DCD Donors Research Articles

The Potential of Repairing Ischemically Damaged Human Kidneys during Acellular Warm Perfusion

Introduction In previous work we demonstrated the feasibility of resuscitating oxidative metabolism of sufficient magnitude to result in restored synthetics functions in kidney allografts with as much as 2H of warm ischemic (WI) injury during an acellular warm perfusion. The restored synthetic functions lead to modulation of both injury and repair proteins in the damaged kidneys. We now report that a longer period of ex vivo warm perfusion of human DCD kidneys results in a more extensive regeneration as revealed by the observation of actual mitosis in the repairing human kidneys by 48H of warm perfusion (Figure 1). We also evaluated whether a Mesenchymal Stem/Stromal Cell (MSC) therapy could accelerate this active reparative process in the ischemically damaged human kidneys during the ex vivo warm perfusion. We hypothesized that by administering MSC directly to the renal tissue, there would be an improved opportunity for cellular repair mediated by the increased intrarenal paracrine effects. Methods The studies were performed using the Exsanguinous Metabolic Support (EMS) platform. Paired human kidney allografts from DCD donors (mean WI of 30 min with unknown down time in 2) were studied. Kidneys were EMS perfused with or without the addition of MSC (1x10^8). The kidneys were evaluated by histological grading, cytokine/chemokine synthesis and a panel of biomarkers indicative of DNA synthesis and cytoskeletal regeneration. Results The period of warm perfusion led to a significant increase in the synthesis of ATP and growth factors resulting in normalization of metabolism and the cytoskeleton during ex vivo perfusion. The addition of a MSC treatment led to a further reduction in the synthesis of inflammatory cytokines as well as an increase in the synthesis of growth factors that are associated with renal regeneration (Table 1). Toluidine Blue staining of MSC treated kidneys demonstrated a significant increase in the number of renal cells undergoing mitosis (23%) compared to EMS perfusion alone (Figure 1). Discussion To our knowledge, our work is the first to have achieved actual cellular regeneration while ischemically damaged human kidneys are perfused ex vivo for several days. The observation of increased growth factor synthesis is significant because the polypeptides are known to potentiate kidney function and have been shown to play an important role in vivo for the recovery of function following renal damage.Conclusion The observed regeneration entails: increased synthesis of ATP, reduced inflammatory response, increased synthesis of growth factors, normalization of the cytoskeleton and mitosis. The added treatment of administering MSCs further potentiated the renal repair. The ability to regenerate renal tissue ex vivo sufficiently to result in immediate function could revolutionize transplantation by helping to address the chronic organ shortage. National Institute of Health - NIAID Grant # R43AI06362.

Donation after Circulatory Death Heart Transplantation

Method 17 DCD heart transplants were performed between July 2014 and October 2017. All hearts were retrieved using normothermic machine perfusion (NMP) according to local protocol. Donor information including cause of death, LV function at time of referral, and important time points during the withdrawal and retrieval process were collected. All hearts were reperfused and assessed using Transmedic OCS Heart™. Recipient data were collected and updated through follow up at the Heart Lung Clinic at St Vincent’s Hospital, Sydney. The following outcomes were analysed: Survival, delayed graft function, ICU and Hospital length of stay (LOS), serial endomyocardial biopsy (EMBx) and echocardiogram results post-transplant. Results Donor mean age was 30±6 years with baseline LV function of 61 ± 5%. There are 13:4 (M:F) donors and 11:6 recipients. Recipient baseline mean transpulmonary gradient was 8.4 ± 3mmHg with cardiac index of 1.7±0.42L/min/m2. Average time from withdrawal to asystole was 10 ± 4min, and warm ischaemic time (WIT) 23 ± 4 min. Time on NMP was 281 ± 72mins. Lactate results are presented below. 6 patients had delayed graft function requiring mechanical support using ECMO, and 1 patient had technical complication requiring return on bypass with resultant ECMO on subsequent weaning off bypass. All recipients however show normal graft function at 1 week post-transplant. Average ICU and hospital stay were 8±5 days and 25±13 days (n=16). All recipients are alive and demonstrate NYHA 1, and normal cardiac function on echocardiogram on most recent follow up, including 3 recipients > 3 years post-HTx. Conclusion DCD outcomes to date are excellent despite high utilisation of ECMO for delayed graft function. Overall, DCD donors have contributed to an annual increase of 10-15% HTx activity in our centre.

ECMO use post DCD Heart Transplantation

Method Between 2014 and 2017, 18 heart transplants were performed from DCD donors using machine perfusion (MP) for transport and resuscitation. Recipients were stratified into two groups based on early ECMO use. Donor data were collected using referral paperwork; retrieval data from local database and recipient data extracted from hospital medical records. Key donor and retrieval factors were identified and compared between the two groups (including. timing of withdrawal, MP duration), intraoperative details, and post-operative outcomes. Results 7 recipients required ECMO support post-operatively. Baseline demographics for donor and recipient between both groups were similar. The time interval between circulatory arrest (CA) and institution of cardioplegia was significantly longer in the ECMO group, due mainly to a longer delay between CA and knife to skin time when compared to non-ECMO group. Cold ischaemic time and time on MP were similar in both groups with poorer lactate recovery in the ECMO group when compared to the non ECMO group. Intraoperatively, ECMO group required longer bypass time and in the post-operative period require significantly longer stay in ICU. All recipients regained normal graft function and overall survival was 100% in both groups. Conclusion ECMO utility in our cohort appears to correlate with prolonged asystole to cardioplegia time, largely due to delays during transportation of donor to the operating table. This is associated with delayed graft recovery. However, all hearts were able to be recovered to normal cardiac function despite ECMO use, and there appears to be no impact on short term survival.

DCD and AKI Allografts Offer a Valuable Platform to Study Molecular Pathways Underlying Successful Adaptive Repair of the Kidney after Damage

Introduction Although the increased incidence of DGF in AKI/DCD recipients, DCD/AKI grafts typically recover and resume an excellent kidney function within one month from the surgery. Therefore, we hypothesize that comparative analysis of peripheral blood and renal allograft tissue throughout the initial 30 days of follow up after a kidney transplant will result in the identification and characterization of ongoing mechanisms of regeneration and repair (RR). Methods Peripheral blood was collected from kidney transplant (KT) patients immediately prior to transplant, immediately after transplant (for up to 5 consecutive days), twice weekly for the next 3 weeks, and at post-transplant day 30 following transplantation of living donor (LD, control group), DCD or AKI donor grafts. Total RNA was isolated from each patient sample and assayed on whole genome microarrays. Longitudinal gene expression was evaluated to identify molecular pathways and processes involved in the recovery phase following KT. Results Remarkably, comparative analysis of longitudinal peripheral blood gene expression between recipients of AKI/DCD vs. LD grafts revealed two significant gene clusters, representing a total of 141 genes that show a different expression profile between AKI/DCD and LD samples. The 77 transcripts that comprise cluster 1 show a significant over-representation of genes in several key biological pathways including mTOR signaling, Granzyme B Signaling, and Th1 and Th2 Activation and wnt Pathway. Immunological Disease is the top diseases and disorders category over-represented in this cluster. The second cluster of differentially-expressed genes (N=64) in the comparison between AKI/DCD and LD are significantly over-represented in Toll-like Receptor Signaling, Adrenergic signaling, and fMLP Signaling in neutrophils pathways. The most significant diseases and disorders category over-represented in the set of transcripts is Inflammatory Response. The 141 transcripts that are differentially expressed in the longitudinal comparison between LD and AKI/DCD include genes found to be different in LD vs AKI only (N=65), LD vs DCD only (N=63) and LD vs AKI + DCD. The 13 transcripts found to differentially-expressed in both DCD and AKI samples compared to LD may represent the most biologically relevant gene targets differentiating the two groups and warrant further investigation. Conclusions The pattern of gene expression in the peripheral blood of KT patients is significantly different, depending upon the source of donor graft. These markedly different expression patterns, particularly the coordinate elevation hundreds of expressed genes seen in DCD and AKI recipients beyond post-transplant day 1, provide further insight into mechanisms (and timing) of kidney RR that occurs following kidney transplantation.

Survival Analysis of Kidney Transplants with Grafts from Uncontrolled DCD Donors under Normothermic Preservation Prior to Organ Retrieval Related to DBD

Survival Analysis of Kidney Transplants with Grafts from Uncontrolled DCD Donors under Normothermic Preservation Prior to Organ Retrieval Related to DBD

A New Technique for Cannulation and External ‘Clamping’ in the Difficult DCD Donor

A New Technique for Cannulation and External ‘Clamping’ in the Difficult DCD Donor

A multicentre investigation of organ and tissue donation education for critical care residents.

To describe critical care medicine residents' training, expertise, and skills regarding organ and tissue donation processes and procedures. We undertook a qualitative multicentre study and employed a purposive sample of program directors, physicians, nurses, residents, and organ donation leaders from all nine academic intensive care unit (ICU) training centres (five adult, four pediatric) in Ontario (n = 71). Interviews, conducted by telephone between December 2015 and March 2016, were audio-recorded and transcribed verbatim. Data collection and analysis were performed using an iterative process and continued until saturation was achieved. Five main themes were identified: 1) gaps in residents' knowledge for both neurologic determination of death (NDD) and circulatory determination of death (DCD) cases; 2) commitment to the provision of organ and tissue donation training; 3) limited experiential learning (NDD and DCD); 4) challenges related to the provision of training on organ donation and need for a standardized curriculum; and 5) communication with family members. Overall, this study showed system-level gaps in training resulting from the lack of a standardized provincial curriculum on organ donation. Qualitative data corroborated that residents need more exposure to clinical cases, especially regarding DCD donors. A standardized education curriculum would be beneficial for all residents within the ICU. Developing a better shared understanding of the donation process will improve team communication and performance, translate into a better end-of-life experience for families, and potentially result in increased donation rates.

Chronic Lung Allograft Dysfunction (CLAD): Donation after Circulatory Death (DCD) vs Donation After Brain Death (DBD) - The First 10 Years

CLAD is the most problematic complication of lung transplant (LTx). DCD donors have been used for LTx with short-term successful outcomes, however the long-term incidence of CLAD with its obstructive (oCLAD and restrictive (rCLAD) phenotypes and CLAD related mortality, have not been explored. Previously described differences between DCD and DBD lung inflammatory signals might predispose to different CLAD outcomes.

PD25-01 KIDNEY PRESERVATION TECHNIQUES IN CONTROLLED CIRCULATORY DEATH: NECMO AND ULTRA-RAPID RETRIEVAL

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery I1 Apr 2018PD25-01 KIDNEY PRESERVATION TECHNIQUES IN CONTROLLED CIRCULATORY DEATH: NECMO AND ULTRA-RAPID RETRIEVAL Begoña Etcheverry Giadrosich, Maria Fiol Riera, Lluis Riera Canals, Sergi Beato García, José Francisco Suárez Novo, Salvador Gil-Vernet Cebrian, and Francesc Vigués Julià Begoña Etcheverry GiadrosichBegoña Etcheverry Giadrosich More articles by this author , Maria Fiol RieraMaria Fiol Riera More articles by this author , Lluis Riera CanalsLluis Riera Canals More articles by this author , Sergi Beato GarcíaSergi Beato García More articles by this author , José Francisco Suárez NovoJosé Francisco Suárez Novo More articles by this author , Salvador Gil-Vernet CebrianSalvador Gil-Vernet Cebrian More articles by this author , and Francesc Vigués JuliàFrancesc Vigués Julià More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1328AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES During the past decade, kidneys obtained after controlled circulatory death (cDCD) have significantly increased, in order to increase the number of donors. It achieved 24% of total Kidneys transplant during the last year in Spain. However, it implies warm ischemia times, resulting a greater risk for organs. Focusing on graft quality optimization, it has implemented the abdominal Normothermic Extracorporeal Membrane Oxygenation (NECMO) in order to restore blood flow before organ recovery. NECMO perfusion provides promising results for the use of liver grafts for cDCD. The aim of this study is to evaluate cDCD kidneys, obtained from NECMO technique compared with cDCD ultra-rapid retrieval. METHODS We perform a case control study of Maastricht category III DCD kidneys transplanted in one single center, Hospital Universitari de Bellvitge, Barcelona. We compared kidneys of both cDCD ultra-rapid retrieval and NECMO retrieval groups. RESULTS From 2013 to 2017, 109 kidneys transplants from Maastricht category III DCD donors were performed. Out of these, 76% (83) were retrieved from our hospital and the remaining 24% (26), came from other centers. Mean age was 63 years old (CI95%: 61-65), 42% (63) were no-EDC (extended donor criteria) We compared 2 groups: ultra-rapid retrieval versus NECMO retrieval for non-EDC Masstricht category III CDC (data is presented in table 1). From multivariable analysis, NECMO is associated with less DGF than Ultra-rapid retrieval, OR 0.19 (IC95%: 0.038-0.96, p= 0.044). CONCLUSIONS Although the Ultra-rapid retrieval is highly extended with satisfactory results, in our series kidney preservation with NECMO shows less DGF, corroborating that it could be a good way to reverse warm ischemia effects. We have better kidney function in the follow-up. However, it is a small sample, and we need more follow-up. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e545-e546 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Begoña Etcheverry Giadrosich More articles by this author Maria Fiol Riera More articles by this author Lluis Riera Canals More articles by this author Sergi Beato García More articles by this author José Francisco Suárez Novo More articles by this author Salvador Gil-Vernet Cebrian More articles by this author Francesc Vigués Julià More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

DCD donor hemodynamics as predictor of outcome after kidney transplantation.

Insufficient hemodynamics during agonal phase-ie, the period between withdrawal of life-sustaining treatment and circulatory arrest-in Maastricht category III circulatory-death donors (DCD) potentially exacerbate ischemia/reperfusion injury. We included 409 Dutch adult recipients of DCD donor kidneys transplanted between 2006 and 2014. Peripheral oxygen saturation (SpO2-with pulse oximetry at the fingertip) and systolic blood pressure (SBP-with arterial catheter) were measured during agonal phase, and were dichotomized into minutes of SpO2>60% or SpO2<60%, and minutes of SBP > 80mmHg or SBP < 80mmHg. Outcome measures were and primary non-function (PNF), delayed graft function (DGF), and three-year graft survival. Primary non-function (PNF) rate was 6.6%, delayed graft function (DGF) rate was 67%, and graft survival at threeyears was 76%. Longer periods of agonal phase (median 16min [IQR 11-23]) contributed significantly to an increased risk of DGF (P=.012), but not to PNF (P=.071) and graft failure (P=.528). Multiple logistic regression analysis showed that an increase from 7 to 20minutes in period of SBP < 80mmHg was associated with 2.19 times the odds (95% CI 1.08-4.46, P=.030) for DGF. In conclusion, duration of agonal phase is associated with early transplant outcome. SBP < 80mmHg during agonal phase shows a better discrimination for transplant outcome than SpO2<60% does.

Psychological Difficulties and Level of Knowledge of Medical Staff Identifying Donors after Irreversible Cardiac Arrest

Over the last fifty years, organ transplantation has become a routine medical procedure, bringing immense benefits to the patients. In Poland, to 2018 by DBD donors (Donor after Brain Death) accounted for about 95% of all donors and about 5% were living donors. A completely unused group are DCD donors (Donors after Cardiac Death). Material and Methods: The survey was done among 500 people from medical staff of intensive care unit and intensive cardiological care where the probability of receiving anonymous donation after circulatory death is the highest, yet only 368 people had filled the survey and their cases were taken into consideration as far as the study was concerned. The rest of people surveyed were not taken into consideration as they had not filled the survey. The survey was conducted in the form of a self-projected questionnaire based on Hospital Attitude Survey. Results: The study showed that 98.4% of respondents accept the transplant. As many as 93.1% of people did not know the Maastricht classification and 57.5% claimed that in Poland there is a permission to take organs from people with a non-beating heart. Discussion: The study found that perceiving the potential of heart-warming donations from donors depends on their professional position. Unlike nurses, the doctor does not see the potential of transplantation from donors with a non-beating heart. Referring to the results of studies in other countries of the European Union, there is an immense difference between personal attitude towards organ donation from patients after brain death DBD and towards patients after circulatory death DCD.

Early Outcomes of the New UK Deceased Donor Kidney Fast-Track Offering Scheme.

The UK Kidney Fast-Track Scheme (KFTS) was introduced in 2012 to identify kidneys at high risk of discard and to rapidly facilitate transplantation. A retrospective analysis of kidneys transplanted through the KFTS was undertaken. UK Transplant Registry data were collected on deceased donor kidneys implanted between November 1, 2012, and April 30, 2015, (donation after brain death [DBD] donors) and March 1, 2013, and April 30, 2015 (donation after circulatory death [DCD] donors). Posttransplant outcomes included 1-year estimated glomerular filtration rate and death-censored graft survival (DCGS). Over the study period, 523 deceased donor kidneys were transplanted through the KFTS and 4174 via the standard National Kidney Allocation Scheme (NKAS). Kidneys in the KFTS were more likely to be from older diabetic donors, had a higher frequency of poor ex vivo perfusion, had longer cold ischemic times, and were transplanted into older recipients. One-year DCGS of KFTS and NKAS DBD donor kidneys was similar (94% vs 95%; P = 0.70), but for DCD donor kidneys, DCGS was lower in those allocated via the KFTS (91% versus 95%; P = 0.04). Median 1-year estimated glomerular filtration rate for DBD donor kidneys was lower in those allocated via the KFTS (49 vs 52 mL/min per 1.73 m; P = 0.01), but for DCD kidneys, there was no difference (45 vs 48 mL/min per 1.73 m; P = 0.10). Although KFTS kidneys have less favorable donor, graft, and recipient risk factors than NKAS kidneys, short-term graft and patient outcomes are acceptable. National schemes that identify and rapidly offer kidneys at high risk of discard may contribute to minimizing the unnecessary discard of organs.

Effect of organ donation after circulatory determination of death on number of organ transplants from donors with neurologic determination of death.

To increase the available pool of organ donors, Ontario introduced donation after circulatory determination of death (DCD) in 2006. Other jurisdictions have reported a decrease in donations involving neurologic determination of death (NDD) after implementation of DCD, with a drop in organ yield and quality. In this study, we examined the effect of DCD on overall transplant activity in Ontario. We examined deceased donor and organ transplant activity during 3 distinct 4-year eras: pre-DCD (2002/03 to 2005/06), early DCD (2006/07 to 2009/10) and recent DCD (2010/11 to 2013/14). We compared these donor groups by categorical characteristics. Donation increased by 57%, from 578 donors in the pre-DCD era to 905 donors in the recent DCD era, with a 21% proportion (190/905) of DCD donors in the recent DCD era. However, overall NDD donation also increased. The mean length of hospital stay before declaration for NDD was 2.7 days versus 6.0 days before withdrawal of life support and subsequent asystole in cases of DCD. The average organ yield was 3.73 with NDD donation versus 2.58 with DCD (p < 0.001). Apart from hearts, all organs from DCD donors were successfully transplanted. From the pre-DCD era to the recent DCD era, transplant activity in each era increased for all solid-organ recipients, including heart (from 158 to 216), kidney (from 821 to 1321), liver (from 477 to 657) and lung (from 160 to 305). Implementation of DCD in Ontario led to increased transplant activity for all solid-organ recipients. There was no evidence that the use of DCD was pre-empting potential NDD donation. In contrast to groups receiving other organs, heart transplant candidates have not yet benefited from DCD.

P264 HLA antibody and liver transplantation

Aim HLA match is important to solid organ transplantation, especially to kidney and thoracic transplant. However, HLA antibody and matches to liver transplant are still critical topics figure out whether liver graft can develop antibody mediated rejection or protect other solid organ transplant. This study is focusing on monitoring pre- and post-transplant DSA of liver transplant to figure out the importance of HLA CI and CII antibody for liver and other organ transplantation. Methods Eight patients with liver transplant only and one patient received liver and kidney. All donors were no DCD donor but either EBV or CMV positive. Solid phase assay: Luminex HLA single antigen beads. Results 1. Two patients had pre HLA CI DSA. After 2–4 days of transplant, CI DSAs were disappeared and other CI antibodies within the same CREG of DSA were disappeared as well. One patient had DSA as B60 as in Fig. and DSA B60 disappeared after 4 days of transplant. 2. Three patients had pre HLA CII DSA. After liver transplanted, CII DSAs were not disappeared and CII DSA’s MFIs went up higher than pre transplant; there was one patient without DSA, when liver function became abnormal, this patient developed HLA CI and CII DSA; for the patient with liver and kidney transplant, liver graft can’t protect the kidney’s AMR caused from CII DSA (see Table). Conclusions The results indicate that if the patients with liver transplant have HLA CI DSA and functional liver, CI DSA will be cleaned soon after grafted and other CI antibody within the same CREG of DSA will be cleaned as well. If the liver graft failed or infected, the patient will develop both CI and CII DSA. There is a high rate of CII DSA detected after liver transplant. More cases will be collected in order to confirm the indication above. Download high-res image (474KB) Download full-size image Download high-res image (112KB) Download full-size image

Ex-Vivo Lung Perfusion Results In a 5% Increase in Lung Transplants

Introduction Ex-Vivo Lung Perfusion (EVLP) can be used to improve the performance of donor lungs determined unsuitable for transplant prior to recovery or after intraoperative evaluation. Methods This was a single OPO, single center study. Surgeons accepted lung offers for standard or EVLP recovery. Lungs were placed for EVLP recovery prior to the OR if there was no interest in standard recovery by local and national lung centers. Lungs were considered for EVLP on brain dead donors with a PaO2 of <300 mmHg and DCD donors. Additionally, EVLP was considered for lungs after intraoperative evaluation of lungs determined they were not acceptable for standard recovery. Results Over 4 years, 339 lung offers were accepted for transplant, 323 (95%) were accepted for standard recovery and 16 (5%) were accepted for EVLP recovery. There were 11 cases where lungs initially accepted for standard recovery were placed on EVLP. In 3 cases, lungs initially accepted for EVLP were recovered and transplanted without being placed on EVLP. Additionally, in 1 case, lungs initially accepted for EVLP were recovered and discarded without being placed on EVLP due to consolidation and pneumonia observed in the OR. Lungs placed on EVLP were transplanted 50% (12/24) of the time. Conclusion EVLP increased the total number of lungs in this study period by 5% (12/248). OPOs should consider utilizing EVLP to not only increase the lung donor pool but also to salvage lungs initially thought to be able to be recovered in the standard fashion. More research is needed to better understand EVLP effects on transplant outcomes and cost.

A Global Strategy to Increase Organ Donation at Hospital and Jurisdictional Levels

Introduction In collaboration with the Québec Hospital Association, Transplant Québec published the Organizational Framework for Organ Donation and Tissue Donation Services as a reference to provide hospitals a structured approach to develop more effective organ donation and tissue donation services. Administrators, physicians and health professionals, supported by the ODO, are the key stakeholders able to improve the culture of organ and tissue donation in an institution. Improved performance will better meet the needs of patients waiting for a transplant. Methods The Framework and tools were created in phases over 5 years: a Standardized Organ Donation Procedure (SODP); an Audit System based on International Classification of Deceases (version 10) implemented with the help of hospital archivists and Transplant Québec donor coordinators (4 indicators); all linked to hospital accreditation (Accreditation Canada), quality processes and online educational materials. The key components of the Framework will be presented and modelling of the approach will be discussed in relation to improving the number of donors and number of organs. Commitment, defined roles and responsibilities, specific procedures for organ donation and tissue donation, and the education of clinical teams are essential elements. Results Beginning in 2012, donor referrals increased by 34 % and family refusals decreased by 30 %. During this period, the number of donors increased from 120 to 172 a year, while the total number of transplants rose by 50%. Additionally, the number of DCD donors increased by 400%. Over 5 000 health professionals (mostly critical care) completed online education on the SODP. The number of hospitals using the Audit system increased from 12 to 35. Future gains and next steps will be considered. The role of the ODO in sustaining and moving change forward is crucial to these improved results. Conclusion There remains untapped potential to improve organ donation from the administrative and clinical perspectives at both the hospital and system levels. Our approach demonstrates the effectiveness of providing standardized guidance for hospital administrators combined with educational resources for health care professionals and an audit system in improving performances. The 5-year trend of these improvements highlights the sustainability of the interventions for improvement of a stronger organ donation culture in institutions. Association québécoise des établissements de santé et de services sociaux.

Anencephalic Infants as Organ Donors After Circulatory Death

Introduction Neonates represent a small percentage of all pediatric organ donors. Donation after circulatory determination of death (DCD) for neonates is increasing in the US. In particular, anencephalic infants are a potential source of neonatal organs and tissues but donation potential has not been studied. We reviewed the experience with anencephalic donors from 3 organ procurement organizations (OPOs) in the US. Methods Data from anencephalic organ donors were retrospectively reviewed from 3 OPOs within the US. Descriptive data included, gestational age, weight, gender, donation discussions prior to delivery, infant management post-delivery, organs recovered, organs transplanted, organs for research, and reasons organs were not recovered or transplanted. Results Seventeen anencephalic donors from 3 different OPO’s were identified over a 6-year period. There were 10 males and 7 females. Average gestational age was 36.9 weeks (range 27-41 weeks). Average weight was 2,346 grams (range 1,200-3,210 grams). Donation was discussed prior to birth in all cases. Parent(s) in 8 (47%) cases contacted the OPO directly. Donation was attempted in 5 (29%) anencephalic infants. Elective intubation was successful in 4 of 5 infants. One patient could not be intubated and was manually ventilated. Two patients had umbilical venous lines and 2 patients had an umbilical arterial line placed. Viable organs/tissues were recovered from 4 infants and included 2 livers, 2 kidneys, and 2 sets of heart valves. Only 2 kidneys were transplanted. Livers were used for hepatocyte transfusion research. Primary reasons organ recovery and transplantation did not occur included: patient did not expire within 60 minutes (n= 1), size and gestational age (n=1), recovery surgeon not available (n=1), family did not want to escalate care once intubated and patient expired (n=1). Donation was not pursued for the other 12 infants because, family declined intubation (n=3), stillborn (n=3), hospital would not allow intubation of the infant (n=1), recovery surgeon not available (n=1), size and gestational age (n=2), did not expire within 60 minutes (n=2). Conclusions Anencephalic donors are a very small percentage of neonatal DCD donors. Size/weight restrictions and progression to death within 60 minutes are limiting factors prohibiting donation. Few viable organs are recovered for transplant from these patients. Livers for hepatocyte transfusion research and heart valves were more commonly recovered. Parent initiated donation is common in this select group of donors.

(963) - Lung Transplantation from DCD Donors After Prolonged Normothermic Portable EVLP

(963) - Lung Transplantation from DCD Donors After Prolonged Normothermic Portable EVLP

(95) - Ex-Vivo Perfusion of a Human Heart Recovered from a DCD Donor for 13 Hours on Organ Care System Platform

(95) - Ex-Vivo Perfusion of a Human Heart Recovered from a DCD Donor for 13 Hours on Organ Care System Platform

(19) - Does the Assessment of DCD Donor Hearts on the Organ Care System Using Lactate Need Redefining?

(19) - Does the Assessment of DCD Donor Hearts on the Organ Care System Using Lactate Need Redefining?