Actual Organ Donors Research Articles

Trinational Study Exploring the Early Impact of the COVID-19 Pandemic on Organ Donation and Liver Transplantation at National and Unit Levels.

The coronavirus disease (COVID-19) pandemic is stressing healthcare services to an unprecedented extent. There is anecdotal evidence of reduction in organ donation and transplantation activity across the world. The weekly organ donation and liver transplant numbers over a 3-month period (Feb 17, 2020, till May 17, 2020) for the United States, United Kingdom, and India were compared with their previous year's activity. Liver transplant activity in 6 centers from these countries with varying local COVID-19 caseload was also compared. The COVID-19 pandemic has led to a significant contraction in organ donation and liver transplantation in all 3 countries. Peak reduction ranged from 25% in the United States to over 80% in the United Kingdom and India. The reduction was different for deceased donor and living donor liver transplantation and varied between centers within a country. There was early evidence of recovery of deceased donation in the United States and United Kingdom and resumption of living donor liver transplantation activity in India toward the end of the study period. A number of policy changes were undertaken at national and transplant center levels to ensure safe transplantation despite significant redirection of resources to combat the pandemic. There was a substantial reduction in organ donation and liver transplantation activity across the 3 countries with signs of recovery toward the end of the study period. Multiple factors including COVID-19 severity, stress on resources and influence of regulatory agencies and local factors are responsible for the reduction and recovery.

Deemed consent to organ donation: what critical care nurses need to know.

British Journal of NursingVol. 29, No. 15 NHS Blood and TransplantDeemed consent to organ donation: what critical care nurses need to knowPhil Walton, Cathy Miller, Steven Maycock, Kristian NicolPhil WaltonLegislation Project Lead—Organ Donation & Nursing, NHS Blood and TransplantSearch for more papers by this author, Cathy MillerLegislation Project Lead—Education and Governance, NHS Blood and TransplantSearch for more papers by this author, Steven MaycockCharge Nurse, Intensive Therapy Unit/High Dependency Unit, Withybush General Hospital, HaverfordwestSearch for more papers by this author, Kristian NicolPractice Development Charge Nurse, Intensive Care, Kettering General Hospital NHS Foundation TrustSearch for more papers by this authorPhil Walton; Cathy Miller; Steven Maycock; Kristian NicolPublished Online:13 Aug 2020https://doi.org/10.12968/bjon.2020.29.15.910AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health and Social Care. Consultation outcome. Organs and tissues to be excluded from the opt-out organ donation system: government response. 2020. https://tinyurl.com/y5szt79g (accessed 5 August 2020) Google ScholarHulme W, Allen J, Manara AR, Murphy PG, Gardiner G, Poppitt E. Factors influencing the family consent rate for organ donation in the UK. Anaesthesia. 2016;71(9):1053-1063. https://doi.org/10.1111/anae.13535 Crossref, Medline, Google ScholarHuman Tissue Authority. Codes of practice and standards. 2020. https://tinyurl.com/yx8zngc3 (accessed 3 August 2020 Google ScholarNational Institute for Health and Clinical Excellence. Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation. Clinical guideline CG135. 2016. https://www.nice.org.uk/guidance/cg135 (accessed 3 August 2020) Google ScholarNHS Blood and Transplant. Timely Identification and Referral of potential organ donors. 2014. https://tinyurl.com/yxa54cvzf (accessed 3 August 2020) Google ScholarNHS Blood and Transplant. Approaching the families of potential organ donors. 2015. https://tinyurl.com/y4cgeoqg (accessed 3 August 2020) Google ScholarNHS Blood and Transplant. Organ donation and transplantation activity report 2018/19. 2019. https://tinyurl.com/vazfuw6 (accessed 3 August 2020) Google ScholarNoyes J, Morgan K, Walton P, Roberts A, Mclaughlin L, Stephens M. Family attitudes, actions, decisions and experiences following implementation of deemed consent and the Human Transplantation (Wales) Act 2013: mixed-method study protocol. BMJ Open. 2017;7:e017287. https://doi.org/10.1136/bmjopen-2017-017287 Crossref, Medline, Google ScholarNoyes J, McLaughlin L, Morgan K et al.. Short-term impact of introducing a soft opt-out organ donation system in Wales: before and after study. BMJ Open. BMJ Open. 2019;9:e025159. https://doi.org/10.1136/bmjopen-2018-025159 Medline, Google Scholar FiguresReferencesRelatedDetailsCited byEmbedding changes in legislation for organ and tissue donation across England and JerseyCathy Miller, Louise Hubner, Sonya Paterson, Bobbee Cotter, Phil Walton, Helen Bentley, Claire Roberts18 March 2021 | British Journal of Nursing, Vol. 30, No. 5 13 August 2020Volume 29Issue 15ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 13 August 2020 Published in print 13 August 2020 Information© MA healthcare LimitedPDF download

New developments and possibilities in the field of post-mortem medicine mortui vivos docent

The body as a whole, along with individual organs and tissues, is the source for many examinations and measures relating to both teaching and research in medicine. There is no possibility of having an alternative model for the body in the near future. When it comes to organ and tissue donation activities, the human body gives other people another chance in life and indicates a better quality of life for many. Therefore, interventions on the deceased are carried out at the Institute of Legal Medicine in Hamburg (with the declaration of consent being taken from the person during lifetime or the relatives) for teaching, research, and clinical practices other than judicial autopsies. This includes scientific investigations in clinical research projects and surgical interventions within the framework of the Post-mortem Learning Centre and tissue donation, especially cornea transplantation in Germany and abroad. For clinical research projects, especially regarding quality assurance and innovation, post-mortem procedures on corpses are increasingly becoming the focus of attention.

\u2018Relative Consent\u2019 or \u2018Presumed Consent\u2019? Organ donation attitudes and behaviour

Legislation, in the form of presumed consent, has been argued to boost organ donation but most evidence disregards the practice of seeking relative’s consent, which can either ‘veto’ donation decisions, or ‘legitimize them’, by removing any possible conflict with the donor’s family. We study the effect of presumed consent alongside family consent on individuals’ willingness to donate (WTD) one’s own and relatives’ organs, and on actual organ donation behaviours. Using data from 28 European countries for the period 2002–2010, we found that presumed consent (PC) policies are associated with increased willingness to donate organs, but this effect was attenuated once internal family discussions on organ donation were controlled for. Our findings indicate that relative’s consent acts as a veto of donation intentions and attenuates the effect of regulation on actual donations. More specifically, PC increases WTD one’s own and relatives’ organs in countries where no family consent is required. Consistently, we find that family consent attenuates the influence of regulatory environment on actual donations. The effect is driven by the influence of family discussions which increased WTD, and in combination with presumed consent translated into higher organ donation rates.

The Impact of COVID-19 on Solid Organ Donation: The North Italy Transplant Program Experience

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak has unfavorably influenced solid organ donation activity. AimThe aim of this study is to investigate the effect of COVID-19 on transplantation in the North Italy Transplant program (NITp). Material and MethodsThis cross-sectional study included all consecutive potential deceased donors proposed in the NITp in 6 weeks after February 21, 2020 (period A) compared to all potential donors during the same time frame of the previous years (period B) and all potential donors 6 weeks before February 20, 2020 (period C). ResultsFifty-eight deceased donors were proposed during period A, 95 were proposed during period B, and 128 were proposed during period C. After the evaluation process, 32 of 58 (55.2%), 60 of 95 (63.2%), and 79 of 128 (61.7%) donors were used for organ donation in periods A, B, and C, respectively (P value = .595). We observed a 47% donation reduction in period A compared to period B and a 60% reduction compared to period C. There was a reduction of 44% and 59% in transplantation comparing period A with period B and period C, respectively. ConclusionsThis study showed an important reduction of donations and transplants during the COVID-19 pandemic.

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

A global pandemic is not a good time to introduce ‘opt-out’ for organ donation

Following several international examples, England introduced a system of deemed consent for organ donation in May 2020. This had been planned for over a year. However, the unprecedented circumstances of the COVID-19 pandemic raise issues that make the timing of this change unfortunate. The planned public awareness campaign has thus far been overshadowed by media coverage of the pandemic, and will likely continue to be, creating a situation in which a significant portion of the population may be unaware of having become potential organ donors. Further, the immediate impact of the new policy is likely to be significantly weakened by the suspension of the majority of organ donation and transplant activity. In this article, we first outline the details of the new model introduced in England, before considering the impact of the pandemic on transplantation services. We put forward three ethical reasons why, given the unprecedented circumstances, the change should have been postponed. We argue that (1) COVID-19 dominating headlines will prevent widespread awareness of the change, thereby undermining the autonomy of those who do not wish to be donors; (2) a lack of transplant activity during the pandemic will make the impact of the change difficult to measure; and (3) trust in the new system may be damaged given controversial decisions regarding Do Not Attempt Cardiopulmonary Resuscitation orders and the allocation of scarce intensive care resources. These reasons combined make for a shaky start at best and present a risk of the new system failing to achieve its desired and essential effect of increasing the number of voluntary organ donors.

Allocation and Distribution of 8488 Consecutive Kidneys Obtained in Mexico During a 12 Years Period

Renal transplantation is the treatment of choice for end-stage renal disease, considered a major health problem in Mexico and important cause of disability and mortality. We describe allocation and distribution of 8488 kidneys obtained from deceased donors from January 2007 to December 2018. We describe a fragmented health system without universal coverage for organ donation and transplantation, a huge regional variability in organ donation and transplantation activity, a great disparity in access to the waiting list, and a faulty system for organ allocation requiring reform to achieve international standards of transparency and traceability.

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<0.001) and extended criteria (as opposed to standard criteria) donor referrals (ptrend<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.

Maintaining the permanence principle for death during in situ normothermic regional perfusion for donation after circulatory death organ recovery: A United Kingdom and Canadian proposal.

There is international variability in the determination of death. Death in donation after circulatory death (DCD) can be defined by the permanent cessation of brain circulation. Post‐mortem interventions that restore brain perfusion should be prohibited as they invalidate the diagnosis of death. Retrieval teams should develop protocols that ensure the continued absence of brain perfusion during DCD organ recovery. In situ normothermic regional perfusion (NRP) or restarting the heart in the donor's body may interrupt the permanent cessation of brain perfusion because, theoretically, collateral circulations may restore it. We propose refinements to current protocols to monitor and exclude brain reperfusion during in situ NRP. In abdominal NRP, complete occlusion of the descending aorta prevents brain perfusion in most cases. Inserting a cannula in the ascending aorta identifies inadequate occlusion of the descending aorta or any collateral flow and diverts flow away from the brain. In thoracoabdominal NRP opening the aortic arch vessels to atmosphere allows collateral flow to be diverted away from the brain, maintaining the permanence standard for death and respecting the dead donor rule. We propose that these hypotheses are correct when using techniques that simultaneously occlude the descending aorta and open the aortic arch vessels to atmosphere.

Importance of Continuing Education for Medical Staff to Improve the Confirmation Rate of Intent for Organ Donation

BackgroundAmong Organisation for Economic Co-operation and Development countries, the number of cadaveric donors per population is the lowest in Japan. The present study investigated whether a continuing educational intervention for medical staff, such as Donor Action Program (DAP) that is aimed at increasing the number of cadaveric donors, improved the confirmation rate of organ donation in potential donors. Material and MethodsWe studied 2 hospitals with emergency centers in Toyama, Japan. DAP was conducted 2 to 3 times each year. We extracted mortality cases recorded in the emergency care departments of each hospital for over 10 years between 2007, prior to DAP’s implementation, and 2017 to examine the confirmation rate of the intent of the families of potential donors for organ donation and the timing and methods for confirming intent to donate in cases that resulted in organ donation. ResultsThe confirmation rate increased after the introduction of DAP and remained high (over 80%) in both hospitals after 2012. Regarding actual organ donation, some patients were asked by staff about their intent when they became potential donors in addition to the hospitalization intake form; it was offered by family members of some of the patients. ConclusionRegular educational training on organ donation improved the confirmation rate of potential organ donors’ donation intention. For organ donation, medical practitioners must take the appropriate steps to confirm the patient’s intent to donate when he/she is determined as a potential donor.

United Arab Emirates' Future Perspective: Converting Potential Organ Donors Into Actual Organ Donors in an Academic Setting.

The wide gap between organ demand and supply has been exponentially increasing worldwide, resulting in longer wait lists for patients. In response, a few countries have started deceased-donor programs. Thus, establishing national self-sufficiency and optimizing the deceased donation process are crucial steps. Recently, a deceased-donor program was initiated in the United Arab Emirates, and a process is being implemented to enhance the donation rate and to decrease the number of missed organ donors. This study aimed to estimate the number of potential brain-dead donors and eligible donors who are medically suitable and have been declared dead based on neurologic criteria. Additionally, the study aimed to highlight latent obstacles that could add valuable strategic input for establishing a successful organ donation process for new programs. For this retrospective study, we reviewed all patients who died at various intensive care units at Shaikh Khalifa Medical City (Abu Dhabi, UAE) from January 2018 to December 2018. Patients were classified as potential donors when meeting the neurologic criteria of brain dead and as eligible donors if no medical contraindication was shown. Barriers to donation were analyzed systematically. In 2018, 411 inpatient deaths were recorded. Of the 39 patients identified as potentially brain dead, 25 were confirmed as brain dead, with 20 of these confirmed as eligible donors. However, none were converted to actual donors. The lack of proper identification and referral of potential organ donors constituted significant obstacles to the organ donation process. This study described the potential organ donation program of our hospital and suggested a systemic approachthattargets the system,organ/donor factors, and consent process to improve the donor conversion rate. New programs might benefit highly from in-house organ donation coordinators, the education and proactive collaboration of hospital staff, and organizational support and management.

333.8: Middle-East organ donation and transplantation activity 2018: results from the international registry on organ donation and transplantation (irodat).

Background: IRODaT is the first worldwide registry in organ donation and transplantation field, which contains statistics of deceased/living donors and transplants since 1998. Our goal is to provide throughout yearly summary reports a globally and regionally overview of donation and transplantation activities. On Middle East countries the gap between supply and demand of organs is growing every year. Living donation is the most widely practiced type of donation in the Middle East1. Methods: Each participant country is represented by a national reporter, who retrospectively registry their country activity into the website. All the data are validated previously to be published. IRODaT follows “The Critical Pathway of Deceased Donation2” definition, ensuring uniformity throughout the registry and aiding correct data interpretation. Our worldwide and regionally summary reports and figures can be accessed at www.irodat.org. Specialized reports for specific investigations are provided under request. Results: After twenty-years of experience IRODaT is a friendly and easy-to-use database. Out of the 111 countries with donation and transplantation activity on the world, 96 national reporters have submitted data at IRODaT. On 2018, some fluctuations (increments/decrements) on the actual deceased and living donors’ rates were recorded in Middle East countries. Middle East data showed that: Turkey has the worldwide highest rate of living donors per million of population (52pmp). Examples of countries with an increment from 2017 to 2018 on their deceased donors’ rates were: Israel from 10.7 to 13pmp, Turkey from 7 to 7.5pmp and United Arab Emirates from 0.32pmp to 0.86pmp in 2018. Countries like Saudi Arabia and Iran maintained their activity from 3.33pmp in 2017 to 3.1 pmp in 2018 and from 11.43 to 11.26 pmp respectively. Conclusions: The data available at IRODaT supports the research activities and planning strategies of organ donation and transplant institutions. Comparative data provides a worldwide and regional overview of which improvements are necessary for the optimization of the three donation models prevalent in the Middle East region: the Saudi, Iranian and Pakistani models.

The wythenshawe hybrid circuit: a novel technique for lung transplantation

Introduction Wythenshawe Hospital is one of only six heart transplant units in the UK and one of five to perform lung transplant. Every year, around 60 transplant operations are performed, and in 2018, 32 lung transplants were carried out, with a 90 day survival rate of 91.7% as per the UK Organ Donation and Transplantation Activity Report 2017/18. Methods When the transplant program was initiated, lungs were initially done using Cardiopulmonary Bypass Support. In the past few years, ECMO has taken over and it is now the preferred method of support. Because lung transplants are surgically challenging operations, occasionally, conversion from ECMO to Cardiopulmonary Bypass during the procedure is needed. Taking this into account, we have designed an Extracorporeal Circulation system that allows quick and easy switching from ECMO to Cardiopulmonary Bypass shall a complication arises (Figure 1). Results Since 2018, we have done 29 lung transplants using our Hybrid Circuit, with no difference in patient outcome compared to lungs done using standard ECMO circuitry. However, the utilization of this circuit offers many user-related advantages versus the usage of standard ECMO. Some of this include easier volume and drug additions, inclusion of volatile agents in the gas mixture, possibility of recording the case using a data management system and a straightforward switch to Cardiopulmonary Bypass if required. Discussion Even if the Hybrid Circuit set up is slightly more complex than setting up an ECMO or a Cardiopulmonary Bypass circuit, we believe that this technique is superior to the previous methods used for lung transplantation. If offers all the benefits of ECMO versus Cardiopulmonary Bypass, such as less Heparin usage and lower priming volumes, plus, it is a more interactive and user-friendly system designed to deal with emergencies in an efficient manner.

Searching for missing donors: a 12-month audit of deaths in two large Sydney teaching hospitals

The DonateLife Audit (DLA) is undertaken at Liverpool and Royal Prince Alfred (RPA) hospitals to measure and report on actual and potential organ donation activity. This includes all patient deaths in the intensive care unit (ICU) and emergency department (ED); and, patients with a neurological condition who died within 24 hours of discharge from ICU or ED. A death review committee was established in RPA in mid-2014 and Liverpool in mid-2017 to analyse all in-hospital deaths to determine whether these hospitals were missing potential organ donors beyond the DLA parameters. The two death review committees analysed 12 months of data for comparison. The findings showed that both hospitals have a low rate of potential organ donors who died from non-neurological conditions. It also highlighted a significant number of unsupportable patients who presented in extremis in Liverpool and a significant number of patients with no suitable organs in RPA. It can be inferred that these limit the potential donor pool and therefore further exploration of these phenomena is warranted.

Reasons Why Organs From Deceased Donors Were Not Accepted for Transplantation

IntroductionThe rate of organ donations from deceased donors in Turkey is among the lowest in the world. We analyzed the reasons why some potential donors whose families had given consent did not become actual solid organ donors. MethodsWe retrospectively reviewed the organ donation, retrieval, and transplantation registries of 102 potential donors from the Ministry of Health Organ and Tissue Transplant Coordination Centre of Istanbul Region from the year 2015. ResultsCardiac arrest occurred in 8 of the potential donors while waiting for organ procurement or during surgery. The organ specific suitability ratio was 83% for kidneys, 82% for livers, 72% for hearts, and 75% for lungs. Of these suitable organs, the transplantation rates were as follows: kidneys 88%, livers 70%, hearts 30%, and lungs 13%. Medical reasons (donor unsuitable) (14%–24%) and poor organ function (2%–24%) were the reasons most organs were not accepted for transplant. These reasons included diabetes insipidus, electrolyte imbalance caused by neuro-humoral changes, inotrope/vasopressor requirement for hemodynamic instability, hypoperfusion, and myocardial dysfunction after brain death. ConclusionThe mismatch between organ donation and demand is a major problem worldwide. In addition to low organ donation rates, late diagnosis of potential donors or inappropriate management of the pathophysiological consequences of brain death reduce the number of transplantable organs even more in our country. In order to overcome these setbacks, we need education programs to improve quality and decrease donor losses in an intensive care unit goal-directed protocol for the management of potential donors.

Endothelial Glycocalyx Shedding Predicts Donor Organ Acceptability and Is Associated With Primary Graft Dysfunction in Lung Transplant Recipients.

The endothelial glycocalyx, a sieve-like structure located on the luminal surface of all blood vessels, has been found to be integral to regulation of capillary permeability and mechanotransduction. Given this, we investigated the role of endothelial glycocalyx breakdown products in organ donors and recipients in terms of acceptability for transplant and risk of primary graft dysfunction (PGD). Endothelial glycocalyx breakdown products were measured in the peripheral blood of 135 intended and actual organ donors. Breakdown product levels were tested for association with donor demographic and clinical data, organ acceptability for transplant along with lung recipient outcomes (n = 35). Liquid chromatography mass spectrometry analysis was performed to confirm glycosaminoglycan levels and sulfation patterns on donor samples (n = 15). In transplant recipients (n = 50), levels were measured pretransplant and daily for 4 days posttransplant. Levels were correlated with PGD severity and intubation time. Decreased hyaluronan levels in peripheral blood independently predicted organ acceptability in intended and actual donors (odds ratio, 0.96; [95% confidence interval, 0.93-0.99] P = 0.026). Furthermore, high donor syndecan-1 levels were associated with PGD in recipients (3142 [1575-4829] versus 6229 [4009-8093] pg/mL; P = 0.045). In recipient blood, levels of syndecan-1 were correlated with severe (grades 2-3) PGD at 72 hours posttransplant (5982 [3016-17191] versus 3060 [2005-4824] pg/mL; P = 0.01). Endothelial glycocalyx breakdown occurs in lung transplant donors and recipients and predicts organ acceptability and development of PGD. Glycocalyx breakdown products may be useful biomarkers in transplantation, and interventions to protect the glycocalyx could improve transplant outcomes.

DONORS (Donation Network to Optimise Organ Recovery Study): Study protocol to evaluate the implementation of an evidence-based checklist for brain-dead potential organ donor management in intensive care units, a cluster randomised trial

IntroductionThere is an increasing demand for multi-organ donors for organ transplantation programmes. This study protocol describes the Donation Network to Optimise Organ Recovery Study, a planned cluster randomised controlled trial...

Portuguese calculated panel reactive antibodies online estimator.

Calculated panel reactive antibodies (CPRA) is a sensitization measure used to classify and prioritize transplant candidates in different kidney transplant allocation systems. CPRA is based on identification of HLA unacceptable on potential organ donors making a transplant candidate ineligible for transplantation. Here, we present a CPRA online estimator based on HLA allelic and haplotypic frequencies from Portuguese donors. We also compare the values we obtained from our CPRA estimator (Portuguese [PT]-CPRA) against CPRA values obtained from: Eurotransplant virtual PRA calculator (ET-CPRA); Canadian CPRA calculator (Canadian [CN]-CPRA) and Organ Procurement and Transplantation Network CPRA calculator (United States [US]-CPRA). When we analyzed correlations between CPRA values obtained from pairs of calculators, we observed that they are significantly and highly correlated. Bland-Altman plots for the comparison between PT-CPRA calculator against the other calculators, show higher differences between PT and CN than between PT and ET and PT and US. Also, the lowest value for Lin's concordance coefficient was obtained for the comparison between PT and CN calculators. CPRA values reliability depend on donors' pool from which it is calculated and it is crucial for classify correctly highly sensitized patients. A CPRA calculator must use donors' HLA frequencies similar from those who would be actual organ donors.

Development of a multinational registry of pediatric deceased organ donation activity.

There are no currently agreed upon international standards for reporting of pediatric deceased organ donation activity. This leads to difficulty in comparisons between jurisdictions for both researchers and policy stakeholders. The goal of this project was to develop and test a standardized registry for pediatric deceased donation activity. Four countries (Canada, Spain, USA, and the UK) with geographical and practice diversity were approached to participate. Iterative exchanges were used to create data fields and definitions that were acceptable to all participants. Data from 2011 to 2015 (inclusive) were requested from national health databases and analyzed on a secure, web-based survey platform. Data were obtained from three of the four countries (Canada unable to provide). Total pediatric donation rates were stable over the 5-year period, but with variation between countries. pDCD rates were the most variable, representing 32.2% of total pediatric donation in the UK, 14.4% in the United States, and 2.6% in Spain during the studied period. Most organs from pediatric donors were allocated to adult recipients, though the rates of allocation of pediatric kidneys to pediatric recipients ranged from 7% in the United States to 40% in Spain. In this limited cohort of three countries, we demonstrated substantial variation in pediatric donation rates and practice. These data highlight opportunities for practice improvement such as the development of rigorous clinical practice guidelines. Future development of this registry will seek to engage more countries, and address barriers that prevented full participation of approached jurisdictions.