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Reed MJ, Currie I, Forsythe J, Young I, Stirling J, Logan L, Clegg GR, Oniscu GC. Lessons from a pilot for uncontrolled donation after circulatory death in the ED in the UK. Emerg Med J 2019; 37:155-161. [PMID: 31757833 DOI: 10.1136/emermed-2019-208650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 11/03/2022]
Abstract
Worldwide there is a shortage of available organs for patients requiring transplants. However, some countries such as France, Italy and Spain have had greater success by allowing donations from patients with unexpected and unrecoverable circulatory arrest who arrive in the ED. Significant advances in the surgical approach to organ recovery from donation after circulatory death (DCD) led to the establishment of a pilot programme for uncontrolled DCD in the ED of the Royal Infirmary of Edinburgh. This paper describes the programme and discusses the lessons learnt.
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Affiliation(s)
- Matthew James Reed
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Ian Currie
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - John Forsythe
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
- NHS Blood and Transplant, The Courtyard Callendar Business Park, Falkirk, UK
| | - Irene Young
- NHS Blood and Transplant, The Courtyard Callendar Business Park, Falkirk, UK
| | - John Stirling
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Lesley Logan
- NHS Blood and Transplant, The Courtyard Callendar Business Park, Falkirk, UK
| | - Gareth R Clegg
- Emergency Medicine Research Group Edinburgh (EMERGE), Royal Infirmary of Edinburgh, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Gabriel C Oniscu
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
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Park UJ, Cho WH, Kim HT, Kim MY, Kim YL, Kim CD, Cho JH, Kim YH, Park SJ, Chung SY, Choi SJN, Lee HK, Park SK, Lee S, Yu HC. Evaluation of the Korean Network for Organ Sharing Expanded Donor Criteria in Deceased Donor Renal Transplantation. KOREAN JOURNAL OF TRANSPLANTATION 2013. [DOI: 10.4285/jkstn.2013.27.4.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ui Jun Park
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Won Hyun Cho
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hyoung Tae Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Min Young Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Chan-Duck Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Young Hoon Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Suk Joo Park
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Young Chung
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Jin Na Choi
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Kyun Lee
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Kwang Park
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Sik Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Hee Chul Yu
- Department of Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
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Bartlett A, Vara R, Muiesan P, Mariott P, Dhawan A, Mieli-Vergani G, Rela M, Heaton N. A single center experience of donation after cardiac death liver transplantation in pediatric recipients. Pediatr Transplant 2010; 14:388-92. [PMID: 20519017 DOI: 10.1111/j.1399-3046.2009.01206.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Many centers are now performing DCD adult LT. There has been a reluctance to transplant pediatric recipients with DCD livers due to concern over the medium to long-term outcome. We describe the outcome of 14 children (median age seven yr, 8 months-16 yr) that underwent LT with DCD grafts from July 2001 to December 2007. Donors had a median age of 23 yr (10-64), intensive care stay of five d (2-14) and bilirubin of 9 mmol/L (6-60). Median warm and cold ischemic time was 16 min (11-29) and seven h (5.5-8.4). Livers were transplanted as a whole organ (4), reduced graft (8), formal split (1) or auxiliary transplant (1). Compared to DBD recipients AST was significantly higher on the first three post-operative days and there was no difference in the INR, bilirubin or GGT out to 12 months. There were no biliary or vascular complications and patient and graft survival is 100% at a median follow-up of 41.8 months (1.7-74 months). LT with DCD grafts in pediatric recipients can be performed with low morbidity and excellent short-to-medium term patient and graft outcome.
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Affiliation(s)
- Adam Bartlett
- Institute of Liver Studies and Transplantation, King's College London School of Medicine at King's College Hospital NHS Foundation Trust, London, United Kingdom.
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Isch DJ. In defense of the reverence of all life: Heideggerean dissolution of the ethical challenges of organ donation after circulatory determination of death. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2007; 10:441-59. [PMID: 17473990 DOI: 10.1007/s11019-007-9053-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Accepted: 02/22/2007] [Indexed: 05/15/2023]
Abstract
During the past 50 years since the first successful organ transplant, waiting lists of potential organ recipients have expanded exponentially as supply and demand have been on a collision course. The recovery of organs from patients with circulatory determination of death is one of several effective alternative approaches recommended to reduce the supply-and-demand gap. However, renewed debate ensues regarding the ethical management of the overarching risks, pressures, challenges and conflicts of interest inherent in organ retrieval after circulatory determination of death. In this article, the author claims that through the engagement of a Heideggerean existential phenomenological and hermeneutic framework what are perceived as ethical problems dissolve, including collapse of commitment to the dead donor rule. The author argues for a revisioned socially constructed conceptual and philosophical responsibility of humankind to recognize the limits of bodily finitude, to responsibly use the capacity of the transplantable organs, and to grant enhanced or renewed existence to one with diminished or life-limited capacity; thereby making the locus of ethical concern the donor-recipient as unitary ''life.'' What ethically matters in the life-cycle (life-world) of donor-recipient is the viability of the organs transplanted; thereby granting reverence to all life.
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Affiliation(s)
- D J Isch
- Hospital, Harris Methodist Fort Worth, Office of Ethics, 1301 Pennsylvania Avenue, Fort Worth, TX, 76104, USA.
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Choperena G, Azaldegui F, Arcega I, Alberdi F, Marco P, Ibarguren K, Reviejo K, Romo E, Mintegi I, Aranzabal J, Olaizola P. Evaluación de los politraumatizados fallecidos en la provincia de Gipuzkoa como fuente potencial de donantes a corazón parado. Med Intensiva 2002. [DOI: 10.1016/s0210-5691(02)79830-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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