Contraindication For Organ Donation Research Articles

Impact of Hepatitis E Virus Screening in the UK Deceased Organ Donor Population.

Universal Hepatitis E Virus (HEV) screening of deceased organ donors was implemented by the UK national organ procurement organisation in October 2017. Donor testing for HEV infection is done post-transplant; detection of HEV ribonucleic acid (RNA) in donor plasma is therefore not a contra-indication for organ donation, with the result being used to inform recipient management. Immediate post-transplant detection of donor HEV viraemia triggers notification to transplant centres. Follow up of liver and kidney recipients has shown that transmission through solid organs is very efficient, particularly through liver grafts, as expected; no other organ types were transplanted in this cohort. Although donors with higher plasma viral load (VL > 103IU/mL) were invariably associated with recipient infection, transmission was also documented at lower VL levels. Knowledge of donor HEV status has led to identification of transmission of infection via solid organ grafts followed by close patient monitoring and informed clinical management decisions. The purpose of this strategy is to allow early detection of infection and recurrence and treatment to circumvent the risk of accelerated liver damage from chronic HEV infection due to undiagnosed, inadvertent donor-derived transmission of infection.

Bilary anastomotic strictures after right lobe living donor liver transplantation: a single-center experience

To determine the incidence of AS after right lobe living donor liver transplantation with various biliary reconstructions and to identify the predictors of this complication. A retrospective and prospective analysis included 245 RLLDLTs for the period 2011-2018 at the Burnazjan Federal Medical Biophysical Center. The results of transplantations in 207 patients aged 19-68 years (median 43 years) were assessed. There were 82 men and 125 women. Follow-up period ranged from 10 to 98 months (median 35 months). We analyzed the relationship between surgical characteristics (preoperative data of recipients and donors, graft parameters, technical features of biliary reconstruction and features of post-transplantation period) and incidence of anastomotic strictures. A total of 58 parameters were analyzed. AS occurred in 20 (9.7%) recipients. Median AS-free period was 5 months (range 1-44). In 17 (85%) patients, AC developed within a year after surgery. Cumulative 1-, 2- and 5-year incidence of AS was 8.3%, 8.9%, and 11%, respectively. Significant predictors of AS were impaired arterial blood supply to the graft (HR 7.8, 95% CI 2.3-26.0, p<0.001), biliary leakage ISGLS class B or C (HR 5.0, 95% CI 2.0-12.8, p<0.001), early allograft dysfunction (HR 4.2, 95% CI 1.5-11.6, p=0.006) and female recipient (HR 3.2, 95% CI 1.1-9.9, p=0.04). In our sample, variant biliary anatomy of the graft and recipient liver, as well as technical features of biliary reconstruction did not affect the risk of AS. Variant biliary anatomy of potential donor alone should not be considered as a contraindication for organ donation and right liver lobe transplantation. Precise surgical technique, high transplantation activity, as well as experience of reconstructive interventions on the bile ducts during other operations can significantly reduce the incidence of AS after RLLDLT up to 9.7%.

Effect of a multidisciplinary program to improve organ donation in the emergency department.

As the emergency department (ED) is an important source of potential organ donors, it may play an important role in the organ donation process. To assess the effectiveness of the multidisciplinary organ donation improvement program (ODIP) on identifying potential donors and improving organ donation in South Korean EDs. This study was a retrospective, observational study of the ED-inclusive ODIP implemented in 55 tertiary teaching hospitals contracted with the Korea Organ Donation Agency (KODA) since 2014. The inclusion criteria were: patients in the ED with a serious brain injury and futile prognosis or expected death of the patient within a few days, no contraindications for organ donation, and no objections registered in the donor registry. The ED-inclusive multidisciplinary approach was implemented to improve organ donation. It included regular meetings of the ODIP committee, hospital visits and staff education, improvement of notifications, and support of a coordination team. We assessed the changes in the number of deceased organ donors per year and notifications of potential brain-dead donors by medical staff after the implementation of the new ED-inclusive ODIP. The entire organ donation process was monitored and measured. There was a significant increase in deceased organ donors per million population after the implementation of the ED-inclusive multidisciplinary ODIP of KODA compared to the pre-intervention period: 5.21 vs. 9.72, difference 4.51 (95% confidence interval 2.11-6.91). During the study period, the proportion of deceased organ donors occurred from KODA-contracted hospitals increased from 25.3 to 50.3% in South Korea's total deceased organ donors. Emergency physicians of KODA-contracted hospitals notified increasingly more potential brain-dead donors each year throughout the study period (36 in 2014 vs. 135 in 2018). The longer the period contracted with KODA, the higher the potential brain-death identification rates (P < 0.001). In this retrospective study, the implementation of multidisciplinary ODIP in the ED led to significantly higher deceased organ donors per million population and awareness of potential brain-dead donors in South Korea.

The Implementation of a Multidisciplinary Approach for Potential Organ Donors in the Emergency Department.

The aim of this study was to evaluate the implementation process of a multidisciplinary approach for potential organ donors in the emergency department (ED) in order to incorporate organ donation into their end-of-life care plans. A new multidisciplinary approach was implemented in 6 hospitals in The Netherlands between January 2016 and January 2018. The approach was introduced during staff meetings in the ED, intensive care unit (ICU), and neurology department. When patients with a devastating brain injury had a futile prognosis in the ED, without contraindications for organ donation, an ICU admission was considered. Every ICU admission to incorporate organ donation into end-of-life care was systematically evaluated with the involved physicians using a standardized questionnaire. In total, 55 potential organ donors were admitted to the ICU to incorporate organ donation into end-of-life care. Twenty-seven families consented to donation and 20 successful organ donations were performed. Twenty-nine percent of the total pool of organ donors in these hospitals were admitted to the ICU for organ donation. Patients with a devastating brain injury and futile medical prognosis in the ED are an important proportion of the total number of donors. The implementation of a multidisciplinary approach is feasible and could lead to better identification of potential donors in the ED.

Successful kidney transplantation from a deceased donor with chronic hepatitis B infection and review of literature

There is huge gap between patients requiring organ transplantation and the available organ donor pool. Various strategies are being pursued to expand the organ donor pool. Infection with hepatitis B virus (HBV) in the donor is considered a contraindication for organ donation. However, HBV infection is endemic in some regions, and a significant number of donors may harbor chronic HBV infection. Safe transplantation from donors with chronic HBV infection may allow significant expansion of the donor pool in such areas. We report the first instance in India of successful organ harvesting and kidney transplantation from a deceased donor with chronic HBV infection with no evidence of transmission of infection for 1 year after transplantation, and we briefly review the relevant literature.

Organ donation after euthanasia in children: Belgian and Dutch perspectives

Organ donation after euthanasia has been performed more than 70 times in Belgium and the Netherlands combined (personal communication, Jan Bollen, 2018). These two countries allow for euthanasia in minors...

Organ Donation and Transplantation From Donors With Systemic Infection: A Single-Center Experience.

Donors with bacteremia and sepsis are often considered to be controversial for organ retrieval due to potential transmission of an infectious agent to the recipient. Herein we report our initial experience of organ donation and transplantation results from donors with systemic infection. From January 2013 to December 2014, 125 cases of donation were completed in our organ procurement organization including 90 cases of donation after brain death (DBD) and 35 cases of donation after circulatory death (DCD). The results of bacterial culture of the donor's peripheral venous blood (PVB), blood from central venous catheter (BCVC), urine, bronchial aspiration, and tip of central venous catheter (TCVC; Maki's semiquantitative culture) were retrospectively reviewed. All liver transplant recipients received specific antibiotics according the susceptibility profiles of the PVB cultures, and all kidney transplant recipients received specific antibiotics according the susceptibility profiles of the PVB and urine cultures. Bacterial infection diseases transmission from donors of the liver and kidney transplant recipients were also retrospectively reviewed. The positive rates of the bacterial culture of the donor's bronchial aspiration, PVB, BCVC, TCVC, and urine were 46.4% (39/84), 20.2% (24/119), 15.8% (12/76), 11.1% (3/27), and 7.0% (8/115), respectively. Only 28.1% (9/32) of donors with positive cultures of PVB or urine received specific antimicrobial therapy before harvesting. Twenty-two livers and 46 kidneys from donors with systemic infection (positive PVB culture) were transplanted, and no case of bacterial infection diseases transmission occurred in the recipients. In the circumstance of donor systemic infection with positive bacterial culture of PVB, the liver and kidney can be transplanted safely with prophylactic antibiotics. Donors with systemic infection are not a contraindication for organ donation.

Access to brain death diagnostics

In Germany the diagnosis of brain death must strictly adhere to the expert guidelines of the German chamber of physicians. For patients with primary supratentorial or hypoxic brain injury aged 2 years or more, repeat clinical examinations or one complete examination combined with an ancillary test are equally accurate. This study aimed to identify factors with potential impact on whether and by which means a formal brain death examination is pursued. A retrospective analysis was carried out of recorded data of all patients who died in the acute phase after severe brain injury during mechanical ventilation in an intensive care unit and who were registered at the north east regional bureau of the German organ procurement organization (Deutsche Stiftung Organtransplantation) between 2001 and 2010. Of 5988 reported patients, a protocol-specified brain death examination was initiated in 3023, leading to a diagnosis of brain death in 2592. All other patients died due to permanent cardiac arrest. Patients were less likely to undergo brain death examinations in the presence of one or more of the following characteristics: perceived medical contraindication for organ donation, patient age greater than 69 years, hypoxic brain damage, treatment in a hospital without neurological and neurosurgical departments and death on a weekend or public holiday. In 2192 patients (72.5%), neurologists or neurosurgeons participated in the diagnostic procedures and in 926 of these cases members of specialized external diagnostic expert teams were involved. Ancillary tests were rarely used by physicians based at the treating hospitals (31.1%) but on a regular basis by members of the external teams (93.4%). The risk of death due to permanent cardiac arrest before completion of the brain death examination was increased approximately 7-fold when a neurological or neurosurgical consultation with ancillary studies was not performed. Access to neurological expertise and to ancillary tests has a significant impact on the provision of guideline-specified diagnostic procedures for suspected brain death. Centralized diagnostic teams offer an effective means to support qualified brain death examinations.

The Barriers of Organ Donation From Brain Death Patients in the Public Donor Centers of Thailand: The Result of National Wide Survey.

Insufficiency of organ donation is a major public health problem in Thailand. There were 3,516 patients waiting for organ donation, but there were only 136 actual donors during the year 2012. Therefore, to achieve sufficiency of brain dead donors, the Ministry of Public Health has collaborated with the Thailand Red Cross and all other stakeholders to make up the national policy and strategic plan for organ donation. To explore the obstacle of organ donation, we established the evaluation program including donor care teams interviewing and the brain death audit survey between June and December 2013 in 17 targeted donor hospital around the whole country. This program revealed that there were 241 patients with severe irreversible brain injury, 31(12.9%) had contraindications for organ donation, 86 (41.0%) out of 210 without contraindications didn't be declared for brain death, 5 (4.0%) out of 124 with brain death didn't be informed for organ donation, 91 (76.5%) out of 119 those had been informed didn't consent for organ donation, 7 (25.0%) out of 28 those consented didn't proceed to operation, finally only 21 (8.7% of all brain injury patients) had been operated for organ retrievals. From the public side, the low rate of consent came from the reasons that they didn't want the brain death patients to have more pain (42.9%), couldn't accept the death (17.6%) and believing that they will miss their organs in the next life (16.5%), From the hospital side, the low rate of brain death declaration and organ utilization came from the excess workload of the health personnel, lack of understanding of management processes and regulations. Conclusion: The major barriers of organ donation in Thailand are the believes of relatives as well as the ineffective system management that potentially be improved by public educational program and national strategic plan management.

Successful renal transplantation from a brain-dead deceased donor with head injury, disseminated intravascular coagulation and deranged renal functions

Deceased donors (DDs) with the brain death due to head injury are the major source of organs for transplantation. The incidence of post-head injury disseminated intravascular coagulation (DIC) ranges from 24% to 50%. Many centers do not accept organs from donors with DIC due to increased risk of primary graft non-function and/or high chances of morbidity/mortality. We performed two successful renal transplants from a DD with head injury with DIC and deranged renal function. One of the recipients developed transient thrombocytopenia, but there was no evidence of DIC or delayed graft functions in either of the recipients. Over a follow-up of 1 month, both are doing well with stable graft function and hematological profile. Thus, a carefully selected DD with severe DIC even with deranged renal function is not a contraindication for organ donation if other risk factors for primary non-function are excluded. This approach will also help in overcoming organ shortage.

Reye Syndrome: Contraindication for Organ Donation? - Case Report of a 20-Year Old Woman

Reye Syndrome: Contraindication for Organ Donation? - Case Report of a 20-Year Old Woman

71: Are Donors Presenting with Cardiac Arrest but Successfully Resuscitated a Contraindication for Organ Donation in Heart Transplant?

71: Are Donors Presenting with Cardiac Arrest but Successfully Resuscitated a Contraindication for Organ Donation in Heart Transplant?

Brain Death Caused by Electric Shock and Organ Donation in Children

Introduction There are still few publications about brain death caused by electric shock and the use of organs for donation in this situation. We sought to present our experience, with brain dead pediatric donors caused by electric shock. Material and Methods Notification registers of potential donors were analyzed from 1998 to 2005. Results During this period, 2086 potential donors were secured, of whom 307 (14.7%) were less than 18 years old. Four pediatric potential donors (1.3%) suffered brain death due to anoxia by electric shock. Six kidneys, three livers, six corneas, and three heart valves were used for transplantation. The hearts and the lungs were not offered, because of a lack of compatible patients on the waiting list. The pediatric donors showed significant alterations of cardiac enzymes and two had altered liver enzymes. Conclusion Brain death caused by electric shock is not a contraindication for organ donation. Follow-up of the recipients is necessary to determine if the transplants were successful.

Drug Use and Kidney Donation: What Are High-Risk Behaviors Today?

Background “Social risk behaviors” are usually considered as contraindications for organ donation. The organ shortage, however, necessitates expansion of the donor pool. Reconsideration of the policy toward substance abusers may be important. Opinions of the overall population may be of use to define this cultural-sensitive issue. Methods A semistructured questionnaire on organ donation, including opinions on drug use (cannabis and cocaine), was administered to various groups of the general public and caregivers: high school students (liceo classico: 59 students, median age 18 years; istituto tecnico: 108, age 17); first- and fourth-year medical school (77, age 19; 46, age 22); continuing medical education (44, age 32); third-year nursing school (31, age 23); “senior citizen university” (51, age 63). Results Cannabis use was mainly accepted for kidney donation (48.6% yes, 26.6% no, 29.8% uncertain/blank), but cocaine use was not (22.1% yes, 44.2% no, 33.7% uncertain/blank). In the univariate analysis, opinions differed according to age, sex, and belonging to the health care teams upon multivariate analysis being a member of the health care team was the strongest predictor of responses ( P < .01). Conclusion It is difficult to define social risk behaviors. Since opinions are important for organ donation, further studies and discussion are needed to periodically analyze our policies.

Heart Transplantation in Neonates: Achievements, Controversies, and Challenges for the Future

After completing this article, readers should be able to: 1. Compare the results of pediatric heart transplantation with those of transplantation in adults, including the survival rates. 2. Compare and contrast the indications for pediatric heart transplant among those younger and older than 1 year of age. 3. List the common complications after pediatric heart transplantation. 4. Compare and contrast new immunosuppressive agents (tacrolimus, mycophenolate, humanized anti-Tac antibodies) and standard therapies (cyclosporine, azathioprine, prednisone, antithymocyte globulin). 5. Describe the controversy surrounding the proper management of infants who have hypoplastic left heart syndrome. Not long after the first successful human heart transplant was performed, the first neonatal heart transplant was attempted. In December of 1967, Kantrowitz and colleagues at Maimonides Hospital in New York transplanted the heart of an anencephalic infant into a 3-week-old who had tricuspid atresia. Although the recipient survived only 6.5 hours, the technical feasibility of cardiac transplantation in the pediatric patients was proven. Thirty-three years later, heart transplantation has gained widespread acceptance as a standard treatment modality for end-stage cardiomyopathy or noncorrectable congenital heart disease in infants and children. The 2 years following Barnard’s pioneering first transplant saw explosive growth in the field of adult heart transplantation, but poor 1-year survival dampened much of the initial enthusiasm and with it, any hope for bringing heart transplantation to the pediatric population. Most centers eventually abandoned the procedure, and many physicians denounced the concept. However, a few centers persisted, most notably Dr Norman Shumway and colleagues at Stanford, gradually improving survival through strong collaborations with basic immunologists and cardiac pathologists. By the mid-1970s, heart transplantation had been extended successfully to teenagers. The introduction of the “wonder drug” cyclosporine in 1980 so dramatically improved survival in adult cardiac transplant recipients that the extension of transplantation to even younger patients became feasible. Almost as important as …

Living donor liver transplantation: ethical considerations

Liver transplantation has become the victim of its own success. As l- and 5-year results continue to improve, blood usage, in-patient stay and morbidity are all falling, more patients are being referred for consideration of the procedure. Although many factors limit the number of patients who are able to be transplanted, scarcity of organs is of major concern. Increasing delay between acceptance and transplantation is often associated with deterioration of the patient’s status and so may reduce the success of the procedure. Attempts to increase the availability of organs have been broad: better use of the existing donor pool, more precise identification of the indications and contraindications for organ donation, splitting of livers to allow one organ to be used for two recipients and in the longer term use of animal organs. The use of living-related donors has undoubtedly been a clinical success, but has raised a number of ethical issues. As part of the series on liver transplantation, we have asked two experts to write on the pros and cons of living-related donors. We have specifically asked them to be controversial rather than give a balanced view.