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Abstract
Context Donor Action, an international initiative to alleviate organ shortage, provides a comprehensive state-of-the-art methodology that helps critical care units develop a tailor-made approach to optimize donation practices and performance. Objective To report the impact of the Donor Action methodology on organ donation rates in 8 countries (70 critical care units) in North America and Europe. Design Baseline data on the clinical potential for donation, staff attitudes, knowledge toward donation, self-reported confidence in performing a range of donation roles, and educational requirements were gathered. These data were analyzed using the Donor Action database and improvement measures were introduced to address identified weaknesses. Results Following introduction of the program's improvement measures, which addressed identified weaknesses, donations increased on average by 53% ( P=.0017) per country at 1 year. Sustained improvements settled at 70% to 160% increases at 3 years. Although Donor Action is at various stages of implementation in different countries, the number of centers and countries demonstrating an immediate awareness effect is increasing and sustained effects in centers with the longest follow-up promise a significant impact on donation rates as more countries implement this methodology.
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Affiliation(s)
- L Roels
- Donor Action Foundation, 38 Pitcarnie Crescent, London, Ontario N6G 4N4, Canada
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2
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Hoste P, Vanhaecht K, Ferdinande P, Rogiers X, Eeckloo K, Blot S, Hoste E, Vogelaers D, Vandewoude K. Care pathways for organ donation after brain death: guidance from available literature? J Adv Nurs 2016; 72:2369-80. [PMID: 27328738 DOI: 10.1111/jan.13051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2016] [Indexed: 01/10/2023]
Abstract
AIMS A discussion of the literature concerning the impact of care pathways in the complex and by definition multidisciplinary process of organ donation following brain death. BACKGROUND Enhancing the quality and safety of organs for transplantation has become a central concern for governmental and professional organizations. At the local hospital level, a donor coordinator can use a range of interventions to improve the donation and procurement process. Care pathways have been proven to represent an effective intervention in several settings for optimizing processes and outcomes. DESIGN A discussion paper. DATA SOURCES A systematic review of the Medline, CINAHL, EMBASE and The Cochrane Library databases was conducted for articles published until June 2015, using the keywords donation after brain death and care pathways. Each paper was reviewed to investigate the effects of existing care pathways for donation after brain death. An additional search for unpublished information was conducted. DISCUSSION Although literature supports care pathways as an effective intervention in several settings, few studies have explored its use and effectiveness for complex care processes such as donation after brain death. IMPLICATIONS FOR NURSING Nurses should be aware of their role in the donation process. Care pathways have the potential to support them, but their effectiveness has been insufficiently explored. CONCLUSION Further research should focus on the development and standardization of the clinical content of a care pathway for donation after brain death and the identification of quality indicators. These should be used in a prospective effectiveness assessment of the proposed pathway.
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Affiliation(s)
- Pieter Hoste
- Department of General Internal Medicine, Ghent University Hospital, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Intensive Care, General Hospital Sint-Lucas, Ghent, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium.,Department of Quality Management, University Hospitals Leuven, Belgium.,European Pathway Association, Kapucijnenvoer, Leuven, Belgium
| | | | - Xavier Rogiers
- Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Transplant Surgery, Ghent University Hospital, Belgium
| | - Kristof Eeckloo
- Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - Stijn Blot
- Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Internal Medicine, Ghent University, Belgium.,Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Eric Hoste
- Department of Intensive Care Medicine, Ghent University Hospital, Belgium.,Research Foundation - Flanders (FWO), Egmontstraat, Brussels, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Internal Medicine, Ghent University, Belgium
| | - Koenraad Vandewoude
- Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Department of Internal Medicine, Ghent University, Belgium
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Powner DJ. Treatment Goals during Care of Adult Donors That Can Influence Outcomes of Heart Transplantation. Prog Transplant 2016; 15:226-32. [PMID: 16252628 DOI: 10.1177/152692480501500305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myocardial dysfunction during care of adult donors can result from injury occurring before hospital admission or during the progression of brain death. Few evidence-based data correlate specific hemodynamic goals during donor care with outcomes of heart transplantation, although many recommendations exist. Spontaneous reversal of early heart damage or correction of poor cardiac performance can yield outcomes equivalent to outcomes in recipients who had ideal donors. Hemodynamic goals developed in the operating room can be applied in intensive care to improve outcomes of transplantation. These goals include maintenance of mean arterial pressure greater than 60 mm Hg, central venous pressure less than 12 mm Hg, cardiac output greater than 3.8 L/min, cardiac index greater than 2.1, and systemic vascular resistance between 800 and 1200 dyne · sec · cm−5. The ejection fraction and other echocardiographic data also provide helpful guidance when determining whether a heart is suitable for transplantation and during therapy. Titration of cardiovascular variables often requires invasive monitoring to ensure that cardiac preload, afterload, and contractility are optimal.
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Affiliation(s)
- David J Powner
- Department of Neurosurgery, University of Texas Health Science Center, Houston, TX, USA
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Esmaeilzadeh M, Dictus C, Kayvanpour E, Sedaghat-Hamedani F, Eichbaum M, Hofer S, Engelmann G, Fonouni H, Golriz M, Schmidt J, Unterberg A, Mehrabi A, Ahmadi R. One life ends, another begins: Management of a brain-dead pregnant mother-A systematic review-. BMC Med 2010; 8:74. [PMID: 21087498 PMCID: PMC3002294 DOI: 10.1186/1741-7015-8-74] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 11/18/2010] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND An accident or a catastrophic disease may occasionally lead to brain death (BD) during pregnancy. Management of brain-dead pregnant patients needs to follow special strategies to support the mother in a way that she can deliver a viable and healthy child and, whenever possible, also be an organ donor. This review discusses the management of brain-dead mothers and gives an overview of recommendations concerning the organ supporting therapy. METHODS To obtain information on brain-dead pregnant women, we performed a systematic review of Medline, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). The collected data included the age of the mother, the cause of brain death, maternal medical complications, gestational age at BD, duration of extended life support, gestational age at delivery, indication of delivery, neonatal outcome, organ donation of the mothers and patient and graft outcome. RESULTS In our search of the literature, we found 30 cases reported between 1982 and 2010. A nontraumatic brain injury was the cause of BD in 26 of 30 mothers. The maternal mean age at the time of BD was 26.5 years. The mean gestational age at the time of BD and the mean gestational age at delivery were 22 and 29.5 weeks, respectively. Twelve viable infants were born and survived the neonatal period. CONCLUSION The management of a brain-dead pregnant woman requires a multidisciplinary team which should follow available standards, guidelines and recommendations both for a nontraumatic therapy of the fetus and for an organ-preserving treatment of the potential donor.
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Affiliation(s)
- Majid Esmaeilzadeh
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christine Dictus
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Elham Kayvanpour
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Farbod Sedaghat-Hamedani
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Michael Eichbaum
- Departments of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany
| | - Stefan Hofer
- Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany
| | - Guido Engelmann
- Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
| | - Hamidreza Fonouni
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jan Schmidt
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Rezvan Ahmadi
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
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Powner DJ. Brain Death: Compliance, Consequences and Care of the Adult Donor. Intensive Care Med 2007. [DOI: 10.1007/978-0-387-49518-7_89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Significant systemic changes occur following neurologic insult and subsequent brain death. If left untreated, the hemodynamic instability and neuroendocrine alterations that ensue may significantly affect the quality of the donor organs, and contribute to posttransplant allograft dysfunction. A number of pharmacologic interventions are often implemented in an attempt to stabilize donor hemodynamics and optimize organ perfusion, thereby increasing the number and quality of cadaveric donor organs available for transplantation. This review provides a summary of these interventions, with an emphasis placed on hormonal resuscitation, which involves utilizing such agents as thyroxin, vasopressin, insulin, and corticosteroids.
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Roels L, Patrzalek D, Cohen B, Gachet C, Wight C. Nonexploited potential for organ donation: donor action pre intervention data and the Polish case. Transplant Proc 2003; 35:1159-62. [PMID: 12947894 DOI: 10.1016/s0041-1345(03)00131-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- L Roels
- Donor Action Foundation, Prinsendreef 10, B-3210 Linden, Belgium.
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Zaroff JG, Rosengard BR, Armstrong WF, Babcock WD, D’Alessandro A, Dec G, Edwards NM, Higgins RS, Jeevanandum V, Kauffman M, Kirklin JK, Large SR, Marelli D, Peterson TS, Ring W, Robbins RC, Russell SD, Taylor DO, Van Bakel A, Wallwork J, Young JB. Maximizing use of organs recovered from the cadaver donor: cardiac recommendations1 1This article was originally published in Circulation. Copyright © 2002 American Heart Association, Inc. Reprinted with permission, Lippincott, Williams & Wilkins. J Heart Lung Transplant 2002. [DOI: 10.1016/s1053-2498(02)00526-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rosendale JD, Chabalewski FL, McBride MA, Garrity ER, Rosengard BR, Delmonico FL, Kauffman HM. Increased transplanted organs from the use of a standardized donor management protocol. Am J Transplant 2002; 2:761-8. [PMID: 12243497 DOI: 10.1034/j.1600-6143.2002.20810.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The organ shortage has resulted in increasing recipient waiting lists and waiting-list deaths. The increased use of expanded donors has been associated with increased discarding of procured organs because of poor organ function. A structured donor management algorithm or critical pathway was tested to determine its effect on the donor management and procurement process. A pilot study examined donors from 88 critical care units in 10 organ procurement organizations managed under the critical pathway and compared them to retrospective data collected at those same pilot sites. The total number of organs both procured and transplanted per 100 donors was significantly greater (p <0.01) in the critical pathway group when compared to the control group. There was no significant difference in 1-year graft survival for any of the organs recovered, and no significant difference in the rate of delayed graft function in the kidneys transplanted. Use of a structured donor management algorithm results in significant increases in organs procured and organs transplanted without any reduction in the quality of the organs being transplanted.
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Affiliation(s)
- John D Rosendale
- Research Department, United Network for Organ Sharing, Richmond, VA, USA.
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