Actual Donors Research Articles

Comparison of donor scores in bilateral lung transplantation-A large single-center analysis.

Objectifying donor lung quality is difficult and currently there is no consensus. Several donor scoring systems have been proposed in recent years. They all lack large‐scale external validation and widespread acceptance. A retrospective evaluation of 2201 donor lungs offered to the lung transplant program at the Medical University of Vienna between January 2010 and June 2018 was performed. Five different lung donor scores were calculated for each offer (Oto, ET, MALT, UMN‐DLQI, and ODSS). Prediction of organ utilization, 1‐year graft survival, and long‐term outcome were analyzed for each score. 1049 organs were rejected at the initial offer (group I), 209 lungs declined after procurement (group II), and 841 lungs accepted and transplanted (group III). The Oto score was superior in predicting acceptance of the initial offer (AUC: 0.795; CI: 0.776–0.815) and actual donor utilization (AUC: 0.660; CI: 0.618–0.701). Prediction of 1‐year graft survival was best using the MALT score, Oto score, and UMN‐DLQI. Stratification of early outcome by MALT was significant for length of mechanical ventilation (LMV), PGD3 rates, ICU stay and hospital stay, and in‐hospital‐mortality, respectively. To the best of our knowledge, this study is the largest validation analysis comparing currently available donor scores. The Oto score was superior in predicting organ utilization, and MALT score and UMN‐DLQI for predicting outcome after lung transplantation.

Perceived vs. Verified Cancer Transmission Risk from Deceased Organ Donors in New South Wales (NSW), Australia, 2010-2015

IntroductionDonor suitability assessment is often time-sensitive, with imperfect information available at referral. Opportunities for donation may be missed if donors are rejected based on inaccurate information.
 Objectives and ApproachWe sought to compare assessment of cancer transmission risk based on information available at referral (perceived) versus subsequently obtained (verified) detailed medical history, and to identify any missed opportunities for donation. We used data from the NSW Biovigilance Register, a cohort study of deceased organ donor referrals in New South Wales (NSW) 2010-2015. Referrals from NSW who had consent and were otherwise suitable for donation (except for perceived or verified tumour) were analysed. Perceived tumour details were obtained from NSW Organ and Tissue Donation Service referral logs, while verified details were based on the Central Cancer Registry and Admitted Patient Data Collection. Cancer transmission risk was graded using Transplantation Society of Australia and New Zealand guidelines.
 ResultsAmong 772 referrals otherwise suitable for donation, 601 (78%) had accurately classified cancer transmission risk (κ=0.59). Overall, 53 suitable referrals were rejected due to cancer transmission risk (missed opportunities), including 49 (92%) with overestimated risk (perceived high, verified low/none), and 4 (8%) due to excessive risk aversion (perceived and verified low risk). Missed opportunities had overestimated transmission risk for tumours including leukaemia (8, 16%), lung (8, 16%), melanoma (7, 14%), brain (6, 12%), and breast (6, 12%).
 Conclusion / ImplicationsDespite time pressure and limited information availability, there is moderate agreement between perceived and verified cancer transmission risk. Nevertheless, improved information availability (e.g. via data linkage) could meaningfully increase the number of actual donors.

Donor-intrinsic variables determine mobilization efficiency: analyses from a cohort of sixty twice-mobilized stem cell donors

BackgroundHealthy volunteer registry donors have become the backbone of stem cell transplantation programs. While most registrants will never become actual donors, a small minority are called upon twice, most commonly for the same patient because of poor graft function. Anecdotal evidence provides no hard reasons to disallow second-time mobilized apheresis, but few centers have treated enough two-time donors for definitive conclusions. Moreover, for reasons unknown, the efficiency of G-CSF varies greatly between donations.MethodsComparison of outcomes of first vs. second donations can formally confirm G-CSF responsiveness as intrinsically, likely genetically, determined. In our database, we identified 60 donors (1.3%) who received two cycles of G-CSF 24 days to 4 years apart and systematically compared mobilization outcomes.ResultsFirst and second mobilization and collection proceeded without severe or unusual adverse effects. First-time mobilization efficiency was highly predictive of second-time mobilization. Neither mobilization efficiency nor time lag between donations affected the similarity of first- and second-time mobilization outcomes.ConclusionsWith the caveat that only donors with an unremarkable first donation were cleared for a second, our data indicate that a second donation is feasible, equally tolerable as a first donation, and efficient. Moreover, the data strongly support the notion of donor-intrinsic variables dictating mobilization response and argue against relevant damage to the stem cell compartment during mobilization with rhG-CSF.

Safety and Biovigilance in Organ Donation (SAFEBOD): Protocol for a Population-Based Cohort Study.

BackgroundTension lies between the need to increase access to organ transplantation and the equally urgent need to prevent inadvertent transmission of infectious diseases or cancer from organ donors. Biovigilance, or the evaluation of potential donors, is often time-pressured and may be based on incomplete information.ObjectiveThe Safety and Biovigilance in Organ Donation (SAFEBOD) study aims to improve estimates of infection and cancer transmission risk and explore how real-time data access could support decision-making.MethodsWe will link existing donor referral, actual donor, recipient, and health-outcome data sets from 2000-2015 in New South Wales. Organ donor data sets will include the Organ Donor Characterizing Risk-Profile of Donors Study, the National Organ Matching System, the Australian and New Zealand Organ Donor Register, and the Australian and New Zealand Living Donor Kidney Register. Recipient data sets will include the Australian and New Zealand Dialysis and Transplant Register, the Australian and New Zealand Cardiothoracic Register, the Australian and New Zealand Islet and Pancreas Register, and the Australian and New Zealand Liver Transplant Register. New South Wales health outcome data sets will include HIV and AIDS Notifications and Surveillance Data, the Notifiable Conditions Information Management System, Admitted Patient Data Collection, Emergency Department Data Collection, the Central Cancer Registry, and the Cause of Death Data Collection. We will link organ donors to transplant recipients and health outcomes data sets using probabilistic data-matching based on personal identifiers. Transmission and nontransmission events will be determined by comparing previous cases in donors and posttransplant cases in recipients. We will compare the perceived-risk at referral with the verified risk from linked health outcome data sets and the odds of cancer or contracting an infectious disease in organ recipients from donors based on their transmission-risk profile and estimate recipient survival by donor transmission risk group.ResultsData were requested from each of the listed registries in September 2018, and data collection is ongoing. Linked data from all listed data sets are expected to be complete in September 2020.ConclusionsThe SAFEBOD study will overcome current limitations in organ donation by accessing comprehensive information on referred organ donors and recipients in existing data sets. The study will provide robust estimates of disease transmission and nontransmission events based on recent data. It will also describe the agreement between perceived risk estimated at the time of referral and verified risk when all health outcome data are accessible. The improved understanding of transmission and nontransmission events will inform clinical decisions and highlight where current policies can be revised to broaden the acceptance of deceased donors.International Registered Report Identifier (IRRID)DERR1-10.2196/18282

Study of blood donation campaign communication methods and attributes of donors: A data analytics approach

ABSTRACT Blood cannot be produced artificially. This life-saving liquid is the most precious thing a human being can donate for another human being to save life. The world is even realizing this now more due to the outbreak of the novel coronavirus COVID-19 pandemic as antibodies through plasma donation for the treatment of COVID-19 patients being used to save lives. Blood organizations use different methods to communicate with potential blood donors. This study analyzes different communication methods and their effect on blood donors. The study compares different ways of communicating with blood donors. The study also analyzes different attributes of the actual donors like age, gender, ethnicity, frequency of donation, donation type, etc. The study finds that sms (text messages) has the highest turn out rate followed by email. The overall turn out rate is about 1.4–1.6%. Some other major findings of the study include: most donors donate blood within 7-day period after they receive communications, average age of donors is 40 years, more male donors donate blood than females, mobile vehicles are popular to blood donors than established centers, etc. This study presents and discusses the results of the analysis in detail as well as provides recommendations.

Bacterial Pneumonia in Brain-Dead Patients: Clinical Features and Impact on Lung Suitability for Donation.

To appraise the epidemiological features of bacterial pneumonia and its impact on lung suitability for donation in brain-dead patients managed with protective ventilatory settings. Retrospective observational study. Six ICUs from two university-affiliated hospitals. Brain-dead adult patients managed in the participating ICUs over a 4-year period. None. Among the 231 included patients, 145 (62.8%) were classified as ideal or extended-criteria potential lung donors at ICU admission and the remaining 86 patients having baseline contraindication for donation. Culture-proven aspiration pneumonia and early-onset ventilator-associated pneumonia occurred in 54 patients (23.4%) and 15 patients (6.5%), respectively (overall pneumonia incidence, 29.9%). Staphylococcus aureus and Enterobacterales were the most common pathogens. Using mixed-effects Cox proportional hazard models, age (adjusted hazard ratio, 0.98; 95% CI [0.96-0.99]), anoxic brain injury (3.55 [1.2-10.5]), aspiration (2.29 [1.22-4.29]), and not receiving antimicrobial agents at day 1 (3.56 [1.94-6.53]) were identified as independent predictors of pneumonia occurrence in the whole study population. Analyses restricted to potential lung donors yielded similar results. Pneumonia was associated with a postadmission decrease in the PaO2/FIO2 ratio and lower values at brain death, in the whole study population (estimated marginal mean, 294 [264-323] vs 365 [346-385] mm Hg in uninfected patients; p = 0.0005) as in potential lung donors (299 [248-350] vs 379 [350-408] mm Hg; p = 0.04; linear mixed models). Lungs were eventually retrieved in 31 patients (34.4%) among the 90 potential lung donors with at least one other organ harvested (pneumonia prevalence in lung donors (9.7%) vs nondonors (49.2%); p = 0.0002). Pneumonia occurs in one-third of brain-dead patients and appears as the main reason for lung nonharvesting in those presenting as potential lung donors. The initiation of antimicrobial prophylaxis upon the first day of the ICU stay in comatose patients with severe brain injury could enlarge the pool of actual lung donors.

READINESS OF THE RETRIEVAL TEAM FOR DECEASED DONOR KIDNEY TRANSPLANTATION IN THAILAND

Background: Deceased donor kidney transplantation has a tendency to increase in Thailand since the implementation of Service Plan in Donation and Transplantation in 2016. Kidney retrieval team serves an essential part, where the retrieval scheme is assigned and allocated for the central and regional teams by Organ Donation Centre, Thai Red Cross Society, based on computerized scoring system and geographical areas. In 2019, the number of deceased kidney donors increased, while some cases lost to be retrieved due to retrieval team unavailability. Never had a clear study about the gaps before. Here, we focused to explore the situation and cause of this problem. Methods: We retrospectively reviewed the retrieval of actual brain death kidney donors data in 2019, from Organ Donation Centre, Thai Red Cross Database. The data was analyzed by using frequency and percentage. We also collected the qualitative data by in-dept interview the key informants and by lesson learned. Results: There were 298 kidney deceased donors in 2019, with 139 cases (46.7%) were donated from Northeastern region donors. Only 54.4% of the first candidate on retrieval team lists had undertaken the surgical kidney retrieval. Available rates of the central and regional team were 28.7 % (43 out of 150 cases) and 79.7% (118 out of 148 cases), respectively. The majority of the first-order teams were Northeastern region team (76.3%) that were available to perform their retrieval within regional designated areas (figure). Qualitative data revealed that the common refusal reasons were unacceptance of controversial high-risk kidney donors, inconvenience to travel via road transportation, unavailability due to their actual job responsibilities, and inappropriate incentives.Conclusions: Majority of the available kidney retrieval teams were the regional teams, compared to the central teams. As for the controversial high-risk kidney donors, using donor’s clinical and histological features predicting donor quality would be helpful in the decision process. In order to improve the kidney retrieval schemes for the central teams, providing faster and more convenient transport, particularly, in the areas not currently reached by air, and providing appropriate incentives should be considered and supported. Meanwhile, promoting and strengthening the regional retrieval teams aside from Northeastern to serve the kidney recovery within the health region areas is prioritized and empowered.

Implementing of Active Brain-Dead Donor Identification Strategy in a Single Donor Center: One Year Experience.

Background and objectives: Organ shortage is considered to be a major limitation for increasing transplantation rates. Brain-dead donors (DBDs) are an important source of organs, but up to 50% of potential DBDs might not be identified. An active brain-dead donor search could potentially increase a deceased donor pool. The aim of this study was to evaluate the effectiveness of an active potential DBD identification program and to evaluate one year impact on the potential organ donor pool in Lithuania‘s biggest medical institution. Materials and Methods: An organ donor coordinator service was established and active DBD search strategy was implemented in the hospital of LSMU Kauno Klinikos, and retrospective data analysis was performed between December 2016 and December 2017. Collected data was compared to the available data of the previous year in the same center and to the donation dynamics of the whole country. Results: A total of 6734 patients were treated in all intensive care units (ICU), and 234 (3.5%) of them were identified as possible donors. No increase in potential donor’s number was observed in study year (n = 34) compared to remote year (n = 37). No significant difference in potential donor’s demographic data, cause of death, family refusals and medical contraindication rates. Cerebral angiography (CA) repeated in 20% of potential donors in order to confirm brain death diagnosis. More potential donors for whom CA was repeated had decompressive craniectomy done (66.7% vs. 33.3%, p = 0.018). Decompressive craniectomy statistically significantly increases the rate of repeated CA (OR 12.7; 95% CI, 1.42–113.37; p = 0.023). Active search strategy increased length of hospital stay of potential donors comparing to previous year (3.97 ± 4.73 vs. 2.51 ± 2.63, p = 0.003). An optimal time of the first four days of hospitalization to identify a potential donor was observed during our study (OR 10.42; 95% CI, 4.29–25.34; p = 0.001). Conclusions: We were not able to demonstrate active donor identification strategy superiority over the passive strategy during a short one year period; nevertheless, valuable knowledge was gained in brain death diagnostics, new terminology was implemented, and the stability of actual donor numbers was observed in the experimental donor center in the light of decreasing national results. Long-term strategy is required to achieve sustainable results in organ donation.

Prediction Model for Timing of Death in Potential Donors After Circulatory Death (DCD III): Protocol for a Multicenter Prospective Observational Cohort Study.

BackgroundControlled donation after circulatory death (cDCD) is a major source of organs for transplantation. A potential cDCD donor poses considerable challenges in terms of identification of those dying within the predefined time frame of warm ischemia after withdrawal of life-sustaining treatment (WLST) to circulatory arrest. Several attempts have been made to develop models predicting the time between treatment withdrawal and circulatory arrest. This time window determines whether organ donation can occur and influences the quality of the donated organs. However, the selected patients used for these models were not always restricted to potential cDCD donors (eg, patients with cancer or severe infections were also included). This severely limits the generalizability of those data.ObjectiveThe objectives of this study are the following: (1) to develop a model predicting time to death within 60 minutes in potential cDCD patients; (2) to validate and update previous prediction models on time to death after WLST; (3) to determine timing and patient characteristics that are associated with prognostication and the decision-making process that leads to initiating end-of-life care; (4) to evaluate the impact of timing of family approach on organ donation approval; and (5) to assess the influence of variation in WLST processes on postmortem organ donor potential and actual postmortem organ donors.MethodsIn this multicenter observational prospective cohort study, all patients admitted to the intensive care unit of 3 university hospitals and 3 teaching hospitals who met the criteria of the cDCD protocol as defined by the Dutch Transplant Foundation were included. The target of enrolment was set to 400 patients. Previously developed models will be refitted in our data set. To further update previous prediction models, we will apply least absolute shrinkage and selection operator (LASSO) as a tool for efficient variable selection to develop the multivariable logistic regression model.ResultsThis protocol was funded in August 2014 by the Dutch Transplant Foundation. We expect to have the results of this study in July 2020. Patient enrolment was completed in July 2018 and data collection was completed in April 2020.ConclusionsThis study will provide a robust multimodal prediction model, based on clinical and physiological parameters, that can predict time to circulatory arrest in cDCD donors. In addition, it will add valuable insight in the process of WLST in cDCD donors and will fill an important knowledge gap in this essential field of health care.Trial RegistrationClinicalTrials.gov NCT04123275; https://clinicaltrials.gov/ct2/show/NCT04123275International Registered Report Identifier (IRRID)DERR1-10.2196/16733

Utilization rate of uncontrolled donors after circulatory death-a 3-year single-center investigation.

Effectiveness of uncontrolled donation after circulatory death (uDCD) has been recently reported to be 75% according to data coming from some European countries in 2016, but few data are to date available on this topic. We assessed the utilization rate (as the percentage of donors who were converted into actual donors) in 37 uDCDs consecutively enrolled at our Center (Careggi Teaching Hospital) from June 2016 to June 2019. In three cases, the family did not give consent for donation (3/37, 8.1%). Among the 37 potential uDCDs, 22 became actual donors (22/37, 59%), with 10 livers and 38 kidneys being transplanted, respectively. Fifteen livers were recovered (15/37, 68%), and 10 livers were transplanted (10/15, 67%). Forty-two kidneys were procured and 38 organs transplanted. The overall effectiveness was 78%. According to our 3-year experience, uncontrolled DCDs do represent an additional means of increasing the number of transplanted organs (kidneys and livers) with an acceptable utilization rate. Research on organ viability assessment (for both livers and kidneys from uDCDs) is still in its infancy, and there is probably space for a further wider use of organs from uDCDs.

Ten Years of Kidney Paired Donation at Mayo Clinic: The Benefits of Incorporating ABO/HLA Compatible Pairs.

We examined the 10-year experience of Mayo Clinic's kidney paired donation (KPD).We aimed to determine the benefits for the recipients of enrolled ABO/HLA compatible pairs and determine the factors associated with prolonged KPD waiting time. We performed a retrospective study of 332 kidney transplants facilitated by the Mayo 3-site KPD program from September 2007 to June 2018. The median (interquartile range) time from KPD entry to transplantation was 89 days (42-187 days). The factors independently associated with receiving a transplant >3 months after KPD entry included recipient blood type O and calculated panel reactive antibodies ≥98%. Fifty-four ABO/HLA compatible pairs participated in KPD for the following reasons: cytomegalovirus mismatch (18.5% [10/54]), Epstein-Barr virus (EBV) mismatch (EBV) (9.3% [5/54]), age/size mismatch (51.9% [28/54]), or altruistic reasons (20.3% [11/54]). Cytomegalovirus and EBV mismatch were avoided in 90% (9/10) and 100% (5/5) of cases. Recipients who entered KPD for age/size mismatch and altruistic reasons received kidneys from donors with lower Living Kidney Donor Profile Index scores than their actual donor (median [interquartile range] 31.5 [12.3-47]; P < 0.001 and 26 (-1 to 46); P = 0.01 points lower, respectively). Median time to transplant from KPD entry for compatible pair recipients was 70 days (41-163 days), and 44.4% (24/54) of these transplants were preemptive. All chains/swaps incorporating compatible pairs included ABO/HLA incompatible pairs. KPD should be considered for all living donor/recipient pairs because the recipients of these pairs can derive personal benefit from KPD while increasing the donor pool for difficult to match pairs.

Effect of methanethiol on process performance, selectivity and diversity of sulfur-oxidizing bacteria in a dual bioreactor gas biodesulfurization system

This study provides important new insights on how to achieve high sulfur selectivities and stable gas biodesulfurization process operation in the presence of both methanethiol and H2S in the feed gas. On the basis of previous research, we hypothesized that a dual bioreactor lineup (with an added anaerobic bioreactor) would favor sulfur-oxidizing bacteria (SOB) that yield a higher sulfur selectivity. Therefore, the focus of the present study was to enrich thiol-resistant SOB that can withstand methanethiol, the most prevalent and toxic thiol in sulfur-containing industrial off gases. In addition, the effect of process conditions on the SOB population dynamics was investigated. The results confirmed that thiol-resistant SOB became dominant with a concomitant increase of the sulfur selectivity from 75 mol% to 90 mol% at a loading rate of 2 mM S methanethiol day−1. The abundant SOB in the inoculum – Thioalkalivibrio sulfidiphilus – was first outcompeted by Alkalilimnicola ehrlichii after which Thioalkalibacter halophilus eventually became the most abundant species. Furthermore, we found that the actual electron donor in our lab-scale biodesulfurization system was polysulfide, and not the primarily supplied sulfide.

MP59-10 LONG-TERM OUTCOMES FOR LIVING KIDNEY DONORS: A JAPANESE SINGLE-CENTER EXPERIENCE

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery III (MP59)1 Apr 2020MP59-10 LONG-TERM OUTCOMES FOR LIVING KIDNEY DONORS: A JAPANESE SINGLE-CENTER EXPERIENCE Kiyohiko Hotta*, Daiki Iwami, Naoya Iwahara, and Nobuo Shinohara Kiyohiko Hotta*Kiyohiko Hotta* More articles by this author , Daiki IwamiDaiki Iwami More articles by this author , Naoya IwaharaNaoya Iwahara More articles by this author , and Nobuo ShinoharaNobuo Shinohara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000928.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Previous studies suggested that live kidney donors do not have a higher risk of death or end-stage kidney disease (ESKD) than the general population. However, recent studies have suggested that screened kidney donors have a higher risk of ESKD than matched healthy controls. Therefore, donor risk is controversial. Furthermore, only a few studies have evaluated long-term renal function after kidney donation. We aimed to evaluate the long-term outcomes including mortality and renal function in Japanese kidney donors. METHODS: We collected the data of 170 living kidney donors (65men, 115 women) who underwent nephrectomy from 1965 to 2012 in our hospital. Median age was 53 years (range, 26-75 years). We evaluated mortality, cause of death, ESKD incidence, and change in renal function. Donor survival rate was compared with the age- and gender-matched expected survival calculated using the mortality data of Japan provided by the National Cancer Center. RESULTS: Medianfollow-up period was 12.6 (2-41) years. Survival analysis showed that157 donors were still alive and 13 (7.6%) were dead. The median interval between donation and death was 9.4 (2.0–32.8) years; median age at death was 70 (41-87) years. The following causes of death were observed: malignancies, 8; cardiovascular disease, 1; pneumonia, 1; suicide, 1; gastrointestinal bleeding, 1; and sudden death 1. Actual donor survival rates at 5, 10, 20, and 30 years were 98.3%, 94.6%, 93.0%, and 82.5% respectively; these values were comparable to age- and gender-matched expected survival (Fig. 1). Only 1 (0.5%) donor developed ESKD 24 years after donation due to contrast-induced nephropathy after undergoing coronary angiography. Next, we evaluated the renal function in 130 donors. During follow-up, donors showed the following estimated glomerular filtration rates (eGFR): 127 (97.6%), eGFR > 30ml/min; 114 (87.7%), eGFR > 45 ml/min;and 41 (32%), eGFR > 60 ml/min. The percentage of donors with eGFR > 45 ml/minat 5, 10, 20, and 30 years were 98.4%, 95.9%, 80.0%, and 80.0% respectively (Fig. 2). CONCLUSIONS: Our data suggested that kidney donors did not have an increased long-term risk of death compared with the general population. However, some donors showed decreased kidney function 10 years after donation. Therefore, long-term follow up of kidney donors is crucial. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e884-e884 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kiyohiko Hotta* More articles by this author Daiki Iwami More articles by this author Naoya Iwahara More articles by this author Nobuo Shinohara More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of Current Donor Scores Calculation on Heart Transplantation Outcomes

Heart transplantation (Htx) remains the gold standard as treatment of patients with advanced heart failure. Donor and recipient characteristics have changed dramatically in recent years, leading to more complex decision-making regarding organ acceptance and postoperative management. Primary aim of the study was to identify donor risk factors variables impacting on in-hospital mortality, early graft failure and follow-up mortality; secondary objective was to validate the available international donor risk scores. Between January 2000 and December 2017, 461 adult patients underwent Htx. UNOS, RADIAL and Eurotransplant scores have been calculated. Clinical features and donor risk scores have been tested in order to identify pre-, intra- and post-operative risk variables and eventually validate the scores on our population. Post-Htx extracorporeal life support (ECLS) was used in 11.1% (51/461). Of the donor related factors, peak of troponine (p<0.001) and use of noradrenaline (p=0.02) negatively influenced on early outcomes, while a ischaemic time >240 minutes (p=0.037) influenced EGF occurrence. The Eurotransplant donor score didn't impact on outcomes, the RADIAL significantly influenced both on early (p=0.02) and late mortality (p=0.004) while the UNOS on late mortality only (p=0.03). On the multivariate model, after adjustment per cohort of scores, noradrenaline infusion resulted to be an independent predictor of in-hospital mortality in the Eurotransplant score >17 population, recipient pre-Htx ECLS and BMI >30 were independent predictors of EGF in the UNOS score >6 population, and recipient age >60 was predictor of late mortality in the RADIAL score >5 (figure 1). Actual heart donor scoring systems do not fully behave as reliable predictors of transplant outcomes. Therefore, every transplant institution should consider developing a local donor scoring systemto provide their own standard graft selection thus preserving the outcomes.

Revisiting the transplantation of donor heart with left ventricular myocardial hypertrophy

Despite the widespread use of mechanical circulatory support systems, modern optimal drug therapy and various interventional methods of heart transplantation remain the "gold standard" for the treatment of end-stage heart failure patients.At the same time the required number of heart transplants is significantly increasing due to the progressively increasing number of patients needing transplants and the actual donor pool. In recent years there has been a trend towards the increase in the number of recipients and the decrease in the number of donor organs. However, the use of donor hearts with pathological changes, including left ventricular myocardial hypertrophy, remains a controversial topic. It is believed that the use of expanded criteria significantly increases the risk of graft failure in the post-transplant period and leads to deterioration of immediate and long-term results. This work aimed to analyze the data on using donor hearts with left ventricular myocardial hypertrophy for allotransplantation.Authors declare no conflict of interest.

Loss of Potential Donors Due to Hemodynamic Maintenance

BackgroundStatistics indicate low utilization of potential donors, where only about one-third are converted into actual donors. In this context, it is plausible to argue that many potential donors are not hemodynamically stable for harvesting multiple organs since the procedures for maintaining parameters of stability may not be a priority in all critical care units in the country. Thus, it is necessary to identify losses of potential donors due to hemodynamic maintenance since reversing this situation enable minimizing mortality on waiting lists. MethodsThis was a retrospective quantitative study, based on information sent to Notification, Organ Procurement, and Distribution Centers by reporting hospitals in the state of São Paulo, using the Death Information Form regarding the specifics of each death registered in their intensive care units and emergency rooms. ResultsHemodynamic instability contributed to a loss of 537 potential donors, corresponding to 61.9% of failures to obtain potentially transplantable organs. ConclusionOf the 33,175 cases of death reported, 867 fulfilled the criteria to be possible and potential donors (ie, patients diagnosed with brain death). Among these cases, 38.1% fulfilled Criterion 3 (ie, they were hemodynamically stable and in ideal organ donation condition). Therefore, this study concludes that losses due to maintenance occurred in 537 brain dead patients. This finding highlights the importance of investing in the development of competencies of professionals who work in critical care units to increase the number of multiple organ and tissue donors and reduce waiting lists.

Critical analysis of the low organ donation rates in Chile

The highest organ donation rate in Chile was 10 donors per million population in 2017, which is low compared with other countries. Local experts attribute the low rate to population's lack of education and generosity, distrust in procurement/allocation system, inadequate legislation and insufficient encouraging campaigns, although without much empirical support: None of the countries from the OECD is also an organ donation leader. Latin Americans who migrate to Spain improve their donation rates, suggesting that the possible explanation is trust in the system where personalities do not have fast access to organs and common people do not have a sense of inaccessibility. Legislation changes in Chile did not have the expected results. Mega campaign did not reduce family refusal, but increased actual donors, probably due to health personnel sensitization. Real problems are inefficiencies in search and procurement processes, because procurement coordinators do not have enough time, dedication or priority to detect possible donors. Eighty seven percent of the latter are not notified to the procurement coordinator. Also, the services that care for possible donors are not adequately aligned. Procurement nurses do not have enough empathy or communication abilities and do not fulfil the professional profile required by the national coordination entity, which is unable to demand for results. The management of procurement coordinators should be improved, and their operational limitations should be visualized. Tools should be provided to the national agency in charge of organ procurement to have more political influence and credibility. Information technologies could ease warns, control and standardize, in real time, the procurement process.

The potential for organ donation in Iceland: A nationwide study of deaths in intensive care units.

The deceased organ donation rate in Iceland has been low compared with other Western countries. The aim of this study was to explore the potential for organ donation after brain death in Iceland. Observational cohort study of patients with catastrophic brain injury who died in intensive care units (ICUs) at hospitals in Iceland in 2003-2016. Medical records were retrospectively reviewed to identify potential donors (PDs), using the WHO Critical Pathway for Deceased Donation. Trends in annual incidence of PDs, conversion to actual donors, and family refusals were assessed. Among 1537 patients who died in the ICU, 125 (8.1%) were identified as PDs. Of 103 PDs who were declared brain dead, consent for organ donation was pursued in 84 cases and granted in 63. Fifty-six became actual donors. The annual donation rate averaged 13 per million population (pmp), but rose abruptly in the final 2years to 36 and 27 pmp, respectively. This was paralleled by an increase in annual incidence of PDs from an average of 28 pmp to 54 and 42 pmp, respectively. The donor conversion rate increased during the study period (P=.026). Twenty-three PDs (18%) were not pursued without an apparent reason. The donation rate increased markedly in the last 2years of the study period after remaining low for more than a decade. This change can largely be explained by a high incidence of PDs and a low family refusal rate. Missed donation opportunities suggest a potential to maintain a high donation rate in the future.

A 10-year analysis of organ donor referrals to a South African tertiary public sector hospital.

South Africa (SA) has one of the lowest deceased organ donor rates in the world (1.4 donors per million population), with thousands of patients awaiting solid-organ transplantation. In order to improve access to transplantation we have to clearly define the reasons for the low deceased donation rate, specific to the population we serve. Review of actual donor statistics highlights our successes, yet is not able to contextualise the factors responsible for the unsuccessful conversion of referred organ donors to actual organ donors. In an attempt to identify key factors preventing referred donors from becoming actual donors, we analysed the donor referral patterns at our institution over a 10-year period. This was a retrospective descriptive study of consecutive deceased donor referrals at Groote Schuur Hospital, Cape Town, SA (from January 2007 to December 2016), utilising a regional donor referral registry. Qualitative and quantitative data were collected and presented as descriptive statistics and temporal trends. Over the 10-year study period, 861 possible organ donors were referred, with a steady increase in the number of referrals over time. Of the referrals, 514 (59.7%) were eligible for donation of at least one solid organ. Of the 508 families that were approached for consent to donation, 342 declined consent for a variety of reasons, resulting in a consent rate of 32.7%. Ultimately, at least one solid organ was obtained from 159 of the 166 consented donors. Despite the increasing number of possible and eligible donors, a statistically significant decline in consent rate was observed over time (ptrend=0.023). Furthermore, increasing trends in medical (as opposed to trauma) (ptrend&lt;0.001) and extended criteria (as opposed to standard criteria) donor referrals (ptrend&lt;0.001) were observed over the 10-year study period. Donor referral patterns have changed over time, with a notable increase in medical and extended criteria donors. Despite the increase in possible and eligible donors, the consent rate has declined. Further qualitative and quantitative research studies are required to understand and address this trend.

Adequacy of decision-making based on each kidney function estimation method for Japanese living kidney donor candidates: a retrospective observational study

BackgroundLiving kidney transplantation comprises the majority of kidney transplantations in Japan. Living kidney donors should be assured of their own health. Therefore, Japanese guidelines define the criterion of kidney function for living donors. Glomerular filtration rates (GFR) ≥ 70 mL/min/1.73 m2 are required for marginal donors. The guidelines require that GFRs of donors be measured by the inulin (In) clearance method (CIn) or the radioisotope method, but these methods can be substituted with the creatinine (Cr) clearance method (CCr). Methods for estimating kidney function are susceptible to error, and decision-making regarding donor eligibility could be affected by the estimation method used. We investigated the adequacy of decision-making based on kidney function estimation methods used in Japanese living kidney donor candidates by comparing CCr or estimated GFR (eGFR), calculated by several equations, and CIn as measured GFR (mGFR).MethodsIn total, 210 people, including 36 actual kidney donor candidates, who had both CIn and CCr measured at Shinshu University Hospital from April 2011 to April 2015, were included. Cr and cystatin C (Cys) levels measured at the same time were used to calculate eGFR (eGFRCr and sGFRCys, respectively). We evaluated the concordance rates of cases whose GFR levels were ≥ 70 mL/min/1.73 m2 in this study and assumed that they were living kidney donor candidates. Only kidney donor candidates underwent an additional sensitivity analysis.ResultsMedian CIn and CCr were 55.5 mL/min/1.73 m2 and 68.0 mL/min/1.73 m2, respectively. CCr had the highest tendency to overestimate kidney function. Some participants were incorrectly evaluated as adequate using CCr, despite their mGFR being inadequate for living kidney donors according to the guidelines. These results were independent of sex or actual living kidney donor candidates. The average of eGFRCr and eGFRCys was well correlated with CIn.ConclusionsKidney function estimated by CCr is not equal to the mGFR. When using CCr as a kidney function estimation method to determine the adequacy of a living kidney donor, it should be noted that CCr overestimates kidney function. In evaluating adequacy for a marginal donor, GFR estimated by CIn should be assessed.