Death Donors Research Articles

The relationship between systemic disorders and anatomical outcomes after Descemet membrane endothelial keratoplasty.

The aim of this study was to investigate the association of anatomical outcomes and medications of patients with systemic diseases who underwent Descemet membrane endothelial keratoplasty with donor factors. Sixty nondiabetic donors of endothelial grafts and 60 patients who underwent operation by a single surgeon were included in this retrospective study. The patients' data, including the presence of diabetes mellitus and hypertension, antidiabetic-antihypertensive medications, and intracameral tamponades and anatomical outcomes, were recorded. The donor data were obtained from eye bank records. Eighteen patients had type 2 diabetes mellitus (30%) and 34 had hypertension (56.6%). Among the patients with diabetes mellitus, 13 were receiving a single-agent antidiabetic drug, 4 were receiving dual oral antidiabetic therapy, and 1 was receiving insulin therapy. Among the hypertensive patients, 11 had monotherapy and 23 had dual antihypertensive therapy. Postoperatively, 35 patients (58.3%) had an endothelial attachment, 8 (13.3%) received reinjection, 7 (11.7%) required re-Descemet membrane endothelial keratoplasty, and 10 (16.7%) underwent penetrating keratoplasty. The mean donor age was 51.2 ± 14.1 years. The most common cause of donor death was cardiopulmonary arrest (36/60 cases; 60.0%). Regression analysis revealed that the presence of diabetes mellitus significantly disrupted graft attachment (p=0.034), while the presence of hypertension, antidiabetic and antihypertensive medication use, and the type of tamponade used in the patients, and the age, sex, cause of death, and specular endothelial cell count of donors were not statistically significantly associated with graft attachment (p>0.05). In this study, the anatomical outcomes of Descemet membrane endothelial keratoplasty surgery were affected by recipient and donor factors. The presence of diabetes mellitus in the recipient significantly negatively affected graft attachment.

Death determination and donation after circulatory death: Can physicians reconcile cardiorespiratory death and irreversible loss of brain function?

Declaration of cardiorespiratory death, as defined by the Uniform Determination of Death Act (UDDA), requires irreversible cessation of circulatory and respiratory function. A physician’s ability to confidently declare death is paramount because death is both a biological and social construct, and can afford a dying patient the opportunity to be an organ donor via donation after circulatory death (DCD). Inconsistencies related to cardiorespiratory death and DCD include the specific language used in the UDDA, specifically the use of the word “irreversible”. Additionally, in DCD there is a large focus on the auto-resuscitative capacity of the heart, however recently some have argued that instead the focus should shift to the brain and a determination of how long it needs to be without circulation to cease functioning prior to declaring death. In this paper, I discuss inconsistencies with cardiorespiratory death as they pertain to organ donation and posit several possible solutions to mitigate these inconsistencies.

Early Allograft Dysfunction to Assess the Liver Function Following Liver Transplantation

Background: Early allograft disfunction (EAD) can be used as a tool to asses function of the liver after transplantation. Currently, most accepted EAD definition can be defined using a number of criteria including but not limited to total bilirubin > 10 mg/dL on post-operative day 7, INR > 1.6 on post-operative day 7, and ALT or AST > 2000 IU/L within the first post-operative 7 days. EAD is associated with mortality and morbidity after liver transplantation which leads to decreased recipient survival rates. It is considered a precursor step in the pathway to eventual graft loss. 
 
 Methods: We have performed a literature review to understand what risk factors increase, including donor and recipient demographics as well as recipients’ MELD (Model for End Stage Liver Disease) scores, which predicts patients’ disease severity. We also compared the incidence of EAD between our center and the literature. 
 
 Results: We found that incidence of EAD was between 23-40% (Table 2). It is higher when livers from donation after circulatory death (DCD) donors were used, as expected. 
 
 
 
 
 Reference (year) 
 
 
 Number of patients 
 
 
 Incidence of EAD 
 
 
 
 
 Ekser et al (2019) 
 
 
 n = 2008 
 
 
 29% 
 
 
 
 
 Olthoff et al (2010) 
 
 
 n = 300 
 
 
 23% 
 
 
 
 
 Wadei et al (2015) 
 
 
 n = 1325 
 
 
 27% 
 
 
 
 
 Lee et al (2014) 
 
 
 n = 205 
 
 
 39.5% (DCD donors) 
 
 
 
 
 
 
 Risk factors that can result in an increase occurrence of EAD were; (i) donor age, (ii) liver stenosis, (iii) expanding criteria for donor livers, (iv) prolonged warm ischemia time (WIT) and (v) cold ischemia time (CIT). Histologically, hepatocellular damage that is shown as coagulative necrosis can be seen immediately after reperfusion. 
 
 Conclusions: During our literature review, potential strategies have been discovered to help prevent EAD including pharmacological treatment using glucose, antioxidants, anti-inflammatories, and apoptotic drugs. Although none of them significantly prevented the occurrence of EAD, it was clear that there are many tools that can be used to attempt to prevent EAD in order to offer a better outcome in patients undergoing liver transplantation.

Patient survival rate and graft survival rate of kidney transplant recipients in Rajavithi Hospital

Objective: To report the outcomes and complications of transplant activity and the survival data of kidney transplant patients and grafts. Material and Method: We conducted a retrospective analysis of patients who received a kidney transplant at our institution, and reported the donor, recipient, and transplant characteristics from January 2012 to September 2019.The primary outcome was patient survival and graft survival at 1, 3, and 5 years. Results: A total of 136 kidney transplants were performed from January 2012 to September 2019; 29% (37) and 71% (89) were living and deceased donor transplants. Patient survival rates were 96.8%, 96%, and 96% at 1, 3, and 5 years, respectively. Graft survival rates were 95.2%, 94.4%, and 92.9% at 1, 3, and 5 years, respectively. Traffic accident was the most common cause of death in the brain-dead donors. The most common cause of end-stage renal disease was biopsy proved IgA nephropathy. The most common early and late complications after transplant were delayed graft function and renal vascular complication, respectively. Infection was the most common cause of death in kidney transplant recipients. Conclusion: We have reported the total number, the graft and the patient survival data of kidney transplant recipients in Rajavithi Hospital from 2012 to 2019. Although the number of patients is lower than in other institutions in Thailand, and also in developed countries, the patient and the graft survival rates are comparable. Better outcomes were found in living donor transplants.

Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation

BackgroundDelayed graft function (DGF) is closely associated with the use of marginal donated kidneys due to deficits during transplantation and in recipients. We aimed to predict the incidence of DGF and evaluate its effect on graft survival.MethodsThis retrospective study on kidney transplantation was conducted from January 1, 2018, to December 31, 2019, at the Second Xiangya Hospital of Central South University. We classified recipients whose operations were performed in different years into training and validation cohorts and used data from the training cohort to analyze predictors of DGF. A nomogram was then constructed to predict the likelihood of DGF based on these predictors.ResultsThe incidence rate of DGF was 16.92%. Binary logistic regression analysis showed correlations between the incidence of DGF and cold ischemic time (CIT), warm ischemic time (WIT), terminal serum creatine (Scr) concentration, duration of pretransplant dialysis, primary cause of donor death, and usage of LifePort. The internal accuracy of the nomogram was 83.12%. One-year graft survival rates were 93.59 and 99.74%, respectively, for the groups with and without DGF (P < 0.05).ConclusionThe nomogram established in this study showed good accuracy in predicting DGF after deceased donor kidney transplantation; additionally, DGF decreased one-year graft survival.

Abstract 17197: Donor Circumstance and Mechanism of Death: Evolving Effects on Heart Transplant Recipient Survival

Introduction: Since 2000, suicide rates have dramatically increased, while deaths from motor vehicle accidents (MVAs) have declined. Poisoning has surpassed MVAs as the leading cause of preventable death, largely due to the opioid epidemic. Analyses regarding the forensic pathology of donor death and heart transplant recipient outcomes are lacking. We sought to determine how donor mechanisms (e.g. drug intoxication, asphyxiation) and circumstances (e.g. suicide, MVA) of death have affected heart transplant outcomes over the last 20 years. Methods: The UNOS database was queried for all first-time isolated heart transplants occurring between January 2000 through March 2019. First-time recipients were included. Donor, recipient, and procurement variables were screened by univariable logistic analysis to identify potential independent predictors of survival with freedom from transplantation at 1 year after heart transplant. A final parsimonious multivariable regression model was created, including all causes, mechanisms and circumstances of donor death. The primary endpoint of analysis was survival with freedom from retransplantation at last follow-up. Analyses were conducted for 2000-19, and stratified by decade (2000-09 and 2010-19). Results: 34,373 patients met inclusion criteria. Median follow-up was 4.3 (IQR1.3-8.9) years. From 2000-19, death by suicide has had worse overall survival (HR 1.27; CI 1.1-1.5). A similar association is seen prior to 2010 (HR1.36; CI1.06-1.74). Since 2010, death by asphyxiation has been associated with improved survival (HR0.7; CI0.5-0.9). Death by MVA has become associated with early (i.e. 30-day) mortality (HR1.7; CI1.1-2.7), and worse survival among patients surviving 1-year after transplant. Donor death from drug intoxication has had no significant effect on recipient outcomes in the past 20 years. Conclusions: Since 2010, donors who died by MVA have worse early survival in heart transplant. Death by asphyxiation now appears to have a protective effect on overall survival. Suicide is no longer associated with poorer outcomes. Further study into how public health initiatives, policy, and epidemics effect transplant outcomes may improve donor selection and organ allocation in heart transplantation.

Estimating the effect of focused donor registration efforts on the number of organ donors.

Waiting times for organs in the United States are long and vary widely across regions. Donor registration can increase the number of potential donors, but its effect on the actual number of organ transplants depends upon several factors. First among these factors is that deceased donor organ donation requires both that death occur in a way making recovery possible and that authorization to recover organs is obtained. We estimate the potential donor death rate and donor authorization rate conditional on potential donor death by donor registration status for each state and for key demographic groups. With this information, we then develop a simple measure of the value of a new donor registration. This combined measure using information on donor authorization rates and potential death rates varies widely across states and groups, suggesting that focusing registration efforts on high-value groups and locations can significantly increase the overall number of donors. Targeting high-value states raises 26.7 percent more donors than a uniform, nationwide registration effort. Our estimates can also be used to assess alternative, but complementary, policies such as protocols to improve authorization rates for non-registered potential donors.

Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience.

BackgroundTransplantation of Human Organ Act was passed in India in 1994 to streamline organ donation and transplantation activities. It is time to retrospect ourselves and analyze the method to increase organ donation.Type of studyRetrospective observational analysis.ObjectivesTo evaluate the change in organ donation rate and reasons for changes in rates.SubjectsBrainstem dead declared patients whose family consented for organ donations in the last 23 years (1997–2019) at Ruby Hall Clinic, Pune, India.Materials and methodsRetrospectively demographic data of the brainstem dead declared donors, the primary diagnoses, comorbidities, and the complete data of their management till organ retrieval was assessed.ResultsOne hundred cases in the age group 15–75 years (mean 41.6 ± 15.3 years) of brainstem death consented for organ donation were retrospectively studied. The period was divided into two groups, group I and group II included study duration from 1997 to 2013 and from 2013 to 2019 respectively. During the entire period, though the major cause of donor death remained road traffic accidents (RTA) in both the groups (84.21% till 2013 vs 48.15% after 2013), the proportion of donors declared brain dead due to RTA dipped significantly after 2013 (p = 0.004) and the non-RTA causes of brain dead contributed more than RTA causes (51.85% non-RTA vs 48.15% RTA). The major contributor among non-RTA causes was intracranial bleeds (5.26% before 2013 vs 33.33% after 2013, p = 0.014). Compared to the previous 17 years (from 1997) there were more than fourfold rise in the rate of transplantation in the last 6 years (2014–2019) at our institute. Kidneys were retrieved from 90% donors followed by cornea 84%, liver 65%, heart 22%, skin 7%, lungs 6%, and pancreas 5%.ConclusionWe have observed that the cadaveric organ donation rate significantly improved after 2013. Reasons might be widening of the donor pool by the selection of more of non-RTA brain death donors over RTA, acceptability of elderly population donor (>60 years) by our transplant teams, early identification of potential organ donor, and better protocol-based management of the cadaver organ donor.How to cite this articleZirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, et al. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020;24(9):804–808.

English

English

Microorganism detection and contamination rate of donor eyes in Japan

To evaluate the microorganism detection and contamination rate of donor eyes. Retrospective study. In this retrospective study, we reviewed all donor cornea data collected from Kyoto Prefectural University of Medicine (KPUM) Eye Bank, Kyoto, Japan from April 2015 to June 2018, including microbiologic data obtained from conjunctival swabs and preservation medium and findings of postoperative infection from the medical records. During the study period, 77 eyes from 44 deceased individuals (mean age at time of death: 75 ± 17.3years [range, 30-102years]) were donated to the KPUM Eye Bank after being harvested using standard safety precautions and disinfection procedures. In 49 of the 77 eyes (63.6%), the conjunctival-swab culture revealed microorganisms, with the 3 most commonly detected being methicillin-resistant Staphylococcus epidermidis (MRSE), methicillin-sensitive S aureus (MSSA), and methicillin-resistant S aureus (MRSA). The data revealed positive microorganism detection in only 4 (5.2%) of the 77 donor-cornea storage-medium cultures. Positive microorganism detection was found in all the age groups, with no statistical difference between the groups (P > .05). In the eyes enucleated ≥ 2.5h postmortem, a higher positive microorganism detection occurred (P = .03). During the postoperative follow-up period, there was no record of corneal infection. The preenucleation conjunctival-swab-culture findings revealed that the rate of positive microorganism detection was similar for advanced-age and younger-age donors and that a shorter elapsed time from donor death to postmortem enucleation resulted in less donor-microorganism contamination.

Evidence-Based Review and Discussion Points.

Evidence-Based Review and Discussion Points.

TIMES REQUIRED FOR EACH STEP OF BRAIN DEATH DONOR MANAGEMENT

Background: Delayed brain death determination or prolonged time period for donor management cause increasing number of donor death, or withdrawal of family’s consent for donation, and increasing the expenditure of intensive care expenses. In order to prepare a plan to minimize the donation failure by understanding the times required for each step of organ donation is urgent. Methods: From January 2016 to December 2018, we reviewed KODA statistical data of reported potential brain death and investigated the time intervals that take to complete each process of brain death management. Organ donation procedures were divided into five steps. The first step started from the end of the first brain death examination to the end of the second examination, the second step was from finishing the second brain death examination until we got the flat EEG, the third stage was from finishing EEG test to the declaration of brain death by brain death committee, and the fourth stage was from end of committee to entrance to operating room and the fifth step was from the operating room entrance to the completion of organ procurement. Results: During the study period, 1,633 cases of potential brain death were managed for organ donation, and we analyzed 1,594 cases excluding donors under age six. The average time spent on organ donation procedure was 33 hours and 16 minutes. The time required for each step was 11 hours 28 minutes for step1, 5 hours 15 minutes for step2, 5 hours 58 minutes for step3, 6 hours 38 minutes for step4 and 3 hours 42 minutes for step5. Among the analyzed cases, 119 cases spent more than 48 hours from step 1 to 4, and 63 cases those included holidays in the donation process took an average of 71 hours and 5 minutes. Ninety three cases were discontinued during the donation procedure and their causes of interruption were poor organ quality 15 cases, patient death in 15, failure in brain death judgement in 13 and withdrawal of donation consent in six. About time of interruption of donation procedures, 45 cases were stopped at step 1 and 2, and the total times spent for step 1 and 2 was 16 hours and 43 minutes which accounting for half of all brain death donation procedures. In particular, the first step took 11 hours and 28 minutes on average, almost twice as long as the 6 hour legal inspection interval. The third step took an average of six hours, which is unnecessary in foreign countries where there is no brain death judgment committee. Conclusion: Brain death determination procedures should be accurate but not unnecessarily delayed. Among the measures to reduce the time required, improvement of the execution of the first and second brain death examinations which repeat the same test, improvement of delay of the EEG examination to obtain flat wave, and careful approach for abolishing the brain death judgment committee are necessary. Delayed brain death organ donation procedure caused by lack of manpower especially during holidays and night time need a government level policy revision and social consensus.

Pre-transplant HLA Antibodies and Delayed Graft Function in the Current Era of Kidney Transplantation.

Delayed graft function (DGF) occurs in a significant proportion of deceased donor kidney transplant recipients and was associated with graft injury and inferior clinical outcome. The aim of the present multi-center study was to identify the immunological and non-immunological predictors of DGF and to determine its influence on outcome in the presence and absence of human leukocyte antigen (HLA) antibodies. 1,724 patients who received a deceased donor kidney transplant during 2008–2017 and on whom a pre-transplant serum sample was available were studied. Graft survival during the first 3 post-transplant years was analyzed by multivariable Cox regression. Pre-transplant predictors of DGF and influence of DGF and pre-transplant HLA antibodies on biopsy-proven rejections in the first 3 post-transplant months were determined by multivariable logistic regression. Donor age ≥50 years, simultaneous pre-transplant presence of HLA class I and II antibodies, diabetes mellitus as cause of end-stage renal disease, cold ischemia time ≥18 h, and time on dialysis >5 years were associated with increased risk of DGF, while the risk was reduced if gender of donor or recipient was female or the reason for death of donor was trauma. DGF alone doubled the risk for graft loss, more due to impaired death-censored graft than patient survival. In DGF patients, the risk of death-censored graft loss increased further if HLA antibodies (hazard ratio HR=4.75, P < 0.001) or donor-specific HLA antibodies (DSA, HR=7.39, P < 0.001) were present pre-transplant. In the presence of HLA antibodies or DSA, the incidence of biopsy-proven rejections, including antibody-mediated rejections, increased significantly in patients with as well as without DGF. Recipients without DGF and without biopsy-proven rejections during the first 3 months had the highest fraction of patients with good kidney function at year 1, whereas patients with both DGF and rejection showed the lowest rate of good kidney function, especially when organs from ≥65-year-old donors were used. In this new era of transplantation, besides non-immunological factors, also the pre-transplant presence of HLA class I and II antibodies increase the risk of DGF. Measures to prevent the strong negative impact of DGF on outcome are necessary, especially during organ allocation for presensitized patients.

Natural History of Pleural Complications After Lung Transplantation

Despite advances in lung transplantation, 5-year survival remains at 56%. Although the focus has been on chronic lung allograft dysfunction and infection, pleural complications in some may contribute to adverse outcomes. Therefore, we determined (1) the prevalence of, and risk factors for, pleural complications after lung transplantation and (2) their association with allograft function and mortality. From 2006 to 2017, 1039 adults underwent primary lung transplantation at Cleveland Clinic in Cleveland, Ohio. Multivariable analyses were performed in the multiphase mixed longitudinal and hazard function domains to identify risk factors associated with allograft function and survival. A total of 468 patients (45%) had pleural complications, including pleural effusion in 271 (26%), pneumothorax in 152 (15%), hemothorax in 128 (12%), empyema in 47 (5%), and chylothorax in 9 (1%). Risk factors for pleural complications within the first 3 months included higher recipient-to-donor weight ratio, lower recipient albumin, and recipient-to-donor race mismatch; risk factors extending beyond 3 months included older age, hypertension, smoking history, lower lung allocation score, and donor death from anoxia. Cardiopulmonary bypass and previous thoracic interventions were not risk factors in patients with pleural effusions who were treated with thoracentesis only, and forced expiratory volume in 1 second improved after drainage; however, repeat percutaneous or surgical interventions did not impart a similar benefit. Pleural complications were associated with worse survival. Pleural complications are common after lung transplantation and are associated with worse allograft function and survival. These complications are likely secondary to other underlying clinical problems. Malnourishment and size mismatch are modifiable risk factors.

Predictors and outcomes of heart transplantation utilizing donors with different brain death mode: A propensity-score matching study from China

BackgroundHeart transplantation (HTx) of brain-dead donors in China has not been reported, not to mention analysis of donors with different brain death mechanisms. The present study aimed to compare clinical outcomes between HTx of traumatically brain-injured (TBI) and non-TBI donors, as well as to establish a risk-prediction model of mortality. MethodsAll patients undergoing HTx at our institute between January 1st, 2015 and December 31st, 2018 were dichotomized according to cause of donor death, and outcomes between the two groups were compared based on propensity score matching (PSM). The primary endpoint was all-cause mortality. Secondary endpoints included cardiac allograft vasculopathy and other postoperative complications. Results342 eligible HTx recipients were included. TBI grafts accounted for 62.87% (215/342). 121 pairs of candidates were generated from PSM. Actuarial and risk-adjusted survival were similar between TBI and non-TBI groups. Risk factors associated with all-cause mortality included recipient age > 60y (HR = 2.781, p = .002), history of cardiac surgery (HR = 2.186, p = .032), chronic kidney disease (HR = 2.948, p = .033) and smoking (HR = 0.465, p = .041), as well as donor age > 45y (HR = 2.701, p = .003) and BMI > 25 kg/m2 (HR = 2.025, p = .045). The risk-prediction model was established successfully based on specific preoperative variables and high-risk group with a score>10 had nearly fourfold increase in mortality (HR = 3.726, p < 0.001) compared to the low-risk group. ConclusionsIn this largest single-center cohort from China, we found similar survival and rates of complications between HTx recipients with TBI and non-TBI donors. The risk-prediction model may help to identify high-risked recipients and donors and optimize organ-sharing.

Use of fresh osteochondral allograft in repair of distal femur after trauma

Preserving the ability to maintain an active lifestyle is a major concern in the reconstruction of the knee in young patients. For the healthy individual who desires to maintain a relatively active lifestyle, fresh osteochondral allografts may serve as an alternative to total joint reconstruction. The use of fresh allografts is primarily indicated in the patient suffering from a traumatic loss of articular segments, who is too young or active for arthroplasty. In addition, fresh osteochondral allografts have a number of advantages over arthroplasty such as providing surgeons with a source of large grafts that can be fitted to replace osteochondral defects and cover the majority or entirety of articular surfaces without any donor site morbidity. In this case, a young, active patient lost a 7 x 8 cm portion of their distal femur, including a large portion of the articulating surface. Using a fresh osteochondral allograft, harvested within 24 hours of donor death, a segment was fitted to match bony apposition, articular congruity, and congruity with the femoral notch and affixed with four partially threaded cancellous screws. Joint function was restored with the allograft in place, allowing the patient to delay the need for a total joint replacement.

COVID-19 and anatomy: Stimulus and initial response.

The outbreak of COVID-19, resulting from widespread transmission of the SARS-CoV-2 virus, represents one of the foremost current challenges to societies across the globe, with few areas of life remaining untouched. Here, we detail the immediate impact that COVID-19 has had on the teaching and practice of anatomy, providing specific examples of the varied responses from several UK, Irish and German universities and medical schools. Alongside significant issues for, and suspension of, body donation programmes, the widespread closure of university campuses has led to challenges in delivering anatomy education via online methods, a particular problem for a practical, experience-based subject such as anatomy. We discuss the short-term consequences of COVID-19 for body donation programmes and anatomical education, and highlight issues and challenges that will need to be addressed in the medium to long term in order to restore anatomy education and practice throughout the world.

Early detection of West Nile Virus mosquitoes and cases in Frisco and Dallas in 2019 using DNA &amp;RNA testing and Climatic prediction with Math lab followed by Descriptive statistical analysis using R-programming

West Nile Virus is a mosquito borne disease that is initially caused in continental US that leads to neurological disease and death. There exists no vaccine or particular antiviral treatment for WNV.The mosquitoes become infected when they bite the infected birds. WNV is confined to the family Flaviviridae containing single stranded positive RNA with 11kb length. The purpose of this paper is to study WNV human cases and WNV positive mosquito traps in Frisco 75035 from Sep-Oct 2019. Also, the paper aims in explaining the current CDC data on WNV cases in detail using descriptive computer statistical analysis method. The data describes the current 2019 WNV neuro cases, WNV non-neuro cases, Death and presumptive viremic blood donors. According to (DSHS, 2019), there is no WNV cases reported yet in Frisco 2019 and one positive WNV case in Dallas county. According to CDC (2019), out of total 777, 98 were presumptive viremic blood donors, 504 was neuro-invasive cases, 273 were non-neuro-invasive cases, and 39 death was reported. Arizona and Colorado have the highest number of WNV Neuro invasive and Non-neuro-invasive cases of 132 and 60. This summary statistics reveals Neuro invasive cases have higher mean of 11.45 to non-neuro-invasive with 6.205. On the T-test it reveals at 95 % confidence level (P=0.007681) a significant difference in total cases versus the presumptive blood donors. It also represents more positive relationship on the scatter plots. According to Texas Department of state Health and Human Services (2019), reported human cases of reportable West Nile Disease of 19; out of which West Nile encephalitis is 15 and West Nile fever is 4. This shows that in Texas there is a drastic reduction of West Nile disease cases reported in 2019 related to good surveillance plans. This review summarizes descriptive statistical analysis of 2019 WNV cases which has shown a new increase in Presumptive viremic blood donors which is the hall mark of this review. Finally, the paper has completed a climatic niche prediction model using Math lab computer software for the future prediction of WNV positive mosquitoes using climatic conditions like high temperature, low temperature, humidity, rainfall, and precipitation.

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

Analysis of causes of death and etiological characteristics of skin tissue donors

Objective: To investigate the causes of death and etiological characteristics of skin tissue donors, and to provide reference for allogeneic skin transplantation. Methods: From October 2008 to October 2018, 49 skin tissue donors accepted by the Burn Department of Wuhan Third Hospital met the inclusion criteria of this study, and a cross-sectional study was conducted. According to the cause of death, the donors were divided into accidental death group (19 cases) and non-accidental death group (30 cases). The sex and death age of 49 donors were recorded, and the death age between different sex donors and that of donors between accidental death group and non-accidental death group were compared. Diseases or circumstances that caused the death of donors, hepatitis B, hepatitis C, acquired immunodeficiency syndrome, syphilis virus carrying status, and peripheral blood microbial culture results of 49 donors were recorded, and the detection of blood-borne infectious risk factors of donors between accidental death group and non-accidental death group was compared. Abnormal skin tissue was also selected during allogenic skin graft preparing for pathological examination. Data were statistically analyzed with Mann-Whitney U test and continuity correction chi-square test. Results: (1) Out of the 49 donors in this group, 38 were male (77.55%) and 11 were female (22.45%). The death age was 42.00 (24.00, 55.00) years, and the death age of male donors was similar to that of female donors (Z=0.120, P>0.05). The death age of donors in accidental death group was lower than that in non-accidental death group, but the difference was not statistically significant (Z=-1.581, P>0.05). (2) Among the causes and circumstances of the 49 donors in this group, there were 19 cases (38.78%) of injury, poisoning, and some other consequences of external causes, 11 cases (22.45%) of circulatory system diseases, 9 cases (18.37%) of tumors, 3 cases (6.12%) of nervous system diseases, 2 cases (4.08%) of respiratory system diseases, and 2 cases (4.08%) of congenital malformation, deformation, and chromosome abnormality, 1 case (2.04%) of blood and hematopoietic organ diseases and some diseases related to immune mechanism, 1 case (2.04%) of digestive system disease, and 1 case (2.04%) of genitourinary system disease. (3) There were 9 donors (18.37%) with blood-borne infectious risk factors among the 49 donors in this group, including 8 cases (16.33%) of blood-borne infectious diseases, which were 5 cases (10.20%) of hepatitis B, 2 cases (4.08%) of syphilis, and 1 case (2.04%) of hepatitis C, respectively. Blood microorganism culture was positive in 1 case (2.04%), in which multi-drug resistant Pseudomonas aeruginosa was detected. Risk factors of blood-borne infection were detected in 2 donors in accidental death group, with detection ratio lower than that in non-accidental death group (7 cases), but the difference was not statistically significant (χ(2)=0.562, P>0.05). (4) A total of 8 donors' abnormal skin tissue were selected, including 4 cases of intradermal pigmented nevus, 1 case of scar, 1 case of pseudoepithelioma hyperplasia, 1 case of epidermal verrucous hyperplasia, and 1 case of large amount of pigment granules in dermis. Conclusions: Non-accidental death caused by diseases is the main cause of death of skin tissue donors, and the risk of donor-derived infection of non-accidentally dead donors is slightly higher than that of accidentally dead donors. Before the allogeneic skin is obtained and transplanted, the cause of death of the donor should be carefully investigated, and the health status should be evaluated, so as to avoid the occurrence of donor-derived infection.