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Patuzzo Manzati S, Galeone A, Onorati F, Luciani GB. Donation After Circulatory Death following Withdrawal of Life-Sustaining Treatments. Are We Ready to Break the Dead Donor Rule? JOURNAL OF BIOETHICAL INQUIRY 2024:10.1007/s11673-024-10382-8. [PMID: 39235682 DOI: 10.1007/s11673-024-10382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 06/27/2024] [Indexed: 09/06/2024]
Abstract
A fundamental criterion considered essential to deem the procedure of vital organ procurement for transplantation ethical is that the donor must be dead, as per the Dead Donor Rule (DDR). In the case of Donation after Circulatory Death (DCD), is the donor genuinely dead? The main aim of this article is to clarify this uncertainty, which primarily arises from the fact that in DCD, death is determined based on cardiac criteria (Circulatory Death, CD), rather than neurological criteria (Brain Death, BD), and that to allow the procurement procedure, physicians reperfuse the organs in an assisted manner. To ensure that the cessation of circulation leads to the irreversible loss of brain functions, DCD regulations require that physicians wait a certain period after CD before commencing vital organ procurement. However, during this "no-touch period," the organs are at risk of damage, potentially rendering them unsuitable for transplantation. When DCD is performed on patients whose CD follows a Withdrawal of Life-Sustaining Treatment (WLST) (DCD Maastricht III category), how long should the no-touch period last? Does its existence really make sense? Does beginning the procedure of vital organ procurement immediately after WLST constitute a violation of the DDR that can be ethically justified? The discussion aims to provide arguments in support of the non-absoluteness of the DDR.
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Affiliation(s)
- Sara Patuzzo Manzati
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of History of Medicine and Bioethics, University of Verona, Piazzale A. Stefani 1, 37129, Verona, Italy
| | - Antonella Galeone
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Piazzale A. Stefani 1, 37129, Verona, Italia.
| | - Francesco Onorati
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Piazzale A. Stefani 1, 37129, Verona, Italia
| | - Giovanni Battista Luciani
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Division of Cardiac Surgery, University of Verona, Piazzale A. Stefani 1, 37129, Verona, Italia
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Vergano M, Jung C, Metaxa V. Intensive care admission aiming at organ donation. Con. Intensive Care Med 2024; 50:440-442. [PMID: 38270641 DOI: 10.1007/s00134-024-07326-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Turin, Italy
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital and Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
- Cardiovascular Research Institute Düsseldorf (CARID), Medical Faculty, Heinrich-Heine University, Duesseldorf, Germany
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
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Hatami S, Conway J, Freed DH, Urschel S. Thoracic organ donation after circulatory determination of death. TRANSPLANTATION REPORTS 2023. [DOI: 10.1016/j.tpr.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Wu X, Wang W, Li Q, Peng Z, Zhu J. Current Situation With Organ Donation and Transplantation in China: Application of Machine Learning. Transplant Proc 2022; 54:1711-1723. [DOI: 10.1016/j.transproceed.2022.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/26/2022] [Indexed: 11/16/2022]
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Cardounel A, Julliard W. Donation after cardiac death in heart transplantation: is there an ethical dilemma? Curr Opin Anaesthesiol 2022; 35:48-52. [PMID: 34878419 DOI: 10.1097/aco.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW In an attempt to address the organ shortages in heart transplantation, USA centres have begun utilizing donation after cardiac death (DCD) as an alternative to traditional donation after brain death (DBD). As this paradigm continues to expand, there is a need to address the medico-legal and ethical aspects of DCD donation, which is the focus of the current review. RECENT FINDINGS Current protocols use criteria established by the Uniform Determination of Death Act (UDDA), which is explicit in defining the irreversibility of circulation and brain function in determining death. By the nature of DCD, the patient may not meet death criteria from a biological systems perspective of irreversibility, and thus, the moral dilemma ensues on whether removing vital organs violates our legal and moral obligations to the patient. SUMMARY In the current article, we review the ethical issues raised with DCD and define DCD protocols and their ability to comply with established regulatory guidelines while respecting the wishes of patients and their surrogates through informed decisions making about organ donation and end-of-life care.
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Affiliation(s)
- Arturo Cardounel
- Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Artiles Medina A, Burgos Revilla FJ, Álvarez Nadal M, Muriel García A, Álvarez Díaz N, Gómez Dos Santos V. Comparison of in situ preservation techniques for kidneys from donors after circulatory death: a systematic review and meta-analysis. Transl Androl Urol 2021; 10:3286-3299. [PMID: 34532253 PMCID: PMC8421834 DOI: 10.21037/tau-21-236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022] Open
Abstract
Background Several techniques have been developed to reduce the warm ischaemic injury of donation after circulatory death (DCD) organs before procurement. There are scarce data about the in situ preservation techniques for kidney graft outcomes. The aim of this systematic review was to evaluate the best in situ preservation method for kidney graft outcomes from organs obtained from controlled and uncontrolled DCD. Methods A systematic review of the PubMed (MEDLINE), Embase, LILACS and Cochrane databases was conducted. Studies that compare two or more in situ preservation techniques were identified and included. Only studies which provided enough data to calculate odds ratio were eligible for meta-analysis. PROSPERO registration: CRD42020179598. Results The search strategy yielded 7,121 studies. Ultimately, 14 retrospective studies were included. Because of heterogeneity, the included studies provided weak evidence that normothermic regional perfusion (NRP) is the best in situ preservation technique in terms of delayed graft function (DGF) rates. Regarding primary nonfunction (PNF), we carried out a meta-analysis of 10 studies with a pooled OR of 0.83 (95% CI: 0.40-1.71), for the NRP. In regard to DGF, pooled OR for NRP was 0.36 (95% CI: 0.25-0.54). Conclusions NRP in the DCD donor could improve kidney graft function and be considered the in situ preservation technique of choice for abdominal organs.
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Affiliation(s)
- Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Francisco Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Marta Álvarez Nadal
- Department of Nephrology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alfonso Muriel García
- Department of Biostatistics, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBERESP, Universidad de Alcalá de Henares (UAH), Madrid, Spain
| | | | - Victoria Gómez Dos Santos
- Department of Urology, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
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Huang Z, Wang Z, Qu W. Influence of Cost and Self-Control on Individual Donation Behavior: The Promoting Effect of Self-Affirmation. Psychol Res Behav Manag 2021; 14:1339-1358. [PMID: 34471392 PMCID: PMC8405225 DOI: 10.2147/prbm.s325651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/13/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Donation behavior plays a crucial role in promoting the development of social and public welfare undertakings. Previous studies have partially explored the influencing factors of donation behavior, but effective methods for boosting individuals' donation behavior remain unclear. Based on the resource dependence theory, our present study further explored the promoting effect of self-affirmation on the relationship among cost, self-control, and individuals' donation behavior, and provided empirical basis for boosting individuals' donation behavior. Methods In preliminary experiment, Carlson's real donation paradigm was conducted to examine the effect of cost on individuals' donation behavior. In experiment 1, we examined the effects of cost, self-control ability, and self-affirmation on individuals' donation behavior. Individuals with high or low self-control ability were assigned to complete the experimental induction of self-affirmation or non-affirmation. Subsequently, all participants completed the donation task under three cost conditions same as preliminary experiment. In experiment 2, we examined the effects of cost, self-control resource, and self-affirmation on individuals' donation behavior. Participants were assigned to complete the different Stroop task to induce the state of self-control resource exhaustion or non-exhaustion. Then, they completed the priming of self-affirmation or non-affirmation same as experiment 1. Finally, all participants completed the donation task under three cost conditions same as preliminary experiment. Results The results of preliminary experiment indicated that participants engaged in more donation behavior under low- and medium-cost conditions compared with high-cost condition. The results of experiment 1 demonstrated that self-affirmation exerted a promoting effect on the donation behavior for individuals with low self-control ability under low-, medium-, and high-cost conditions. The results of experiment 2 demonstrated that self-affirmation promoted the donation behavior of individuals with self-control resource exhaustion under low-, medium-, and high-cost conditions. Conclusion Self-affirmation could promote the donation behavior of individuals with low self-control ability and those with self-control resource exhaustion, whether donation's cost was high or low. Self-affirmation plays a crucial role for boosting individuals' donation behavior.
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Affiliation(s)
- Zijun Huang
- Department of Psychology, School of Education Science, Hunan Normal University, Changsha, People's Republic of China.,Department of Psychology, Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, People's Republic of China
| | - Zixuan Wang
- Department of Psychology, School of Education Science, Hunan Normal University, Changsha, People's Republic of China.,Department of Psychology, Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, People's Republic of China
| | - Weiguo Qu
- Department of Psychology, School of Education Science, Hunan Normal University, Changsha, People's Republic of China.,Department of Psychology, Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, People's Republic of China
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Weiss MJ, van Beinum A, Harvey D, Chandler JA. Ethical considerations in the use of pre-mortem interventions to support deceased organ donation: A scoping review. Transplant Rev (Orlando) 2021; 35:100635. [PMID: 34174656 DOI: 10.1016/j.trre.2021.100635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/03/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
AIM Pre-mortem interventions (PMIs) are performed on patients before the determination of death in order to preserve or enhance the possibility of organ donation. These interventions can be ethically controversial, and we thus undertook a scoping review of the ethical issues surrounding diverse PMIs. METHODS Using modified scoping review methods, we executed a search strategy created by an information specialist. Screening and iterative coding of each article was done by two researchers using qualitative thematic analysis, and narrative summaries of coded themes were presented. RESULTS We identified and screened 5365 references and coded 196 peer-reviewed publications. The most frequently cited issues were related to possible harms to the patient who is a potential donor, and legitimacy of consent. The most controversial issue was that PMIs may place patients at risk for physical harm, yet benefit is accrued mainly to recipients. Some authors argued that lack of direct medical benefit to the still living patient precluded valid consent from surrogate decision makers (SDMs), while many stated that some medical risk could be approved by SDMs if it aligns with non-medical benefits valued by the patient. CONCLUSION PMIs require consensus that benefit includes concepts beyond medical benefit to the patient who is a potential donor. Informed consent must be confirmed for each PMI and not assumed to be part of general consent for donation. Risk must be proportionate to the potential benefit and newly proposed interventions should be reviewed carefully for medical efficacy and potential risks.
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Affiliation(s)
- Matthew J Weiss
- Transplant Québec, 4100 Rue Molson #200, Montréal, QC H1Y 3N1, Canada; Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Division of Pediatric Intensive Care, Centre Mère-Enfant Soleil du CHU de Québec, 2705 boul Laurier, Québec, Québec, Canada.
| | - Amanda van Beinum
- Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Department of Sociology and Anthropology, B750 Loeb Building, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Dan Harvey
- Nottingham University Hospital NHS Trust, Derby Road, Nottingham NG72UH, UK; University of Nottingham, University Park, Nottingham NG72RD, UK; National Health Services Blood & Transplant, Fox Den Road, Stoke Gifford, Avon, Bristol BS348RR, UK
| | - Jennifer A Chandler
- Canadian Donation and Transplantation Research Program (CDTRP), Room 6002, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB T6G 2E1, Canada; Bertram Loeb Research Chair, University of Ottawa, 57 Louis Pasteur St., Ottawa, Ontario K1N 6N5, Canada; Centre for Health Law, Policy and Ethics, Faculty of Law, University of Ottawa, 57 Louis Pasteur St., Ottawa, Ontario K1N 6N5, Canada.
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Jochmans I, Hessheimer AJ, Neyrinck AP, Paredes D, Bellini MI, Dark JH, Kimenai HJAN, Pengel LHM, Watson CJE. Consensus statement on normothermic regional perfusion in donation after circulatory death: report from the European Society for Organ Transplantation's Transplant Learning Journey. Transpl Int 2021; 34:2019-2030. [PMID: 34145644 DOI: 10.1111/tri.13951] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/27/2022]
Abstract
Normothermic regional perfusion (NRP) in donation after circulatory death (DCD) is a safe alternative to in situ cooling and rapid procurement. An increasing number of countries and centres are performing NRP, a technically and logistically challenging procedure. This consensus document provides evidence-based recommendations on the use of NRP in uncontrolled and controlled DCDs. It also offers minimal ethical, logistical and technical requirements that form the foundation of a safe and effective NRP programme. The present article is based on evidence and opinions formulated by a panel of European experts of Workstream 04 of the Transplantation Learning Journey project, which is part of the European Society for Organ Transplantation.
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Affiliation(s)
- 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
| | - 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
| | - Arne P Neyrinck
- Anesthesiology and Algology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - David Paredes
- Donation and Transplant Coordination Unit, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain
| | - Maria Irene Bellini
- Department of Emergency Medicine and Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - John H Dark
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Hendrikus J A N Kimenai
- Division of Transplant Surgery, Department of Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Liset H M Pengel
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Christopher J E Watson
- University of Cambridge, Department of Surgery, Addenbrooke's Hospital, NIHR Cambridge Biomedical Research Centre, Cambridge, UK
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Murphy N, Weijer C, Smith M, Chandler J, Chamberlain E, Gofton T, Slessarev M. Controlled Donation After Circulatory Determination of Death: A Scoping Review of Ethical Issues, Key Concepts, and Arguments. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:418-440. [PMID: 34665091 DOI: 10.1017/jme.2021.63] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Controlled donation after circulatory determination of death (cDCDD) is an important strategy for increasing the pool of eligible organ donors.
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Zanierato M, Dondossola D, Palleschi A, Zanella A. Donation after circulatory death: possible strategies for in-situ organ preservation. Minerva Anestesiol 2020; 86:984-991. [DOI: 10.23736/s0375-9393.20.14262-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Argalious MY. Organ preservation for donation after circulatory death: combining in-situ and ex-situ strategies. Minerva Anestesiol 2020; 86:910-912. [DOI: 10.23736/s0375-9393.20.14735-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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de Kok MJC, Schaapherder AFM, Alwayn IPJ, Bemelman FJ, van de Wetering J, van Zuilen AD, Christiaans MHL, Baas MC, Nurmohamed AS, Berger SP, Bastiaannet E, Ploeg RJ, de Vries APJ, Lindeman JHN. Improving outcomes for donation after circulatory death kidney transplantation: Science of the times. PLoS One 2020; 15:e0236662. [PMID: 32726350 PMCID: PMC7390443 DOI: 10.1371/journal.pone.0236662] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/10/2020] [Indexed: 01/08/2023] Open
Abstract
The use of kidneys donated after circulatory death (DCD) remains controversial due to concerns with regard to high incidences of early graft loss, delayed graft function (DGF), and impaired graft survival. As these concerns are mainly based on data from historical cohorts, they are prone to time-related effects and may therefore not apply to the current timeframe. To assess the impact of time on outcomes, we performed a time-dependent comparative analysis of outcomes of DCD and donation after brain death (DBD) kidney transplantations. Data of all 11,415 deceased-donor kidney transplantations performed in The Netherlands between 1990–2018 were collected. Based on the incidences of early graft loss, two eras were defined (1998–2008 [n = 3,499] and 2008–2018 [n = 3,781]), and potential time-related effects on outcomes evaluated. Multivariate analyses were applied to examine associations between donor type and outcomes. Interaction tests were used to explore presence of effect modification. Results show clear time-related effects on posttransplant outcomes. The 1998–2008 interval showed compromised outcomes for DCD procedures (higher incidences of DGF and early graft loss, impaired 1-year renal function, and inferior graft survival), whereas DBD and DCD outcome equivalence was observed for the 2008–2018 interval. This occurred despite persistently high incidences of DGF in DCD grafts, and more adverse recipient and donor risk profiles (recipients were 6 years older and the KDRI increased from 1.23 to 1.39 and from 1.35 to 1.49 for DBD and DCD donors). In contrast, the median cold ischaemic period decreased from 20 to 15 hours. This national study shows major improvements in outcomes of transplanted DCD kidneys over time. The time-dependent shift underpins that kidney transplantation has come of age and DCD results are nowadays comparable to DBD transplants. It also calls for careful interpretation of conclusions based on historical cohorts, and emphasises that retrospective studies should correct for time-related effects.
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Affiliation(s)
- Michèle J. C. de Kok
- Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ian P. J. Alwayn
- Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederike J. Bemelman
- Department of Internal Medicine (Nephrology), Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine (Nephrology), Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Arjan D. van Zuilen
- Department of Internal Medicine (Nephrology), University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten H. L. Christiaans
- Department of Internal Medicine (Nephrology), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marije C. Baas
- Department of Internal Medicine (Nephrology), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Azam S. Nurmohamed
- Department of Internal Medicine (Nephrology), Amsterdam UMC, VU Medical Center, Amsterdam, The Netherlands
| | - Stefan P. Berger
- Department of Internal Medicine (Nephrology), University Medical Center Groningen, Groningen, The Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger J. Ploeg
- Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Aiko P. J. de Vries
- Division of Nephrology, Department of Internal Medicine and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan H. N. Lindeman
- Department of Surgery and Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
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Analysis of factors involved in brain-death donor processing for face transplantation in Korea: How much time is available from brain death to transplantation? Arch Plast Surg 2019; 46:405-413. [PMID: 31462025 PMCID: PMC6759447 DOI: 10.5999/aps.2019.00150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background Face transplantation has naturally evolved from reconstructive procedures. However, few institutions perform face transplantations, because it is time-consuming and it is necessary to justify non-vital organ transplantation. We investigated the process of organ donation from brain-dead patients and the possibility of incorporating face transplantation into the donation process. Methods A retrospective review was performed of 1,074 brain-dead patients from January 2015 to December 2016 in Korea. We analyzed the time intervals from admission to brain death decisions (first, second, and final), the causes of brain death, and the state of the transplanted organs. Results The patient base (n=1,074) was composed of 747 males and 327 females. The average period between admission to the first brain death decision was 8.5 days (±15.3). The average time intervals between the first brain death decision and medical confirmation using electroencephalography and between the first brain death decision and the final determination of brain death were 16 hours 58 minutes (±14 hours 50 minutes) and 22 hours 57 minutes (±16 hours 16 minutes), respectively. The most common cause of brain death was cerebral hemorrhage/stroke (42.3%), followed by hypoxia (30.1%), and head trauma (25.2%). Conclusions When face transplantation is performed, the transplantation team has 22 hours 57 minutes on average to prepare after the first brain death decision. The cause of brain death was head trauma in approximately one-fourth of cases. Although head trauma does not always imply facial trauma, surgeons should be aware that the facial tissue may be compromised in such cases.
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