Effects of gene induction and cytokine production in donor care

Organ retrieval and banking in brain dead trauma patients: Our experience at level-1 trauma centre and current views

Background:

Organ retrieval from brain dead patients is getting an increased attention as the waiting list for organ recipients far exceeds the organ donor pool. In our country, despite a large population the number of brain dead donors undergoing organ donation is very less (2% in our study).

Aims:

The present study was undertaken to address issues related to organ donation and share our experience for the same.

Methods:

A retrospective case record analysis of over 5 years from September 2007 to August 2012 was performed and the patients fulfilling brain death criterion as per Transplantation of Human Organs and Tissue (Amendment) Act were included. Patient demographics (age, sex), mode of injury, time from injury to the diagnosis of brain death, time from diagnosis of brain death to organ retrieval and complications were analysed.

Statistics Analysis:

Student's t test was used for parametric data and Chi square was used for categorical data.

Results:

Out of 205 patients who were identified as brain dead, only 10 patients became potential organ donors.

Conclusion:

Aggressive donor management, increasing public awareness about the concept of organ donation, good communication between clinician and the family members and a well-trained team of transplant coordinators can help in improving the number of organ donations.

Hospital-independent organ recovery from deceased donors: a two-year experience

Early experience with deceased donor (DD) organ recovery outside of the hospital setting was found to be safe, efficient and cost effective. A 2-year experience under current practice protocols implemented to further process improvements is now reviewed. From December 1, 2001 to December 31, 2003, 123 criteria eligible DDs were transferred from local and regional hospitals to the Mid-America Transplant Services (MTS) facility for organ and tissue recovery. In this retrospective analysis, outcome comparisons were made with 79 conventional hospital-based recoveries. Compared to hospital recoveries, MTS facility recoveries were associated with significantly reduced critical care unit time (819 vs. 502 min), time to cross-clamp following brain death (966 vs. 731 min), operating room delay (54 vs. 9 min) and a trend toward reduced organ cold ischemia times which reached significance for heart and lungs when compared to regional hospital recoveries (147 vs. 221 and 192 vs. 327 min). MTS facility recovery afforded substantial cost savings over local and regional hospital recoveries (US 6,690 dollars and US 5,452 dollars per donor, respectively). The current practice of DD recovery at the MTS facility was applicable for most recoveries, improved process efficiency, and afforded substantial cost savings without donor compromise.

Renal effects of parenteral fish oil administered to heart-beating organ donors and renal-transplant recipients: a tolerance study

BACKGROUND & AIMS

Nutrition can interfere with organ function during the different stages of transplantation. Oral fish oil supplementation to kidney transplant recipients has been found to improve renal function. The aim of the present study was to determine the safety and tolerance of intravenous administration of fish-oil emulsion to heart-beating brain-dead donors and, subsequently, to the kidney recipients, and to assess its effects on renal function.

METHODS

A lipid emulsion enriched with omega-3 fatty acids (MLF 541) was given intravenously to 8 heart-beating, brain-dead organ donors for up to 4 h before organ harvesting and to the kidney recipients for 5 days postoperatively. Hemodynamic, biochemistry and hematological parameters were measured before and at the end of lipid administration in the donors and on posttransplantation days 1, 5, 30 and 180 in the recipients. Findings in the recipients were compared with a concurrent control group.

RESULTS

There were no significant changes in hemodynamic or laboratory parameters during the MLF infusion in the donors or the 5 days of MLF administration in the recipients. Blood urea nitrogen and serum creatinine levels decreased over time in both the study and control recipients (P < 0.05 for both), with no significant between-group difference at any of the time points studied.

CONCLUSIONS

Administration of MLF 541 is safe in organ donors and in kidney recipients. Further studies involving nutrients as pharmacological agents in organ transplantation are warranted.