharma A, Kumar A, Ramachandran B, Balakrishnan KR, Mirza D, Mehta D, Zirpe KG, Dhital K, Sahay M, Simha S, Sundaram R, Pandit R, Mani RK, Gursahani R, Gupta S, Kute VB, Shroff S. Organ Donation after Circulatory Determination of Death in India: A Joint Position Paper. Indian J Crit Care Med 2022; 26:421-438. [PMID: 35656056 PMCID: PMC9067489 DOI: 10.5005/jp-journals-10071-24198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Avnish K Seth
- Manipal Organ Sharing and Transplant (MOST), Manipal Hospital, New Delhi, India
| | - Ravi Mohanka
- Department of Liver Transplant and HPB Surgery, Reliance Foundation Hospital, Mumbai, Maharashtra, India
- Ravi Mohanka, Department of Liver Transplant and HPB Surgery, Reliance Foundation Hospital, Mumbai, Maharashtra, India, Phone: +91 7506668666, e-mail:
| | | | | | - Ashish Sharma
- Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Kumar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Bala Ramachandran
- Department of Pediatric Intensive Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
| | | | - Darius Mirza
- University of Birmingham, United Kingdom and Apollo Hospitals, Navi Mumbai, Maharashtra, India
| | | | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Kumud Dhital
- Department of Heart and Lung Transplantation, SS Sparsh Hospital, Bengaluru, Karnataka, India
| | - Manisha Sahay
- Osmania Medical College and Hospital, Hyderabad, Telangana, India
| | - Srinagesh Simha
- Department of Palliative Care, Karunashraya, Bengaluru, Karnataka, India
| | | | | | - Raj K Mani
- Department of Critical Care and Pulmonology, Yashoda Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India
| | - Roop Gursahani
- Department of Neurology, PD Hinduja National Hospital, Mumbai, Maharashtra, India
| | - Subash Gupta
- Max Centre for Liver and Biliary Sciences, New Delhi, India
| | - Vivek B Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India
| | - Sunil Shroff
- Madras Medical Mission, Chennai, Tamil Nadu, India
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12
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Feo M, Miñambres E, Suberviola B, Campos-Fernández S, Sánchez-Arguiano J, Kislikova M, Ballesteros MA. Controlled Donation After Circulatory Death Program: Analysis and Results at a Tertiary Care Hospital. Transplant Proc 2022; 54:70-72. [PMID: 34974895 DOI: 10.1016/j.transproceed.2021.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The objective of the study was to evaluate the impact in organs obtained and transplanted from controlled donation after circulatory death (cDCD). METHODS Transplants from cDCD donors performed at the Hospital Universitario Marqués de Valdecilla from the beginning of the program (December 2013) to December 2020 were evaluated. All procedures were performed with normothermic regional perfusion. Donors after brain death (DBDs) during the same period were used as a control group. RESULTS A total of 95 donors after cardiac death and 152 DBDs were included. Age was similar in both groups (60 years [IQR, 53-68 years vs 62 years {IQR, 51-79 years]; P = .390). The number of organs recovered per donor was higher in the DBD group (4 [IQR, 3-5] vs 3 [IQR, 2-4], P < .001], as well as the number of transplanted organs (4 [IQR, 2-4] vs 2 [IQR, 2-4]; P = .002]. However, the number of noneffective donors was similar. DBDs presented a higher rate of liver donation (30.5% vs 46.7%; P = .012), lung donation (25.3% vs 38.2%; P = .036), and cardiac donation (1.1% vs 21.7%; P < .001) with respect to the donors after cardiac death group, but kidney and pancreatic donation were similar. CONCLUSIONS The cDCD with normothermic regional perfusion program is fully established in our center. The age of the cDCD donor has increased with experience and it is currently identical to the control group (DBD). After overcoming the learning curve, cDCD is a multiorgan donation that presents an excellent profitability in the number of organs extracted and transplanted.
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Affiliation(s)
- Marlene Feo
- Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Eduardo Miñambres
- Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Transplant Coordination Unit, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; School of Medicine, University of Cantabria, Santander, Spain
| | - Borja Suberviola
- Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Transplant Coordination Unit, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Sandra Campos-Fernández
- Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Juncal Sánchez-Arguiano
- Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Maria Kislikova
- Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - María A Ballesteros
- Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain; Transplant Coordination Unit, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.
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13
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Shroff S, Seth A, Mohanka R, Navin S, Gokhale AK, Sharma A, Kumar A, Ramachandran B, Balakrishnan KR, Mirza D, Mehta D, Zirpe K, Dhital K, Sahay M, Simha S, Sundaram R, Pandit R, Mani R, Gursahani R, Gupta S, Kute V. Organ donation after circulatory determination of death in India: A joint position paper. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Branchereau J, Ogbemudia AE, Bas-Bernardet SL, Prudhomme T, Rigaud J, Karam G, Blancho G, Mesnard B. Novel Organ Perfusion and Preservation Strategies in Controlled Donation After Circulatory Death in Pancreas and Kidney Transplantation. Transplant Proc 2021; 54:77-79. [PMID: 34879976 DOI: 10.1016/j.transproceed.2021.09.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Kidney and pancreatic transplants from controlled donation after circulatory death donors are vulnerable to ischemia-reperfusion injuries. In this context of transplant shortage, there is a need to optimize the function of these transplants and to develop novel perfusion and preservation strategies in controlled donation after circulatory death in kidney and pancreatic transplants. IN SITU PERFUSION AND PRESERVATION STRATEGIES In situ regional normothermic perfusion improves the outcome of kidney transplants from controlled donation after circulatory death and provides equivalent results for the kidney from brain-dead donors. In situ regional normothermic perfusion is under investigation for pancreatic transplants. EX SITU PERFUSION AND PRESERVATION STRATEGIES Perfusion on hypothermic machine perfusion is highly recommended for the kidney from controlled donation after cardiac death. Hypothermic oxygenated perfusion machine decreases the rate of graft rejection and graft failure in kidney transplantation. Ex situ normothermic perfusion is an easy way to assess renal function. In the future, kidney transplants could benefit from drug therapy during ex situ normothermic perfusion. In pancreas transplantation, hypothermic machine perfusion and ex situ normothermic perfusion present encouraging results in preclinical studies.
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Affiliation(s)
- J Branchereau
- Department of Urology and Transplantation Surgery, Nantes, France; Nuffield Department of Surgical Science, Oxford, United Kingdom; Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France.
| | - A E Ogbemudia
- Nuffield Department of Surgical Science, Oxford, United Kingdom
| | - S Le Bas-Bernardet
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
| | - T Prudhomme
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
| | - J Rigaud
- Department of Urology and Transplantation Surgery, Nantes, France
| | - G Karam
- Department of Urology and Transplantation Surgery, Nantes, France; Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
| | - G Blancho
- Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
| | - B Mesnard
- Department of Urology and Transplantation Surgery, Nantes, France; Centre de Recherche en Transplantation et Immunologie (ou CRTI), Inserm, Nantes University, Nantes, France
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15
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Callaghan CJ, Ibrahim M, Counter C, Casey J, Friend PJ, Watson CJE, Karydis N. Outcomes after simultaneous pancreas-kidney transplantation from donation after circulatory death donors: A UK registry analysis. Am J Transplant 2021; 21:3673-3683. [PMID: 33870619 DOI: 10.1111/ajt.16604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 01/25/2023]
Abstract
There are concerns that simultaneous pancreas-kidney (SPK) transplants from donation after circulatory death (DCD) donors have a higher risk of graft failure than those from donation after brain death (DBD) donors. A UK registry analysis of SPK transplants between 2005 and 2018 was performed. Pancreas survivals of those receiving organs from DCD or DBD donors were compared. Multivariable analyses were used to adjust for baseline differences between the two groups and to identify factors associated with pancreas graft loss. A total of 2228 SPK transplants were implanted; 403 (18.1%) were from DCD donors. DCD donors were generally younger, slimmer, less likely to have stroke as a cause of death, with lower terminal creatinines and shorter pancreas cold ischemic times than DBD donors. Median (IQR) follow-up was 4.2 (1.6-8.1) years. On univariable analysis, there were no statistically significant differences in 5-year death-censored pancreas graft survival between the two donor types (79.5% versus 80.4%; p = .86). Multivariable analysis showed no statistically significant differences in 5-year pancreas graft loss between transplants from DCD (n = 343) and DBD (n = 1492) donors (hazard ratio 1.26, 95% CI 0.76-1.23; p = .12). The findings from this study support the increased use of SPK transplants from DCD donors.
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Affiliation(s)
- Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, UK
| | - Claire Counter
- Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, UK
| | - John Casey
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Peter J Friend
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Christopher J E Watson
- Department of Surgery, University of Cambridge, and Cambridge NIHR Biomedical Research Centre, The NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, Cambridge, UK
| | - Nikolaos Karydis
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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16
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De Beule J, Vandendriessche K, Pengel LHM, Bellini MI, Dark JH, Hessheimer AJ, Kimenai HJAN, Knight SR, Neyrinck AP, Paredes D, Watson CJE, Rega F, Jochmans I. A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation. Transpl Int 2021; 34:2046-2060. [PMID: 34570380 DOI: 10.1111/tri.14121] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 12/29/2022]
Abstract
In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research.
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Affiliation(s)
- Julie De Beule
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | | | - Liset H M Pengel
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK
| | - Maria Irene Bellini
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - John H Dark
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Amelia J Hessheimer
- Department of General & Digestive Surgery, Institut Clínic de Malalties Digestives i Metabòliques (ICMDM), Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Simon R Knight
- Nuffield Department of Surgical Sciences, Centre for Evidence in Transplantation, University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Arne P Neyrinck
- Department of Cardiovascular Sciences, Anesthesiology and Algology, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - David Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Christopher J E Watson
- Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,The NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Filip Rega
- Department of Cardiovascular Sciences, Cardiac Surgery, KU Leuven, Leuven, Belgium.,Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium.,Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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17
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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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18
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Kidney Transplants in Controlled Donation Following Circulatory Death, or Maastricht Type III Donors, With Abdominal Normothermic Regional Perfusion, Optimizing Functional Outcomes. Transplant Direct 2021; 7:e725. [PMID: 34291147 PMCID: PMC8288885 DOI: 10.1097/txd.0000000000001174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/31/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background. Warm ischemia time and ischemia-reperfusion damage result in higher rates of delayed graft function and primary nonfunction in kidney transplants (KTs) from controlled donation after circulatory death (cDCD). This study aimed to assess early and late kidney function and patient and graft survival of KT from cDCD preserved with normothermic regional perfusion (NRP) and to compare with KT from brain death donors (DBDs) and cDCD preserved with rapid recovery (RR). Methods. Patients who received a KT at our institution from 2012 to 2018 were included, with a minimum follow-up period of 1 y. They were categorized by donor type and conditioning methods: DBD, cDCD with NRP, and cDCD with RR. Early and late graft function, along with patient and graft survival were analyzed in all groups. Results. A total of 182 KT recipients were included in the study (98 DBD and 84 cDCD). Out of the cDCDs, 24 kidneys were recovered with the use of NRP and 62 with RR; 22 of the 24 kidneys were ultimately transplanted. The cDCD using NRP group showed lower rates of delayed graft function compared with the cDCD with RR group (36.3% versus 46.7%, P = 0.01). Also, primary nonfunction rates were lower in the cDCD using NRP group (4.5% versus 6.4% cDCD-RR and 10.2% DBD). Patient survival rates were >90% in all groups. No differences were found in graft survival rates at 1 y. Conclusions. The use of abdominal NRP improves early function recovery of KT from cDCD, making their outcomes comparable with those of DBD.
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19
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de Jong RW, Stel VS, Heaf JG, Murphy M, Massy ZA, Jager KJ. Non-medical barriers reported by nephrologists when providing renal replacement therapy or comprehensive conservative management to end-stage kidney disease patients: a systematic review. Nephrol Dial Transplant 2021; 36:848-862. [PMID: 31898742 PMCID: PMC8075372 DOI: 10.1093/ndt/gfz271] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Large international differences exist in access to renal replacement therapy (RRT) modalities and comprehensive conservative management (CCM) for patients with end-stage kidney disease (ESKD), suggesting that some patients are not receiving the most appropriate treatment. Previous studies mainly focused on barriers reported by patients or medical barriers (e.g. comorbidities) reported by nephrologists. An overview of the non-medical barriers reported by nephrologists when providing the most appropriate form of RRT (other than conventional in-centre haemodialysis) or CCM is lacking. METHODS We searched in EMBASE and PubMed for original articles with a cross-sectional design (surveys, interviews or focus groups) published between January 2010 and September 2018. We included studies in which nephrologists reported barriers when providing RRT or CCM to adult patients with ESKD. We used the barriers and facilitators survey by Peters et al. [Ruimte Voor Verandering? Knelpunten en Mogelijkheden Voor Verbeteringen in de Patiëntenzorg. Nijmegen: Afdeling Kwaliteit van zorg (WOK), 2003] as preliminary framework to create our own model and performed meta-ethnographic analysis of non-medical barriers in text, tables and figures. RESULTS Of the 5973 articles screened, 16 articles were included using surveys (n = 10), interviews (n = 5) and focus groups (n = 1). We categorized the barriers into three levels: patient level (e.g. attitude, role perception, motivation, knowledge and socio-cultural background), level of the healthcare professional (e.g. fears and concerns, working style, communication skills) and level of the healthcare system (e.g. financial barriers, supportive staff and practice organization). CONCLUSIONS Our systematic review has identified a number of modifiable, non-medical barriers that could be targeted by, for example, education and optimizing financing structure to improve access to RRT modalities and CCM.
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Affiliation(s)
- Rianne W de Jong
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Mark Murphy
- The Irish Kidney Association CLG, Dublin, Ireland
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Team 5, CESP UVSQ, University Paris Saclav, Villejuif, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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20
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Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe. Kidney Int 2021; 100:182-195. [PMID: 33359055 DOI: 10.1016/j.kint.2020.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
The aims of this study were to determine the frequency of dialysis and kidney transplantation and to estimate the regularity of comprehensive conservative management (CCM) for patients with kidney failure in Europe. This study uses data from the ERA-EDTA Registry. Additionally, our study included supplemental data from Armenia, Germany, Hungary, Ireland, Kosovo, Luxembourg, Malta, Moldova, Montenegro, Slovenia and additional data from Israel, Italy, Slovakia using other information sources. Through an online survey, responding nephrologists estimated the frequency of CCM (i.e. planned holistic care instead of kidney replacement therapy) in 33 countries. In 2016, the overall incidence of replacement therapy for kidney failure was 132 per million population (pmp), varying from 29 (Ukraine) to 251 pmp (Greece). On 31 December 2016, the overall prevalence of kidney replacement therapy was 985 pmp, ranging from 188 (Ukraine) to 1906 pmp (Portugal). The prevalence of peritoneal dialysis (114 pmp) and home hemodialysis (28 pmp) was highest in Cyprus and Denmark respectively. The kidney transplantation rate was nearly zero in some countries and highest in Spain (64 pmp). In 28 countries with five or more responding nephrologists, the median percentage of candidates for kidney replacement therapy who were offered CCM in 2018 varied between none (Slovakia and Slovenia) and 20% (Finland) whereas the median prevalence of CCM varied between none (Slovenia) and 15% (Hungary). Thus, the substantial differences across Europe in the frequency of kidney replacement therapy and CCM indicate the need for improvement in access to various treatment options for patients with kidney failure.
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21
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Abstract
Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of transplantation activity (for example, in the number of transplantations, the number of people with a functioning graft, in rates of living versus deceased donation, and in the use of expanded criteria donors) suggest that there is ample room for improvement. Herein we review the policy and clinical measures that should be considered to increase access to transplantation and improve post-transplantation outcomes. This Roadmap, generated by a group of major European stakeholders collaborating within a Thematic Network, presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation. This framework can be adopted by countries and institutions that are interested in advancing transplantation, both within and outside the European Union. Within this framework, a priority ranking of initiatives is suggested that could serve as the basis for a new European Union Action Plan on Organ Donation and Transplantation.
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22
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Cold Pulsatile Machine Perfusion Versus Static Cold Storage for Kidneys Donated After Circulatory Death: A Multicenter Randomized Controlled Trial. Transplantation 2020; 104:1019-1025. [PMID: 31403552 DOI: 10.1097/tp.0000000000002907] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The benefits of cold pulsatile machine perfusion (MP) for the storage and transportation of kidneys donated after circulatory death are disputed. We conducted a UK-based multicenter, randomized controlled trial to compare outcomes of kidneys stored with MP versus static cold storage (CS). METHODS Fifty-one pairs of kidneys donated after circulatory death were randomly allocated to receive static CS or cold pulsatile MP. The primary endpoint, delayed graft function, was analyzed by "intention-to-treat" evaluation. RESULTS There was no difference in the incidence of delayed graft function between CS and MP (32/51 (62.8%) and 30/51 (58.8%) P = 0.69, respectively), although the trial stopped early due to difficulty with recruitment. There was no difference in the incidence of acute rejection, or in graft or patient survival between the CS and MP groups. Median estimated glomerular filtration rate at 3 months following transplantation was significantly lower in the CS group compared with MP (CS 34 mL/min IQR 26-44 vs MP 45 mL/min IQR 36-60, P = 0.006), although there was no significant difference in estimated glomerular filtration rate between CS and MP at 12 months posttransplant. CONCLUSIONS This study is underpowered, which limits definitive conclusions about the use of MP, as an alternative to static CS. It did not demonstrate that the use of MP reduces the incidence of delayed graft function in donation after circulatory death kidney transplantation.
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23
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Bogaert S, Peeters P, Suchonos N, Decruyenaere A, Decruyenaere P, Vermassen F, Hoste EA. WITHDRAWN: Impact on Delayed Graft Function of the Renal Resistive Index in the Immediate Postoperative Period After Kidney Transplantation: A Cohort Analysis. Transplant Proc 2020:S0041-1345(19)31053-X. [PMID: 32703673 DOI: 10.1016/j.transproceed.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Stijn Bogaert
- Intensive Care Unit, Ghent University Hospital, Ghent, Belgium; Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
| | | | - Nicole Suchonos
- Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
| | | | | | - Frank Vermassen
- Department of Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Eric Aj Hoste
- Intensive Care Unit, Ghent University Hospital, Ghent, Belgium; Research-Foundation (FWO), Brussels, Belgium
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24
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Miñambres E, Rodrigo E, Suberviola B, Valero R, Quintana A, Campos F, Ruiz-San Millán JC, Ballesteros MÁ. Strict selection criteria in uncontrolled donation after circulatory death provide excellent long-term kidney graft survival. Clin Transplant 2020; 34:e14010. [PMID: 32573027 DOI: 10.1111/ctr.14010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND We aimed to report our experience in uncontrolled donation after circulatory death (uDCD) kidney transplantation applying a strict donor selection and preservation criteria. METHODS All kidney recipients received a graft from a local uDCD. As controls, we included all renal transplants from local standard criteria donation after brain death (SDBD) donors. Normothermic regional perfusion was the preservation method in all cases. RESULTS A total of 19 kidneys from uDCD donors were included and 67 controls. Delayed graft function (DGF) was higher in the uDCD group (42.1% vs 17.9%; P = .033), whereas no differences were observed in primary nonfunction (0% cases vs 3% controls; P = .605). The estimated glomerular filtration rate was identical in both groups. No differences were observed in graft survival censored for death between the uDCD and the SDBD groups at 1-year (100% vs 95%) or 5-year follow-up (92% vs 91%). uDCD kidney recipients did not have higher risk of graft loss in the multivariate analysis adjusted by recipient age, cold ischemic time, presence of DGF, and second kidney transplant (HR: 0.4; 95% CI 0.02-6; P = .509). CONCLUSIONS Obtaining renal grafts from uDCD is feasible in a small city and provides similar outcomes compared to standard DBD donors.
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Affiliation(s)
- Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,School of Medicine, University of Cantabria, Santander, Spain
| | - Emilio Rodrigo
- School of Medicine, University of Cantabria, Santander, Spain.,Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Borja Suberviola
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Rosalía Valero
- Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Alfredo Quintana
- Extrahospitalary Emergency, Gerencia de Atención Primaria-061, Santander, Spain
| | - Félix Campos
- Service of Urology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Juan Carlos Ruiz-San Millán
- School of Medicine, University of Cantabria, Santander, Spain.,Service of Nephrology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - María Á Ballesteros
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
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Denfield SW, Azeka E, Das B, Garcia-Guereta L, Irving C, Kemna M, Reinhardt Z, Thul J, Dipchand AI, Kirk R, Davies RR, Miera O. Pediatric cardiac waitlist mortality-Still too high. Pediatr Transplant 2020; 24:e13671. [PMID: 32198830 DOI: 10.1111/petr.13671] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 12/28/2022]
Abstract
Cardiac transplantation for children with end-stage cardiac disease with no other medical or surgical options is now standard. The number of children in need of cardiac transplant continues to exceed the number of donors considered "acceptable." Therefore, there is an urgent need to understand which recipients are in greatest need of transplant before becoming "too ill" and which "marginal" donors are acceptable in order to reduce waitlist mortality. This article reviewed primarily pediatric studies reported over the last 15 years on waitlist mortality around the world for the various subgroups of children awaiting heart transplant and discusses strategies to try to reduce the cardiac waitlist mortality.
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Affiliation(s)
- Susan W Denfield
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Estela Azeka
- Division of Pediatric Cardiology, University of Sao Paolo, Sao Paolo, Brazil
| | - Bibhuti Das
- Texas Children's Hospital, Baylor College of Medicine, Austin, TX, USA
| | - Luis Garcia-Guereta
- Division of Pediatric Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Claire Irving
- Division of Pediatric Cardiology, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Mariska Kemna
- Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Zdenka Reinhardt
- Division of Pediatric Cardiology, Freeman Hospital, New Castle upon Tyne, UK
| | - Josef Thul
- Division of Pediatric Cardiology, Children's Heart Center, University of Giessen, Giessen, Germany
| | - Anne I Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Richard Kirk
- Division of Pediatric Cardiology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryan R Davies
- Department of Cardiovascular and Thoracic Surgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, Deutsches Herzzentrum, Berlin, Germany
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26
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Figini MA, Paredes-Zapata D, Juan EO, Chiumello DA. Mobile Extracorporeal Membrane Oxygenation Teams for Organ Donation After Circulatory Death. Transplant Proc 2020; 52:1528-1535. [PMID: 32327262 DOI: 10.1016/j.transproceed.2020.02.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/05/2020] [Indexed: 01/25/2023]
Abstract
The shortage of available organ donors is a significant problem worldwide, and various efforts have been carried out to avoid the loss of potential organ donors. Among them, organ donation from cardiocirculatory deceased donors (DCD), in which withdrawal of life-sustaining therapies is ongoing (Maastricht type III donors), is one emerging strategy. Thanks to the latest advances in transplantation and organ preservation, such as normothermic regional perfusion (NRP), ex vivo perfusion techniques, and good organization and communication among prehospital care providers, emergency departments, intensive care units, and transplantation units, DCD is rapidly increasing; it's estimated that it will increase the number of donations of lungs and splanchnic organs by more than 40%. Although Maastricht type II DCD requires a 24/7 available experienced extra corporeal membrane oxygenation (ECMO) team in the institution, Maastricht DCD type III could be organized in secondary care and spoke hospitals without in loco ECMO facilities for NRP. This article analyses a potential mobile team organization based on the hub-and-spoke model, which already exists and functions in Italy, by estimating the dimension of the controlled DCD phenomenon in Italy, coordination requirements, costs, personnel training, and education, and reporting a single center experience in Milan, Italy.
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Affiliation(s)
- Maria Adele Figini
- Department of Anesthesia and Intensive Care Unit, ASST Santi Paolo e Carlo, Milano, Italy.
| | - David Paredes-Zapata
- Donation and Transplantation Coordination Unit, Hospital Clinic, Barcelona, Spain
| | - Eva Oliver Juan
- Transplantation Unit, Hospital de Bellvitge, Barcelona, Spain
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27
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Othman MH, Dutta A, Kondziella D. Public opinion and legislations related to brain death, circulatory death and organ donation. J Neurol Sci 2020; 413:116800. [PMID: 32251871 DOI: 10.1016/j.jns.2020.116800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is poorly understood how public perception of the difference between brain death and circulatory death may influence attitudes towards organ donation. We investigated the public opinion on brain death versus circulatory death and documented inconsistencies in the legislations of countries with different cultural and socioeconomic backgrounds. METHODS Using a crowdsourcing approach, we randomized 1072 participants from 30 countries to a case report of organ donation after brain death or to one following circulatory death. Further, we sampled guidelines from 24 countries and 5 continents. RESULTS Of all participants, 73% stated they would be willing to donate all organs, while 16% would want to donate some of their organs. To increase the rate of donations, 47% would agree with organ donation without family consent as the default. Exposure to "brain death" was not associated with a lesser likelihood of participants agreeing with organ donation (82.1%) compared to "circulatory death" (81.9%; relative risk 1.02, 95% CI 0.99 to 1.03; p = .11). However, participants exposed to "circulatory death" were more certain that the patient was truly dead (87.9% ± 19.7%) than participants exposed to "brain death" (84.1% ± 22.7%; Cohen's d 0.18; p = 0:004). Sampling of guidelines revealed large differences between countries regarding procedures required to confirm brain death and circulatory death, respectively. CONCLUSIONS Implementation of organ donation after circulatory death is unlikely to negatively influence the willingness to donate organs, but legislation is still brain death-based in most countries. The time seems ripe to increase the rate of circulatory death-based organ donation.
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Affiliation(s)
- Marwan H Othman
- Departments of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, State University of New York, NY, United States
| | - Daniel Kondziella
- Departments of Neurology, Rigshospitalet, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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28
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van Reeven M, van Leeuwen OB, van der Helm D, Darwish Murad S, van den Berg AP, van Hoek B, Alwayn IPJ, Polak WG, Porte RJ. Selected liver grafts from donation after circulatory death can be safely used for retransplantation - a multicenter retrospective study. Transpl Int 2020; 33:667-674. [PMID: 32065433 PMCID: PMC7318636 DOI: 10.1111/tri.13596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/15/2019] [Accepted: 02/13/2020] [Indexed: 12/14/2022]
Abstract
Due to the growing number of liver transplantations (LTs), there is an increasing number of patients requiring retransplantation (reLT). Data on the use of grafts from extended criteria donors (ECD), especially donation after circulatory death (DCD), for reLT are lacking. We aimed to assess the outcome of patients undergoing reLT using a DCD graft in the Netherlands between 2001 and July 2018. Propensity score matching was used to match each DCD-reLT with three DBD-reLT cases. Primary outcomes were patient and graft survival. Secondary outcome was the incidence of biliary complications, especially nonanastomotic strictures (NAS). 21 DCD-reLT were compared with 63 matched DBD-reLTs. Donors in the DCD-reLT group had a significantly lower BMI (22.4 vs. 24.7 kg/m2 , P-value = 0.02). Comparison of recipient demographics and ischemia times yielded no significant differences. Patient and graft survival rates were comparable between the two groups. However, the occurrence of nonanastomotic strictures after DCD-reLT was significantly higher (38.1% vs. 12.7%, P-value = 0.02). ReLT with DCD grafts does not result in inferior patient and graft survival compared with DBD grafts in selected patients. Therefore, DCD liver grafts should not routinely be declined for patients awaiting reLT.
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Affiliation(s)
- Marjolein van Reeven
- Department of Surgery, Section of HPB Surgery and Liver Transplantation, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Otto B van Leeuwen
- Department of Surgery, Section of HPB Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
| | - Danny van der Helm
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Aad P van den Berg
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ian P J Alwayn
- Department of Surgery, Section of Transplantation Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Wojciech G Polak
- Department of Surgery, Section of HPB Surgery and Liver Transplantation, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J Porte
- Department of Surgery, Section of HPB Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands
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29
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Quader M, Toldo S, Chen Q, Hundley G, Kasirajan V. Heart transplantation from donation after circulatory death donors: Present and future. J Card Surg 2020; 35:875-885. [PMID: 32065475 DOI: 10.1111/jocs.14468] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The first successful human heart transplantation was reported on 3 December 1967, by Christiaan Barnard in South Africa. Since then this life-saving procedure has been performed in over 120 000 patients. A limitation to the performance of this procedure is the availability of donor hearts with as many as 20% of patients dying before a donor's heart is available for transplant. Today, hearts for transplantation are procured from individuals experiencing donation after brain death (DBD). Interestingly, this, however, was not always the case as the first heart transplants occurred after circulatory death. Revisiting the availability of hearts for transplant from those experiencing donation after circulatory death (DCD) could further expand the number of hearts suitable for transplantation. There are several considerations pertinent to transplanting hearts from those undergoing circulatory death. In this review, we summarize the main distinctions between DBD and DCD heart donation and discuss the research relevant to increasing the number of hearts available for transplantation by including individual's hearts that experience circulatory death.
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Affiliation(s)
- Mohammed Quader
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Stefano Toldo
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Qun Chen
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Greg Hundley
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
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30
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Lazzeri C, Bonizzoli M, Marra F, Muiesan P, Ghinolfi D, De Simone P, Nesi MG, Migliaccio ML, Peris A. Uncontrolled donation after circulatory death and liver transplantation: evidence and unresolved issues. Minerva Anestesiol 2020; 86. [DOI: 10.23736/s0375-9393.19.13746-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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31
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Gottin L, Taiana M. Uncontrolled donation after circulatory death and liver transplantation: much still remains to be done. Minerva Anestesiol 2020; 86:129-131. [DOI: 10.23736/s0375-9393.19.14095-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Miñambres E, Ruiz P, Ballesteros MA, Álvarez C, Cifrián JM, Atutxa L, Ventoso A, Castillo F, Gastaca M. Combined lung and liver procurement in controlled donation after circulatory death using normothermic abdominal perfusion. Initial experience in two Spanish centers. Am J Transplant 2020; 20:231-240. [PMID: 31265753 DOI: 10.1111/ajt.15520] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/01/2019] [Accepted: 06/21/2019] [Indexed: 01/25/2023]
Abstract
Combining simultaneously lung and liver procurement in controlled donation after circulatory death (cDCD) using normothermic abdominal perfusion (NRP) for abdominal grafts and cooling and rapid recovery technique (RR) for the lungs increases the complexity of the procurement procedure and might injure the grafts. A total of 19 cDCDs from two centers using this combined procedure were evaluated, and 16 liver and 21 lung transplantations were performed. As controls, 34 donors after brain death (DBDs) were included (29 liver and 41 lung transplantations were performed). Two cDCD liver recipients developed primary nonfunction (12.5%). No cases of ischemic cholangiopathy were observed among cDCD recipients. The 1-year and 2-year liver recipients survival was 87.5% and 87.5% for the cDCD group, and 96% and 84.5% for the DBD group, respectively (P = .496). The 1-year and 2-year lung recipients survival was 84% and 84% for the cDCD group and 90% and 90% for the DBD group, respectively (P = .577). This is the largest experience ever reported in cDCD with the use of NRP combined with RR of the lungs. This combined method offers an outstanding recovery rate and liver and lung recipients survival comparable with those transplanted with DBDs. Further studies are needed to confirm our findings.
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Affiliation(s)
- Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | - Patricia Ruiz
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Bilbao, Spain
| | - Maria Angeles Ballesteros
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Carlos Álvarez
- Service of Thoracic Surgery, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Jose Manuel Cifrián
- Service of Neumology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Lander Atutxa
- Transplant Coordination Unit & Service of Intensive Care, Donostia University Hospital, San Sebastian, Spain
| | - Alberto Ventoso
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Bilbao, Spain
| | - Federico Castillo
- Hepatobiliary Surgery and Liver Transplantation Unit, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Mikel Gastaca
- Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Bilbao, Spain
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33
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The Comparable Efficacy of Lung Donation After Circulatory Death and Brain Death: A Systematic Review and Meta-analysis. Transplantation 2019; 103:2624-2633. [DOI: 10.1097/tp.0000000000002888] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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34
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Donation after circulatory death in lung transplantation—five-year follow-up from ISHLT Registry. J Heart Lung Transplant 2019; 38:1235-1245. [DOI: 10.1016/j.healun.2019.09.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/08/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022] Open
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35
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Takagi K, Domagala P, Porte RJ, Alwayn I, Metselaar HJ, van den Berg AP, van Hoek B, Ijzermans JNM, Polak WG. Liver retransplantation in adult recipients: analysis of a 38-year experience in the Netherlands. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 27:26-33. [PMID: 31769614 DOI: 10.1002/jhbp.701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/21/2019] [Accepted: 11/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver retransplantation (re-LT) accounts for up to 22% after primary liver transplantation (LT), and using donor livers for retransplantation can only be justified by successful outcomes. METHODS A total of 2,387 adult recipients with 2,778 LT, between 1979 and 2017, were analyzed to determine risk factors and outcome of re-LT in the Netherlands. RESULTS Of 2,778 LT, 336 (12.1%) were first, 43 (1.5%) were second, and 12 (0.5%) were third or fourth re-LT. The 5-year patient survival for primary LT, and first, second, and third or fourth re-LT were 74.0%, 70.8%, 63.3%, and 57.1%, respectively (P = 0.10). Recipient age (≤60 years) (OR 1.96, P < 0.001), era (1979-2006) (OR 1.56, P = 0.003), donor after circulatory death (DCD) (OR 1.96, P < 0.001), and cold ischemia time (CIT) (>9 h) (OR 1.42, P = 0.007) were significant risk factors for retransplantation after primary LT. CONCLUSIONS Recipient age, era, DCD, and prolonged CIT were identified as parameters for retransplantation. The outcome after the first re-LT was good, and comparable to those of primary transplants. Survival after multiple re-LT was not significantly different from the first retransplant group, legitimizing third and fourth re-LT to well-selected patients.
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Affiliation(s)
- Kosei Takagi
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Piotr Domagala
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J Porte
- Division of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Ian Alwayn
- Department of Surgery, Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Herold J Metselaar
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Aad P van den Berg
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan N M Ijzermans
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wojciech G Polak
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Lomero M, Gardiner D, Coll E, Haase‐Kromwijk B, Procaccio F, Immer F, Gabbasova L, Antoine C, Jushinskis J, Lynch N, Foss S, Bolotinha C, Ashkenazi T, Colenbie L, Zuckermann A, Adamec M, Czerwiński J, Karčiauskaitė S, Ström H, López‐Fraga M, Dominguez‐Gil B, Sarkissian A, Liashchuk S, Tsvetkova E, Bušić M, Michael N, Ilkjaer LB, Dmitriev P, Makisalo H, Rahmel A, Tomadze G, Ioannis B, Mihály S, Carella C, Codreanu I, Jansen N, Konijn C, França A, Zota V, Žilinská Z, Avsec D, Gautier S, Sánchez‐Ibáñez J, Terrón C, Vidal C, Beyeler F, Weiss J, Ilbars T, Forsythe J, Johnson R, Enckevort A. Donation after circulatory death today: an updated overview of the European landscape. Transpl Int 2019; 33:76-88. [DOI: 10.1111/tri.13506] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/28/2019] [Accepted: 08/26/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Mar Lomero
- European Directorate for the Quality of Medicines & Healthcare/Council of Europe Strasbourg France
| | - Dale Gardiner
- National Clinical Lead for Organ Donation NHS Blood and Transplant Watford UK
| | | | | | - Francesco Procaccio
- Italian National Transplant Centre Italian National Institute of Health Rome Italy
| | - Franz Immer
- Swisstransplant The Swiss National Foundation for Organ Donation and Transplantation Bern Switzerland
| | - Lyalya Gabbasova
- Ministry of Health of the Russian Federation Moscow Russian Federation
| | | | | | - Nessa Lynch
- Organ Donation Transplant Ireland Dublin Ireland
| | | | - Catarina Bolotinha
- National Transplantation Coordination Instituto Português do Sangue e da Transplantação Lisboa Portugal
| | - Tamar Ashkenazi
- Israel Transplant Center State of Israel Ministry of Health Tel‐Aviv Israel
| | - Luc Colenbie
- DG Health Care Organs Embryo's and Bio‐Ethics Brussels Belgium
| | | | - Miloš Adamec
- Koordinační Středisko Transplantací Prague Czech Republic
| | | | - Sonata Karčiauskaitė
- National Transplant Bureau Under the Ministry of Health of the Republic Lithuania Vilnius Lithuania
| | - Helena Ström
- Department for Knowledge‐Based Policy of Health Care National Donation Centre Stockholm Sweden
| | - Marta López‐Fraga
- European Directorate for the Quality of Medicines & Healthcare/Council of Europe Strasbourg France
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37
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Factors That Complicated the Implementation of a Program of Donation After Unexpected Circulatory Death of Lungs and Kidneys. Lessons Learned From a Regional Trial in the Netherlands. Transplantation 2019; 103:e256-e262. [DOI: 10.1097/tp.0000000000002814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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38
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Moris D, Tsilimigras DI, Bokos J, Vernadakis S. Organ Donation After Circulatory Death in Greece: Time to Consider. EXP CLIN TRANSPLANT 2019; 18:539-540. [PMID: 31424355 DOI: 10.6002/ect.2019.0100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dimitrios Moris
- From the Transplantation Unit, Laikon General Hospital, Athens, Greece
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39
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den Hartogh G. When are you dead enough to be a donor? Can any feasible protocol for the determination of death on circulatory criteria respect the dead donor rule? THEORETICAL MEDICINE AND BIOETHICS 2019; 40:299-319. [PMID: 31562590 PMCID: PMC6790209 DOI: 10.1007/s11017-019-09500-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The basic question concerning the compatibility of donation after circulatory death (DCD) protocols with the dead donor rule is whether such protocols can guarantee that the loss of relevant biological functions is truly irreversible. Which functions are the relevant ones? I argue that the answer to this question can be derived neither from a proper understanding of the meaning of the term "death" nor from a proper understanding of the nature of death as a biological phenomenon. The concept of death can be made fully determinate only by stipulation. I propose to focus on the irreversible loss of the capacity for consciousness and the capacity for spontaneous breathing. Having accepted that proposal, the meaning of "irreversibility" need not be twisted in order to claim that DCD protocols can guarantee that the loss of these functions is irreversible. And this guarantee does not mean that reversing that loss is either conceptually impossible or known to be impossible with absolute certainty.
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Affiliation(s)
- Govert den Hartogh
- Department of Philosophy, University of Amsterdam, Amsterdam, Netherlands.
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41
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Measures influencing post-mortem organ donation rates in Germany, the Netherlands, Spain and the UK : A systematic review. Anaesthesist 2019; 68:377-383. [PMID: 31101922 DOI: 10.1007/s00101-019-0600-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/28/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND German post-mortem organ donation rates have been declining since 2010. Several transplantation scandals led to a negative portrayal of organ donation in the media. Spain, the UK and the Netherlands achieved a rise in organ donation rates while retaining organ donation legislation. METHODS A systematic review of publications focusing on (1) organ donation legislation, (2) data on post-mortem organ donation rates and (3) measures to increase post-mortem organ donation rates in Europe was conducted in November 2017 in PubMed, PsycINFO and Web of Science. Quality parameters of the World Bank and the World Health Organization (WHO) were studied to analyze national health services, frequent causes of death and life expectancy. RESULTS Quality parameters of national health services were similar in all countries. The Netherlands and Germany have an opt in system. An increase of 37.4% in post-mortem organ donation rates from 2008 to 2015 in the UK was accomplished through the establishment of a donation task force, adopting parts of the Spanish model, while maintaining an opt in system. Spain has the highest organ donation rate worldwide (39.7 per million persons in 2015). The implementation of transplantation coordinators and the change in legislation in Germany in 2012 has so far shown no effect. Public awareness of organ donation in the Netherlands increased following various information campaigns. CONCLUSION Donation after cardiac death (DCD), expanded donor criteria, increasing public awareness and introduction of an organ donor register should be discussed as measures to increase organ donation rates in Germany.
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Introducing of the First DCD Kidney Transplantation Program in Poland. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6302153. [PMID: 31016193 PMCID: PMC6425340 DOI: 10.1155/2019/6302153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/31/2018] [Indexed: 11/17/2022]
Abstract
In many countries, including Poland, the main problem with transplantation is the insufficiency of organ donors in relation to the demand for organs. Hence, the common aim globally is to increase the pool of donors. The prolonged survival of patients after transplantation, with respect to the survival time of patients on dialysis, makes the search much more intense. After the recourse of expanded criteria donors (ECD), the next step was obtaining kidneys from donors after irreversible cardiac death (DCD). Therefore, based on Dutch, British, and Spanish experience, it can be hypothesized that the introduction of DCD procedures in countries that have not launched these programs and the improvement of DCD procedures may shorten the waiting time for organ transplantation globally. The legal basis for the procurement of organs after irreversible cardiac arrest came into existence in Poland in 2010. Previously, such organ procurements were not in practice. Since 1984, when Poland published irreversible cardiac arrest as a criterion of brain death, it became the only way to determine death prior to the procurement of organs. The aim of this report was to evaluate the results of the first 19 transplantation cases involving harvested kidneys from donors after cardiac arrest, which was irreversible and clinically confirmed, without any doubt as per the ethical protocol of DCD. Understanding, support, and public perception are essential for this program's initiation and maintenance.
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Impact of Cold Ischemia Time on Outcomes of Deceased Donor Kidney Transplantation: An Analysis of a National Registry. Transplant Direct 2019; 5:e448. [PMID: 31165083 PMCID: PMC6511440 DOI: 10.1097/txd.0000000000000888] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/21/2019] [Accepted: 02/24/2019] [Indexed: 11/25/2022] Open
Abstract
Background Cold ischemia time (CIT) is known to impact kidney graft survival rates. We compare the impact of CIT on graft failure and mortality in circulatory death versus brain death donor kidneys and how it relates to donor age. Methods We used the prospective Dutch Organ Transplantation Registry to include 2153 adult recipients of brain death (n = 1266) and circulatory death (n = 887) donor kidneys after static cold storage from transplants performed between 2005 and 2012. CIT was modeled nonlinearly with splines. Associations and interactions between CIT, donor type, donor age, 5-year (death-censored) graft survival, and mortality were evaluated. Results The median CIT was 16.2 hours (interquartile range 12.8-20), ranging from 3.4 to 44.7 hours for brain death and 4.7 to 46.6 hours for circulatory death donor kidneys. At >12 hours of CIT, we observed an increased risk of graft failure in kidneys donated after circulatory death versus after brain death. This risk rose significantly at >22 hours of CIT (hazard ratio 1.45; 95% confidence interval, 1.01-2.49; P = 0.043). Kidneys that came from 60-year-old circulatory death donors demonstrated elevated hazard risk at 19 hours of CIT, a shorter timeline than that for kidneys that came from brain death donors of the same age (hazard ratio 1.33; 95% confidence interval, 1.00-1.78; P = 0.045). The additional harmful effects of increased CIT in kidneys from circulatory-death donors were also found for death-censored graft failure but did not affect mortality rates in any significant way. Conclusions The findings support the hypothesis that prolonged cold ischemia is more harmful for circulatory death donor kidneys that have already been subjected to a permissible period of warm ischemia. Efforts should be made to reduce CIT, especially for older circulatory death donor kidneys.
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Evolution of Deceased Organ Donation Activity Versus Efficiency Over a 15-year Period: An International Comparison. Transplantation 2019; 102:1768-1778. [PMID: 29677069 DOI: 10.1097/tp.0000000000002226] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The donation rate (DR) per million population is not ideal for an efficiency comparison of national deceased organ donation programs. The DR does not account for variabilities in the potential for deceased donation which mainly depends on fatalities from causes leading to brain death. In this study, the donation activity was put into relation to the mortality from selected causes. Based on that metric, this study assesses the efficiency of different donation programs. METHODS This is a retrospective analysis of 2001 to 2015 deceased organ donation and mortality registry data. Included are 27 Council of Europe countries, as well as the United States. A donor conversion index (DCI) was calculated for assessing donation program efficiency over time and in international comparisons. RESULTS According to the DCI and of the countries included in the study, Spain, France, and the United States had the most efficient donation programs in 2015. Even though mortality from the selected causes decreased in most countries during the study period, differences in international comparisons persist. This indicates that the potential for deceased organ donation and its conversion into actual donation is far from being similar internationally. CONCLUSIONS Compared with the DR, the DCI takes into account the potential for deceased organ donation, and therefore is a more accurate metric of performance. National donation programs could optimize performance by identifying the areas where most potential is lost, and by implementing measures to tackle these issues.
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Controlling the uncontrolled: Can we realise the potential of uncontrolled donation after circulatory death? Resuscitation 2019; 137:234-236. [DOI: 10.1016/j.resuscitation.2019.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 12/29/2022]
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Suberviola B, Mons R, Ballesteros MA, Mora V, Delgado M, Naranjo S, Iturbe D, Miñambres E. Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death. Am J Transplant 2019; 19:1195-1201. [PMID: 30582287 DOI: 10.1111/ajt.15237] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 01/25/2023]
Abstract
We aimed to propose a simple and effective preservation method in lungs procured for transplantation from uncontrolled donation after circulatory death (uDCD) associated with excellent long-term results. Outcome measures for lung recipients were survival and primary graft dysfunction (PGD) grade 3. Survival was estimated using the Kaplan-Meier method. A total of 9 lung uDCDs were evaluated and 8 lung transplants were performed. Mean no-flow time was 9.8 minutes (standard deviation [SD] 8.6). Mean time from cardiac arrest to topical cooling was 96.8 minutes (SD 16.8). Preservation time was 159 minutes (SD 31). Ex vivo lung perfusion was used to assess lung function prior to transplantation in 2 cases. Mean recipient age was 60.8 years (SD 3.1), and mean total ischemic time was 678 minutes (SD 132). PGD grade 3 was observed in 2 cases (25%). The 1-month, 1-year, and 5-year survival rates were 100%, 87.5%, and 87.5%, respectively. Mean follow-up was 52 months. The logistic complexity of procuring lungs from uDCDs for transplantation requires the development of new strategies designed to facilitate this type of donation. A program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes.
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Affiliation(s)
- Borja Suberviola
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Roberto Mons
- Service of Thoracic Surgery, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Maria Angeles Ballesteros
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Victor Mora
- Service of Neumology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - María Delgado
- Service of Thoracic Surgery, Complexo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - Sara Naranjo
- Service of Thoracic Surgery, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - David Iturbe
- Service of Neumology, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Eduardo Miñambres
- Transplant Coordination Unit & Service of Intensive Care, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain.,School of Medicine, University of Cantabria, Santander, Spain
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Mateos Rodriguez A, Navalpotro Pascual J, Peinado Vallejo F, Les González J, Muñecas Cuesta Y, Carrillo Moya A, Muñoz Isabel B, González León M. Post ROSC deceased patients are potential donors of organs and tissues. Resuscitation 2019; 136:148. [DOI: 10.1016/j.resuscitation.2019.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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Guzik-Makaruk EM, Olesiuk-Okomska M, Matuszkiewicz-Rowińska J, Małyszko J. Selected Legal Aspects of Donation After Circulatory Death in Poland. Ann Transplant 2019; 24:93-99. [PMID: 30773527 PMCID: PMC6394144 DOI: 10.12659/aot.912567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Organ transplantation is one of the most critical ethical topics in law and medicine and a matter of debate in various countries. Lack of organs for engraftment to meet the existing demand has resulted in a substantial crisis due to organ shortage and a rise in the critical conditions of certain waitlisted patients, as well as increased mortality of patients while waiting. Organ shortages for transplantation raised the issue of procurement of organs not only from living donors and cadaveric donors after brain death, but also after circulatory death. Renewed interest in donation after circulatory death started in the 1990s, and has been on the rise in recent years, reaching up 40% of donation in some countries. Both legislation on and practice of donation after circulatory death differ significantly throughout the world. Lack of unified guidelines and regulations have challenged the medical, ethical, legal, and transplant communities. Moreover, studies on legal aspects of donation after circulatory death are still lacking. In this review, we present selected legal issues in regulation of donation after circulatory death, and we address the most important legal challenges in this regard with particular attention to category III of donors after circulatory death.
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Affiliation(s)
- Ewa M Guzik-Makaruk
- Department of Criminal Law and Criminology, Faculty of Law, University of Białystok, Białystok, Poland
| | - Magda Olesiuk-Okomska
- Department of Criminal Law and Criminology, Faculty of Law, University of Białystok, Białystok, Poland
| | | | - Jolanta Małyszko
- Department Nephrology, Dialysis, and Internal Diseases, Warsaw Medical University, Warsaw, Poland
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Abstract
PURPOSE OF REVIEW Donation after circulatory death (DCD) is still performed in a limited number of countries. This article summarizes the development of DCD in Spain and presents recent Spanish contributions to gain knowledge on the potential benefits and the practical use of normothermic regional perfusion (nRP). RECENT FINDINGS DCD now contributes to 24% of deceased donors in Spain. The development of DCD has been based on an assessment of practices in the treatment of cardiac arrest and end-of-life care to accommodate the option of DCD; the creation of an adequate regulatory framework; and institutional support, professional training and public education. Appropriate posttransplant outcomes have been obtained with organs from both uncontrolled and controlled DCD donors. nRP is increasingly used, with preliminary data supporting improved results compared with other in-situ preservation/recovery approaches. Mobile teams with portable extracorporeal membrane oxygenation devices are making nRP possible in hospitals without these resources. To avoid the possibility of reestablishing brain circulation after the determination of death, a specific methodology has been validated. SUMMARY DCD has been successfully developed in Spain following a streamlined process. nRP may become a standard in DCD, although further evidence on the benefits of this technology is eagerly awaited.
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Abstract
PURPOSE OF REVIEW The global shortage of organ donors will not be resolved solely by relying on deceased donation following a brain death determination (DBD). Expansion of deceased donation after circulatory death (DCD) will be needed to address the shortfall of organs for transplantation. Approximately 120 000 organ transplants are performed each year; however, the WHO estimates that this number of transplants only resolves 10% of the annual worldwide transplant need. RECENT FINDINGS The report addresses the opportunity of DCD expansion by evaluating the DCD potential that is not being realized, the utility of DCD enabling DBD to emerge in some clinical situations, by the effectiveness of a donor registry in achieving DCD, and by the current clinical research of heart, lung, and liver transplantation from DCD. SUMMARY The future of deceased donation must include DCD and ex-vivo organ repair if the organ shortage is to be reconciled even partially to the ongoing demand. Although the religious and legal impediments have been overcome to determine brain death, the possibility of DCD has not been addressed. A program of DCD is feasible in all countries with transplantation services. The excellent results following kidney and lung transplantation suggest opportunities of heart and liver transplantation should be the focus of needed DCD accomplishment in the near future.
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