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Ali F, Chant K, Scales A, Sellwood M, Gallagher K. Neonatal organ donation: Retrospective audit into potential donation in a single neonatal unit. Nurs Crit Care 2024; 29:532-535. [PMID: 37353898 DOI: 10.1111/nicc.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/03/2023] [Accepted: 06/01/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Research has shown that many babies who die in neonatal units could have been potential tissue and/or organ donors. Despite the existence of guidelines supporting its implementation, the incidence of neonatal donation remains rare in the United Kingdom. AIM The aim of this audit was to retrospectively determine potential eligibility for neonatal tissue and/or organ donation referral in infants who died in a single UK tertiary-level neonatal unit between 2012 and 2021. Cause of death and documentation of any discussions held regarding referral for donation were also explored. STUDY DESIGN An audit was undertaken to identify all neonatal deaths at a single tertiary-level NICU in London from 2012-2021. Infants who retrospectively could have been referred as potential tissue and/or organ donors were identified using current NHS Blood and Transplant inclusion and exclusion criteria. RESULTS AND CONCLUSION A significant missed potential for neonatal tissue and/or organ donation referrals was identified, which is likely not just limited to the unit audited. Causes of death were as expected for a tertiary level neonatal unit and centre for therapeutic cooling of babies born with hypoxic perinatal brain injuries. Only one documented conversation was found regarding neonatal donation. RELEVANCE TO CLINICAL PRACTICE To enable conversations regarding neonatal donation to become a routine part of end-of-life care discussions with families as appropriate, good links between neonatal healthcare professionals and Specialist Nurses in Organ Donation need to be established. This will facilitate the referral of all suitable neonates as potential donors and ensure that neonatal staff feel supported to care for babies identified as potential donors.
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Affiliation(s)
- Faizah Ali
- Clinical Research Facility, Great Ormond Street Hospital, London, UK
| | - Kathy Chant
- University College London Hospital NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK
| | | | - Mark Sellwood
- University College London Hospital NHS Foundation Trust, London, UK
| | - Katie Gallagher
- University College London Hospital NHS Foundation Trust, London, UK
- Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK
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2
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Bluhme E, Henckel E, Jorns C. Potential of neonatal organ donation and outcome after transplantation. Pediatr Transplant 2023; 27:e14486. [PMID: 36792069 DOI: 10.1111/petr.14486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 02/17/2023]
Abstract
Organ transplantation is limited by access to suitable organs. Infant recipient waitlist mortality is increased due to the scarcity of size-matched organs. Neonatal organ donors have been proposed as an underutilized source of donor organs. However, the literature on the actual prevalence and outcome of neonatal organ donation and transplantation is fragmented and not well analyzed. This literature review aims to summarize the available literature on the potential of neonatal organ donation and to analyze published cases of neonatal organ transplantation. A systematic search of the Medline and Cochrane databases yielded 2964 articles, which were screened for eligibility. In total, 86 articles were considered eligible, of which 34 were included in the literature review: 8 articles describing the potential of neonatal organ donation programs, and 26 articles describing clinical transplantation. Current evidence suggests there is a large pool of potential neonatal organ donors. In contrast, the literature on neonatal organ donor utilization is sparse. However, case series of successful kidney, heart, liver, hepatocyte, and multivisceral transplantation using organs from neonatal donors are summarized. Although good posttransplant organ function was achieved, the use of neonatal organs is associated with increased risk of thrombosis in both kidney and liver transplantation. Neonatal organ donation is a promising alternative for expanding the current donor pool. Experience is limited, but reported patient and graft survival are acceptable and more research on the subject is warranted.
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Affiliation(s)
- Emil Bluhme
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Ewa Henckel
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Carl Jorns
- Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
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3
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Fernández-Fructuoso JR, Gil-Sánchez FJ, Sáez-Miravete S, Pina-Molina JM, Fuentes-Gutiérrez C, Lloreda-García JM, Olmo-Sánchez M, Mañas-Uxo MI, García-González A, Leante-Castellanos JL. Implementation of a neonatal donation protocol in the neonatal intensive care unit: A single-center experience. Pediatr Transplant 2022; 26:e14403. [PMID: 36165676 DOI: 10.1111/petr.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/04/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lack of specific protocols for neonatal donation contributes to the rarity of neonatal donors. In this study, we evaluate the impact of the implementation of a neonatal donation protocol in our NICU. METHODS In this single-center study, we conducted a retrospective chart review of neonatal deaths in our NICU from January 2013 to January 2022. The study was divided into two periods: before and after the implementation of a neonatal donation protocol. The referral rates of potential neonatal donors to the OPO in the two periods were compared using the chi-square test. A p value < .05 was considered statistically significant. RESULTS Sixty-four infants were reviewed. Seven (10.9%) met the inclusion criteria for potential neonatal donors after DCC. The referral rate of potential neonatal donors increased from 2.5% to 16.7% after the implementation of this protocol (p = .041), and one infant (4.1%) became an effective heart-valve donor. CONCLUSION The implementation of a local neonatal donation protocol could have contributed to increase the referral rate of potential neonatal donors in our NICU. Following the implementation of a local neonatal donation protocol, we were able to perform a heart-valve donation for the first time in our unit.
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Affiliation(s)
| | | | - Salvadora Sáez-Miravete
- Intensive Care Unit, Donor Coordination Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - José Miguel Pina-Molina
- Pediatric Emergency Department, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | | | | | - María Olmo-Sánchez
- Neonatology Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | | | - Ana García-González
- Neonatology Unit, Hospital General Universitario Santa Lucía, Cartagena, Spain
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Caserío S, Arnaez J. Eligible neonatal donors after circulatory determination of death (Maastricht type III): A national survey of level III NICUs. Pediatr Transplant 2022; 26:e14129. [PMID: 34472170 DOI: 10.1111/petr.14129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Organ donation continues to increase worldwide, but in general paediatric patients remain less likely to receive a transplant. The inclusion of neonates as donors after cDCD should be considered in an effort to increase donation rates. METHODS The survey for a cross-sectional national study of potential cDCD neonatal donors (Maastricht type III) was sent to all 90 level III Spanish neonatal units to explore: 1) protocols, education, and specific opinions on donation and 2) potential cDCD that could have been eligible over a 2-year period (2014-2015). RESULTS Forty-five centers (50%) completed the survey, and 38/45 gave information about potential eligible donors. In 16% of the centers specific protocols on neonatal donation exist. All hospitals demanded more specific training, and 65% noted that the donation process could be a problem in the family's dismissal of the child. During the study period 46 805 neonates were admitted in the 38 centers, and 625 neonates died. Ninety-five born at a gestational age ≥34 weeks and above 2000 gr died after an EoL decision, 38 (40%) and 13 (14%) of them due to neonatal encephalopathy and multiple congenital anomalies, respectively. There were 31 (33%) elegible infants who died in less than 120 min due to pathologies that did not contraindicate donation. CONCLUSIONS Neonatal cDCD could help to reduce the gap between the supply of and demand for organs according to the potentially eligible patients emerging from this study. Training in EoL and donation processes should be provided to healthcare professionals.
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Affiliation(s)
- Sonia Caserío
- Neonatology, Hospital Universitario Rio Hortega de Valladolid, Valladolid, Spain.,NeNe Foundation, Madrid, Spain
| | - Juan Arnaez
- NeNe Foundation, Madrid, Spain.,Neonatology, Complejo Universitario de Burgos, Burgos, Spain
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Dame C, von der Hude K, Kliemann M, Rösner B, Bührer C, Garten L. [... because We Should not Forget! Neonatal Organ Donation]. Z Geburtshilfe Neonatol 2021; 225:366-370. [PMID: 34384134 DOI: 10.1055/a-1509-3688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Obwohl sich fast 40% aller Todesfälle im Kindes- und Jugendalter während der Neugeborenenperiode ereignen, kommt es in der Neonatologie nur selten zur Organspende. Wir berichten über ein Neugeborenes, bei dem nach perinataler Asphyxie der endgültige, nicht behebbare Ausfall der Gesamtfunktion des Großhirns, des Kleinhirns und des Hirnstamms ("Hirntod") gemäß Transplantationsgesetz diagnostiziert wurde. Das Herz wurde nach der sogenannten zweiten richtliniengemäßen "Hirntoddiagnostik" zur Organspende entnommen und erfolgreich transplantiert. Besondere juristische Herausforderungen ergaben sich aus dem Umstand der anonymen Geburt, den notwendigen Regelungen der Vormundschaft sowie der Zuordnung des Totenfürsorgerechts. Medizinisch standen die speziellen Regelungen der Diagnostik des irreversiblen Hirnfunktionsausfalls bei Neugeborenen und der optimale Erhalt der Organfunktion vor Entnahme im Vordergrund. Für die Pflegenden stellte sich der Ablauf grundlegend anders dar als bei einer Therapiezieländerung mit anschließender palliativen Versorgung in Anwesenheit der Eltern. Angesichts der großen emotionalen Herausforderungen erwiesen sich die Einbindung aller Beteiligten in die Entscheidungsabläufe und die Übernahme der besonderen Verantwortung als hilfreich.Although almost 40% of all deaths prior to 18 years of age occur within the neonatal period, organ donation is rare in neonatology. Herein we report about a newborn infant with perinatal asphyxia and permanent, irreversible loss of brain function (cerebrum, cerebellum and brain stem), managed according to the criteria and instructions defined by the German law of donor organ transplantation. After confirmation of irreversible loss of brain function, the heart was successfully transplanted. Specific legal challenges resulted from the instance of an anonymous birth, the guardianship required, and the specific regulations of welfare of the deceased individual. The most prominent medical challenges consisted in the specific regulatory purposes for the diagnosis of the irreversible loss of brain function in neonates and the optimal maintenance of organ functions prior to donation. From the nursing point of view, the proceeding differed entirely compared to redirection of care into palliation while parents are present. Involving all stakeholders in every step of decision making was regarded as emotionally helpful.
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Affiliation(s)
- Christof Dame
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kerstin von der Hude
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Markus Kliemann
- Region Nord-Ost, Deutsche Stiftung Organtransplantation, Frankfurt, Deutschland
| | - Bianka Rösner
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Bührer
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Lars Garten
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Vileito A, Hulzebos CV, Toet MC, Baptist DH, Verhagen EAA, Siebelink MJ. Neonatal donation: are newborns too young to be recognized? Eur J Pediatr 2021; 180:3491-3497. [PMID: 34105002 PMCID: PMC8589733 DOI: 10.1007/s00431-021-04139-3] [Citation(s) in RCA: 3] [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: 03/04/2021] [Revised: 05/03/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
Neonatal organ and tissue donation is not common practice in the Netherlands. At the same time, there is a transplant waiting list for small size-matched organs and tissues. Multiple factors may contribute to low neonatal donation rates, including a lack of awareness of this option. This study provides insight into potential neonatal organ and tissue donors and reports on how many donors were actually reported to the procurement organization. We performed a retrospective analysis of the mortality database and medical records of two largest neonatal intensive care units (NICUs) in the Netherlands. This study reviewed records of neonates with a gestational age >37 weeks and weight >3000g who died in the period from January 1, 2005 through December 31, 2016. During the study period, 259 term-born neonates died in the two NICUs. In total, 132 neonates with general contra-indications for donation were excluded. The medical records of 127 neonates were examined for donation suitability. We identified five neonates with documented brain death who were not recognized as potential organ and/or tissue donors. Of the remaining neonates, 27 were found suitable for tissue donation. One potential tissue donor had been reported to the procurement organization. In three cases, the possibility of donation was brought up by parents.Conclusion: A low proportion (2%) of neonates who died in the NICUs were found suitable for organ donation, and a higher proportion (12%) were found suitable for tissue donation. We suggest that increased awareness concerning the possibility of neonatal donation would likely increase the identification of potential neonatal donors. What is Known: • There is an urgent need for very small organs and tissues from neonatal donors What is New: • A number of neonates who died in the NICU were suitable organ or/and tissue donors but were not recognized as donors. • Knowledge on neonatal donation possibilities is also important for proper counseling of parents who sometimes inquire for the possibility of organ and tissue donation.
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Affiliation(s)
- Alicija Vileito
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700, RB, Groningen, the Netherlands.
| | - Christian V. Hulzebos
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - Mona C. Toet
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dyvonne H. Baptist
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - Eduard A. A. Verhagen
- Department of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, the Netherlands
| | - Marion J. Siebelink
- University Medical Center Groningen Transplant Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Trottier A, Maitre G, Hébert A, Weiss MJ. Potential Heart, Liver, and Kidney Donation after Circulatory Determination of Death in a Neonatal Intensive Care Unit. Neonatology 2021; 118:546-552. [PMID: 34352783 DOI: 10.1159/000517660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric organ donation after circulatory determination of death (DCD) has increased in recent years; however, there are few data reporting the number of neonatal potential DCD organ donors and no Canadian-specific reports. OBJECTIVE The main objective of this study was to estimate the number of patients who may have become actual DCD organ donors from a single, tertiary neonatal intensive care unit (NICU) over 5 years. METHODS We reviewed all medical charts of newborns ≥2.5 kg, who died in our center's NICU from January 2013 to December 2017. We determined how many could have become actual organ donors after brain death (DBD) or DCD based on 3 sets of organ-specific eligibility criteria defined as conservative, standard, and liberal. RESULTS Of the 39 deceased patients, none met the criteria for DBD. Twenty-nine (75%) died after the withdrawal of life-sustaining therapies. According to the conservative criteria, 1 patient would have been eligible for kidneys and liver donation. Three patients met standard criteria for kidneys and 1 for liver. Eight patients would have been eligible donors for kidneys, 7 for liver, and 2 for heart according to liberal criteria. Only 2 patients were evaluated for DCD, and no organ donation was performed. CONCLUSIONS While uncommon, we identified potential DCD organ donors in the NICU population for kidney, heart, and liver transplants. The substantial variability in the number of potential donors depending on the selected eligibility criteria emphasizes the need for a standardized definition adapted to local capacities.
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Affiliation(s)
- Alexandra Trottier
- Department of Pediatrics, University Laval, Medicine faculty, Québec, Québec, Canada.,Department of Pediatrics, Emergency Unit, CHU Ste-Justine, University of Montréal, Montréal, Québec, Canada
| | - Guillaume Maitre
- Pediatric Intensive Care Unit, McGill University Health Center, Montreal Children's Hospital, Montréal, Québec, Canada.,Division of Pediatrics, Department "Woman-Mother-Child", Pediatric Intensive Care Unit, Biology and Medicine faculty, Lausanne University Hospital, Lausanne, Switzerland
| | - Audrey Hébert
- Department of Pediatrics, Neonatal Intensive Care Unit, CHU de Québec, Centre Mère-Enfant Soleil, University Laval, Medicine faculty, Québec, Québec, Canada
| | - Matthew J Weiss
- Division of Pediatric Intensive Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, University Laval, Medicine faculty, Québec, Québec, Canada.,Transplant Québec, Montréal, Québec, Canada.,Canadian Donation and Transplantation Research Program (CDTRP), Ottawa, Ontario, Canada
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8
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Vileito A, Siebelink MJ, Vermeulen KM, Verhagen AAE. Lack of knowledge and experience highlights the need for a clear paediatric organ and tissue donation protocol in the Netherlands. Acta Paediatr 2020; 109:2402-2408. [PMID: 32124464 PMCID: PMC7687146 DOI: 10.1111/apa.15241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
Aim This study explored the attitudes of medical professionals to organ and tissue donation in paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) in the Netherlands. It also examined their compliance with the existing Dutch donation protocol and assessed whether a paediatric donation protocol was needed. Methods We invited 966 professionals working in all eight PICUs and the two largest NICUs to complete an online survey from December 2016 until April 2017. Results A quarter (25%) took part and they included PICU intensivists, neonatologists, nurses and other health and allied professionals. Most were female and nurses. More than half (54%) of the PICU respondents considered paediatric organ donation to be very important and 53% supported tissue donation. In contrast, only 22% of the NICU respondents believed that both neonatal organ and tissue donation were very important. Familiarity and compliance with the existing national donation protocol were low. PICU nurses had significantly less experience than PICU intensivists and felt less comfortable with the donation process. None of the NICU respondents had prior donation experience. Conclusion Paediatric intensive care units and NICU professionals lack specialised knowledge and experience on organ and tissue donation. A comprehensive and clear paediatric donation protocol is clearly needed.
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Affiliation(s)
- Alicija Vileito
- Department of Paediatrics Beatrix Children's Hospital University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - Marion J. Siebelink
- Transplant Centre University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - Karin M. Vermeulen
- Department of Epidemiology University Medical Centre Groningen University of Groningen Groningen the Netherlands
| | - A. A. Eduard Verhagen
- Department of Paediatrics Beatrix Children's Hospital University Medical Centre Groningen University of Groningen Groningen the Netherlands
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Aghion A, Hussey-Gardner B, Davis NL, Falck AJ. Patient and provider factors impacting referral for neonatal organ donation. Pediatr Transplant 2020; 24:e13744. [PMID: 32478967 DOI: 10.1111/petr.13744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/28/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND As determination of brain death is infrequent in neonates, the AAP endorses donation after circulatory determination of death as an acceptable alternative. Despite this recommendation, neonatal organ donation is infrequent. Timely referral to OPOs is a vital first step in the organ donation process. The aim of this study was to identify patient and provider factors impacting timely referral for neonatal organ donation. METHODS Medical records were reviewed for deaths occurring in a Level IV NICU from 2007 to 2017. Clinical and demographic factors, provider type, timing of OPO referral (before or after death), and outcome were assessed. Bivariate and multivariable logistic regression models were utilized to identify predictors of OPO referral characteristics. RESULTS Between 2007 and 2017, 329 deaths occurred in the NICU or delivery room. Of the 265 infants meeting inclusion criteria, 96% had late referrals (after death) and were declined for organ donation. Frequency of timely referrals (before death) improved when OPO contact was by an attending neonatologist, when withdrawal of life support was planned, and with increasing birthweight, gestational age, and PMA. Factors associated with decreased OPO referral included male sex, lower weight at death, earlier PMA, and deaths occurring while receiving maximal intensive care support. No organs or tissues were donated. CONCLUSIONS This study is the first to report NICU referral patterns for organ donation. We found that timely provider referral of neonates to the OPO was rare. Exploration of provider knowledge will guide future educational interventions aimed to improve the referral process.
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Affiliation(s)
- Abigail Aghion
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Brenda Hussey-Gardner
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Natalie L Davis
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alison J Falck
- Division of Neonatology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
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Lago P, Cavicchiolo ME, Rusalen F, Benini F. Summary of the Key Concepts on How to Develop a Perinatal Palliative Care Program. Front Pediatr 2020; 8:596744. [PMID: 33344387 PMCID: PMC7744474 DOI: 10.3389/fped.2020.596744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose of review: The aim of this study is to assess the most significant Perinatal Palliative Care (PnPC) development projects in the literature and summarize the shared key principles. Recent findings: PnPC is a new concept in neonatal intensive care approach. Advancements in perinatal diagnostics and medical technology have changed the landscape of the perinatal world. The threshold of viability continues to decrease, and diagnostic information is available earlier in pregnancy and more rapidly at the bedside; overall outcomes continue to improve. This rapid technological improvement brings ethical debates on the quality of life of patients with life-limiting and life-threatening conditions and the need to involve the family in the decision-making process, according to their wishes and cultural beliefs. Although the Perinatal Hospice concept was developed in the 1980s in the US, the first recommendations on how to develop a PnPC pathway were published in the early 2000s. We considered the most relevant position statements or guidelines on PnPC published in the last two decades. Some of them were more pertinent to pediatrics but still useful for the fundamental concepts and PnPC project's development. Summary: Health care providers and institutions are encouraged to develop PnPC programs, which have the goal of maximizing the quality of life of infants with non-curable conditions. These may generally include the following: a formal prenatal consultation; development of a coordinated birth plan between obstetrician, newborn care, and family; access to other neonatal and pediatric specialties, as needed; comfort palliative care during the prenatal, birth, and postnatal periods; and psychosocial and spiritual support for families, siblings, and staff.
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Affiliation(s)
- Paola Lago
- Neonatal Intensive Care Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Maria Elena Cavicchiolo
- Department of Woman and Child Health, Neonatal Intensive Care Unit, University of Padua, Padua, Italy
| | - Francesca Rusalen
- Department of Woman and Child Health, Paediatric Pain and Palliative Care Service, University of Padua, Padua, Italy
| | - Franca Benini
- Department of Woman and Child Health, Paediatric Pain and Palliative Care Service, University of Padua, Padua, Italy
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11
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Darlington AS, Long-Sutehall T, Randall D, Wakefield C, Robinson V, Brierley J. Parents' experiences of requests for organ and tissue donation: the value of asking. Arch Dis Child 2019; 104:837-843. [PMID: 31079074 DOI: 10.1136/archdischild-2018-316382] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/13/2019] [Accepted: 03/11/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE A proportion of children die, making them potentially eligible to be organ/tissue donors. Not all are approached for donation, and experiences of those parents are not well understood. The objective was to investigate to what extent organ and tissue donation (OTD) is discussed as part of end-of-life care and to explore parents' and healthcare professionals' (HCPs) experiences. DESIGN A retrospective qualitative study. SETTING Multicentre study with participants recruited through two neonatal intensive care units (ICUs), two paediatric ICUs, a cardiac ICU and a children's hospice. PATIENTS Bereaved parents, parents of a child with a long-term condition (LTC) and HCPs. INTERVENTIONS None. MAIN OUTCOMES AND MEASURES Parents' and HCPs' views and experiences of discussions about OTD. RESULTS 24 parents of 20 children were interviewed: 21 bereaved parents and 3 parents of a child with a LTC. Seven parents were asked about donation (13 not asked), four agreed and two donated. 41 HCPs were interviewed. Themes: complexity of donation process, OTD as a coping strategy, the importance of asking, difficulty of raising the topic,\ and parents' assumptions about health of organs (when donation is not discussed). CONCLUSIONS The findings add new knowledge about parents' assumptions about the value of their child's organs when discussions about OTD are not raised, and that HCPs do not routinely ask, are sometimes hesitant to ask in fear of damaging relationships, and the reality of the complexity of the donation process. Given the current levels of awareness around OTD, the topic should be raised.
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Affiliation(s)
| | | | - Duncan Randall
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Claire Wakefield
- School of Women's and Children's Health, UNSW Sydney, Sydney, New South Wales, Australia.,Kids Cancer Centre, Syndey Children's Hospital, Sydney, NSW, Australia
| | - Victoria Robinson
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Joe Brierley
- Department of Critical Care & Paediatric Bioethics Centre, Great Ormond Street Hospital for Children, London, UK
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Abstract
OBJECTIVES To describe important considerations during the process of caring for critically ill children who may be potential organ donors and supporting the family during the death of their child. DESIGN Literature review and expert commentary. MEASUREMENT AND MAIN RESULTS Medical literature focusing on pediatric donation, best pediatric donation practices, donor management, and factors influencing donation were reviewed. Additional pediatric data were obtained and reviewed from the U.S. Organ Procurement and Transplantation Network. Achieving successful organ donation requires the coordinated efforts of the critical care team, organ donation organization, and transplant team to effectively manage a potential donor and recover suitable organs for transplantation. Collaboration between these teams is essential to ensure that all potential organs are recovered in optimal condition, to reduce death and morbidity in children on transplantation waiting lists as well as fulfilling the family's wishes for their dying child to become a donor. CONCLUSIONS Organ donation is an important component of end-of-life care and can help the healing process for families and medical staff following the death of a child. The process of pediatric organ donation requires healthcare providers to actively work to preserve the option of donation before the death of the child and ensure donation occurs after consent/authorization has been obtained from the family. Medical management of the pediatric organ donor requires the expertise of a multidisciplinary medical team skilled in the unique needs of caring for children after neurologic determination of death and those who become donors following circulatory death after withdrawal of life-sustaining medical therapies.
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Martinez-Lopez S, Wijetunga I, Ecuyer C, Ahmad N. Bilateral adrenal hemorrhage in a neonatal kidney donor. Pediatr Transplant 2018; 22:e13173. [PMID: 29624811 DOI: 10.1111/petr.13173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 11/27/2022]
Abstract
EKT from neonatal donors remains rare despite successful outcome being reported. The surgical aspects of neonatal abdominal organ recovery remain unfamiliar to the vast majority of abdominal organ recovery teams and renal transplant surgeons. BAH is not uncommon in newborn babies suffering distress in the perinatal period. BAH is often also associated with RVT and will impact on utilization of kidneys for transplantation. We present a case of a neonatal kidney donor with massive BAHs discovered at the time of organ recovery. This made the procurement challenging. Both kidneys were recovered en bloc with pancreas and the liver with aorta and inferior vena cave as vascular conduits. The kidneys were successfully implanted into an adult recipient with good function at 1-year follow-up. Association between adrenal hemorrhage and RVT needs to be considered before utilizing such kidneys. This case exemplifies successful outcome after careful assessment and transplantation of such kidneys.
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Affiliation(s)
| | - Imeshi Wijetunga
- Department of Transplantation, St James's University Hospital, Leeds, UK
| | - Clare Ecuyer
- Department of Transplantation, St James's University Hospital, Leeds, UK
| | - Niaz Ahmad
- Department of Transplantation, St James's University Hospital, Leeds, UK
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14
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Hawkins KC, Scales A, Murphy P, Madden S, Brierley J. Current status of paediatric and neonatal organ donation in the UK. Arch Dis Child 2018; 103:210-215. [PMID: 29242244 DOI: 10.1136/archdischild-2017-313466] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Kay C Hawkins
- Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Manchester, UK
| | | | | | | | - Joe Brierley
- Department of Critical Care & Bioethics, Great Ormond Street Hospital, London, UK
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15
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Gelbart B. Challenges of paediatric organ donation. J Paediatr Child Health 2017; 53:534-539. [PMID: 28398658 DOI: 10.1111/jpc.13541] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
Abstract
Paediatric organ donation represents a small fraction of overall organ donation in Australia and New Zealand and indeed world-wide. Many factors contribute to low donation rates including low paediatric intensive care mortality, consent rates and medical suitability relating to disease, age and size. In the past decade, the re-emergence of donation after circulatory death has changed the landscape for the paediatric population. This article reviews the current status and challenges of organ donation for the paediatric population.
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Affiliation(s)
- Ben Gelbart
- Paediatric Intensive Care Unit, Royal Children's Hospital, Murdoch Children's Research Institute, DonateLife, Victoria, Melbourne, Victoria, Australia
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16
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Abstract
The Ethics Committee of The Transplantation Society convened a meeting on pediatric deceased donation of organs in Geneva, Switzerland, on March 21 to 22, 2014. Thirty-four participants from Africa, Asia, the Middle East, Oceania, Europe, and North and South America explored the practical and ethical issues pertaining to pediatric deceased donation and developed recommendations for policy and practice. Their expertise was inclusive of pediatric intensive care, internal medicine, and surgery, nursing, ethics, organ donation and procurement, psychology, law, and sociology. The report of the meeting advocates the routine provision of opportunities for deceased donation by pediatric patients and conveys an international call for the development of evidence-based resources needed to inform provision of best practice care in deceased donation for neonates and children.
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17
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Abstract
OBJECTIVE Although pediatric donation after circulatory determination of death is increasing in frequency, there are no national or international donation after circulatory determination of death guidelines specific to pediatrics. This scoping review was performed to map the pediatric donation after circulatory determination of death literature, identify pediatric donation after circulatory determination of death knowledge gaps, and inform the development of national or regional pediatric donation after circulatory determination of death guidelines. DATA SOURCES Terms related to pediatric donation after circulatory determination of death were searched in Embase and MEDLINE, as well as the non-MEDLINE sources in PubMed from 1980 to May 2014. STUDY SELECTION Seven thousand five hundred ninety-seven references were discovered and 85 retained for analysis. All references addressing pediatric donation after circulatory determination of death were considered. Exclusion criteria were articles that did not address pediatric patients, animal or laboratory studies, surgical techniques, and local pediatric donation after circulatory determination of death protocols. Narrative reviews and opinion articles were the most frequently discovered reference (25/85) and the few discovered studies were observational or qualitative and almost exclusively retrospective. DATA EXTRACTION Retained references were divided into themes and analyzed using qualitative methodology. DATA SYNTHESIS The main discovered themes were 1) studies estimating the number of potential pediatric donation after circulatory determination of death donors and their impact on donation; 2) ethical issues in pediatric donation after circulatory determination of death; 3) physiology of the dying process after withdrawal of life-sustaining therapy; 4) cardiac pediatric donation after circulatory determination of death; and 5) neonatal pediatric donation after circulatory determination of death. Donor estimates suggest that pediatric donation after circulatory determination of death will remain an event less common than brain death, albeit with the potential to substantially expand the existing organ donation pool. Limited data suggest outcomes comparable with organs donated after neurologic determination of death. Although there is continued debate around ethical aspects of pediatric donation after circulatory determination of death, all pediatric donation after circulatory determination of death publications from professional societies contend that pediatric donation after circulatory determination of death can be practiced ethically. CONCLUSIONS This review provides a comprehensive overview of the published literature related to pediatric donation after circulatory determination of death. In addition to informing the development of pediatric-specific guidelines, this review serves to highlight several important knowledge gaps in this topic.
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18
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Abstract
BACKGROUND Significant disparity exists in the United Kingdom between the need for organ transplant and supply of deceased donor organs. In the recent years, efforts to increase donation has improved the rate of mainly deceased donors after circulatory death and from older donors. The rate of donation from pediatric population has remained low and those younger than 2 years including neonatal donation has remained largely unexplored. METHODS A retrospective review of the outcome of renal transplantation from pediatric donor (<18 years) kidneys in the United Kingdom. RESULTS Our results show a poor referral and conversion rate, and high discard rate (43%) of kidneys procured from donors younger than 2 years. During the 15-year study period (1997-2011), 47 donors younger than 2 years were referred (3 per year). Of these, 26 proceeded to donation resulting in 17 transplants (65% utilization). The referral rate for donors 2 years or older to younger than 5 years also remains low (76 in 15 years), but the conversion (88%) and utilization rates (73%) are better in this group. There was better utilization in donors aged 5 years or older to younger than 18 years. Overall graft and patient survival remains excellent in all 3 groups; with comparable survival of 82%, 85%, and 77% (P = 0.29) with mean follow-up periods of 9, 12.5, and 11.8 years, respectively. CONCLUSIONS Despite excellent outcome, the referral, donation, and utilization of kidneys from donors younger than 5 years and particularly those younger than 2 years remain low. We suggest implementing improved strategies to increase donation from this group of population.
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19
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Abstract
OBJECTIVES To estimate the organ donation potential of patients dying at a children's hospital. DESIGN Retrospective cohort study. SETTING A free-standing, 271-bed, tertiary Children's Hospital with a pediatric trauma center. PATIENTS Patients dying in any ICU during 2011-2012. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 224 deaths, 23 (10%) met neurologic criteria for death: 18 donated organs (conversion rate 78%), 47 (19%) died without prior limitation of life-sustaining therapies, and the remaining 69% had withdrawal of life-sustaining therapies. Among those dying after withdrawal of life-sustaining therapies (n = 154), the organ procurement organization was not notified prior to death in 24%, and older patients were more likely to be referred compared to those less than 1 year old. Infection, cancer, and organ dysfunction were the most frequent conditions that disqualified dying patients from suitability for donation. Just over half of children more than 1 year old were suitable for donation after withdrawal of life-sustaining therapies compared to a fifth of infants (19%). Of 45 suitable for donation, 37 (82%) died within 1 hour. None of 7 infants younger than 1 month old died within 20 minutes, compared with 46% of infants between 1 month and 1 year (n = 6) and 72% of older children. Thirty-three families (73%) did not permit donation after circulatory criteria for death whereas 12 (27%) gave permission for donation, and all 12 were actual donors (conversion rate 12/37 [32%]). CONCLUSIONS The number of pediatric potential candidates for donation after circulatory determination of death was significantly larger than potential candidates for donation after neurologic determination of death at our hospital, but the actual donation rate was significantly lower. Increasing acceptance of donation after circulatory determination of death could increase organ donation. Among all children having withdrawal of life-sustaining therapies, donation after circulatory determination of death potential is less for infants.
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20
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Wijetunga I, Ecuyer C, Martinez-Lopez S, Benetatos N, Griffiths A, Adappa R, Francis C, Murphy P, Ahmad N. Neonatal organ donation for transplantation in the UK. Arch Dis Child Fetal Neonatal Ed 2015; 100:F469. [PMID: 26126845 DOI: 10.1136/archdischild-2015-308575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 11/04/2022]
Affiliation(s)
- I Wijetunga
- Department of Transplantation, St James's University Hospital, Leeds, UK
| | - C Ecuyer
- Department of Transplantation, St James's University Hospital, Leeds, UK
| | - S Martinez-Lopez
- Department of Transplantation, St James's University Hospital, Leeds, UK
| | - N Benetatos
- Department of Hepatobiliary Surgery and Liver Transplantation, Queen Elizabeth Hospital, Birmingham, UK
| | | | - R Adappa
- Department of Neonatology, University Hospital of Wales, Cardiff, UK
| | - C Francis
- Department of Obstetrics, University Hospital of Wales, Cardiff, UK
| | | | - N Ahmad
- Department of Transplantation, St James's University Hospital, Leeds, UK
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21
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Moorlock G, Neuberger J, Draper H. Split liver transplantation: Papering over the cracks of the organ shortage. CLINICAL ETHICS 2015; 10:83-89. [DOI: 10.1177/1477750915599703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Splitting livers allows two people (usually an adult and a child) to receive a liver transplant from one donated adult liver, but the risks to the adult recipient are greater than if they had received the equivalent whole liver. It has been suggested, therefore, that splitting livers harms adult recipients. Without liver splitting, however, there would be few livers available for children, and paediatric waiting time and waiting list mortality would significantly increase. In this paper, we argue that although splitting livers makes adults worse off, this should be considered sub-optimal benefit rather than harm. We explore justifications for sub-optimally benefitting adults in this way and consider alternatives to the current approach. We argue that splitting livers masks the more fundamental problem of low paediatric donation rates and that increasing the number of paediatric donations would improve the situation for both adult and paediatric liver patients.
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Affiliation(s)
- Greg Moorlock
- Institute of Applied Health Research, University of Birmingham, UK
| | | | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, UK
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22
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Affiliation(s)
- Joanna C E Wright
- Department of Neonatal Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Adam D Barlow
- Department of Surgery, University of Cambridge, and NIHR Cambridge Biomedical Research Centre, Cambridge, UK
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23
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Wijetunga I, Pandanaboyana S, Farid SG, Ecuyer C, Lewington A, Hostert L, Attia M, Ahmad N. Neonatal kidney donation and transplantation: a realistic strategy for the treatment of end-stage renal disease. Arch Dis Child Fetal Neonatal Ed 2014; 99:F518-9. [PMID: 24972989 DOI: 10.1136/archdischild-2014-306592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Imeshi Wijetunga
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK
| | - Sanjay Pandanaboyana
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK
| | - Shahid G Farid
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK
| | - Clare Ecuyer
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK
| | - Andrew Lewington
- Department of Renal Medicine, St James's University Hospital, Leeds, UK
| | - Lutz Hostert
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK
| | - Magdy Attia
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK
| | - Niaz Ahmad
- Department of Hepatobiliary and Transplant Surgery, St James's University Hospital, Leeds, UK
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