Donor Donation Research Articles

The effect of pneumatic tube system on complete blood count parameters and thrombocyte donation in healthy donors

This paper is the first report whether or not pneumatic tube system affects the selection of apheresis donors according to the results of complete blood count. According to the apheresis guidelines, hemoglobin level must be ⩾12.5g/dL and platelet level ⩾150/μL to be a donor. Paired blood samples of 26 healthy volunteers were transported by either hand delivered or a pneumatic tube system to the laboratory. No statistically significant differences were observed in order to mean values of routine complete blood cell count and white cell differential parameters that were send for selection of apheresis donor before the procedure. Therefore, all healthy volunteers decided as a donor according to the laboratory results independent from transport method.

841 The Number of Grafts Available for Liver Transplantation is Decreasing as a Result of Increasing Donor Age, Metabolic Syndrome and Donation After Cardiac Death

Background: The number of liver transplants performed in the US increased annually until 2006, but has since declined despite ongoing increases in demand. One possible reason for this decline is a reduction in donor organ utilization as a result of decreased organ quality. We aimed to (1) evaluate the association between various donor characteristics and organ discard and (2) examine trends over time in these characteristics that may explain any increased discard rate. Methods: We performed a retrospective cohort study using the United Network for Organ Sharing database comprising all donors ≥ 18 years old who successfully donated at least one organ between 1994 and 2010. Living donors, split livers, and donors with a body mass index (BMI) 50 kg/m2 were excluded. Multivariable logistic regression was used to evaluate the association between donor characteristics and the discard of donor livers. Population attributable risk proportions were determined to estimate the contribution of various donor factors to liver discard. Results: Of 93,232 organ donors, 69,833 (75%) livers were used, and 23,399 (25%) went unused. The number of discarded organs was stable until 2003, and then increased from 1,058 (19%) in 2003 to 1,828 (26%) in 2010. In bivariate analysis, discarded livers were more often from donors who were older (median 49 vs. 43 years). Rates of discard were higher in donors with obesity (35% vs. 22% of non-obese donors), diabetes (DM) (35% vs. 24% of non-diabetics), hypertension (HTN) (31% vs. 22% of normotensive donors), and donation after cardiac death (DCD) (65% vs. 22% of non-DCD). In the multivariable model, discarded livers were associated with donor age (OR 1.03 for each year increase, 95% CI 1.03-1.04), obesity (OR 1.92, 95% CI 1.82-2.03), DM (OR 1.42, 95% CI 1.32-1.53), HTN (OR 1.15, 95% CI 1.081.22), and DCD (OR 12.3, 95%CI 11.3-13.4). Between 1994 and 2010, there were significant increases in the median donor age (40 to 46) and the prevalence of obesity (13% to 31%), DM (3% to 13%), HTN (22% to 39%), and DCD (2% to 12%). In 2010, 44% of non-use was due to increased age, 9% to obesity, 5% to diabetes, and 5% to hypertension. These proportions were stable over time. In contrast, the proportion discarded due to DCD rose dramatically from 0.2% in 2000 to 26% in 2010. The OR for DCD liver discard also increased from 1.80 to 25.0 reflecting increasing reluctance to use these grafts. Conclusions: Organ donors are increasingly older, with more obesity, DM, and HTN, all of which may limit expansion of the donor pool. DCD is becoming more common, but its ability to expand the donor pool is significantly hindered by an increasing discard rate. Indeed, if the DCD option is taken merely as an alternative to donation after brain death, then more DCD will lead to a significant decline in usable grafts.

Psychiatric history in living kidney donor candidates

To critically discuss recent studies of living kidney donor candidates with a past or current psychiatric history and to offer guidance for the psychosocial evaluation of such donors. A global consensus has been developed that active, significant mental illness and substance abuse are absolute contraindications to organ donation due to diminished ability to make a well informed, rational decision about donation or to maintain health status after donation. However, to date, there has been little information published on the suitability for donation and the long-term psychosocial and medical outcomes after donation in donors with mental health issues, especially relatively milder psychiatric disorders, or past significant psychiatric history. To resolve the ethical dilemma of whether living donor candidates with mental health issues should be allowed to donate as is their right or be considered a vulnerable group in need of protection, we need more information. Information should include careful evaluation, possible intervention and follow-up to optimize donation.

Sickle Cell and Renal Transplant: A National Survey and Literature Review

Sickle cell disease is an inherited, structural hemoglobin defect with multisystemic sequelae including renal failure. Patients with sickle cell disease are thought to benefit from renal transplant, but the long-term outcomes in such patients are unclear and have not been supported by any large prospective studies. Similarly, the renal morbidity and outcome after transplant in patients with sickle cell trait is also unclear. There is little evidence concerning living donation in donors with sickle cell disease or sickle cell trait, either for the donor health or for the graft outcome, and there are no United Kingdom guidelines. The aim of this study is to review the evidence surrounding renal transplant in recipients and donors with sickle syndromes and to determine the attitudes and current practices of United Kingdom transplant centers to performing such operations.

Laparoscopic live donor nephrectomy: Current practice and results of renal transplantation

Objective: In 2009, 1659 patients with end-stage renal failure in Hong Kong were waiting for a renal transplant. The overall number of renal transplants carried out locally remains low, with an even lower number being live donor donations. Yet, live donor kidney transplantation yields results that are consistently superior to those of deceased donor kidney transplantation, and laparoscopic donor nephrectomy (LDN) is increasingly accepted worldwide as a safe and preferred surgical option. We aim to evaluate the outcome of LDN in our setting, and to compare with that of deceased donors in this retrospective review. Patients and Methods: A total of 12 patients received LDN over the study period of 2006–2009. Standard left transperitoneal LDN was carried out. Grafts including three with double vessels were prepared using the bench technique. The postoperative outcomes up to 1 year for both the donors and the recipients were studied. Contemporary results for the 47 deceased donor kidneys were studied and compared. Results: All donors had an eventful recovery. The operating time was 225.0 ± 67.4 min. The hospital stay was 5.6 ± 2.3 days. The recipient outcomes including hospital stay and creatinine levels at discharge and 1 year were 11 days, 121 umol/L and 116 umol/L, respectively. Specifically, no ureteric stricture or graft loss was noted at the 1-year follow up. Recipient complications included haematoma (1 patient), renal artery stenosis (1 patient) and redo of vascular anastomosis (1 patient). In contrast, the deceased donor graft recipients had a hospital stay of 11 days, and creatinine levels of 205 umol/L on discharge and 205 umol/L at 1 year, respectively. The delayed graft function rates for the live donor and deceased donors group were 0% and 14.9%, whereas the 1-year graft survival rates were 100% and 87.2% respectively. Conclusion: The results showed that the donor morbidity rate was low, as reflected by the short hospital stay. Also, the overall parameters of recipients were good. In particular, no ureteric stricture was noted, and graft survival was 100% at 1 year. Living donor kidney transplant program using the laparoscopic technique is a viable option to improve the pool of kidneys for transplantation.

Magnetic bead technology for viral RNA extraction from serum in blood bank screening

Nucleic acid amplification testing (NAT) was recently recommended by Brazilian legislation and has been implemented at some blood banks in the city of São Paulo, Brazil, in an attempt to reduce blood-born transmission of human immunodeficiency virus (HIV) and hepatitis C virus. ObjectiveManual magnetic particle-based extraction methods for HIV and HCV viral nucleic acids were evaluated in combination with detection by reverse transcriptase -polymerase chain reaction (RT-PCR) one-step. MethodsBlood donor samples were collected from January 2010 to September 2010, and minipools of them were submitted to testing. ELISA was used for the analysis of anti-HCV/HIV antibodies. Detection and amplification of viral RNA was performed using real-time PCR. ResultsOut of 20.808 samples screened, 53 samples (29 for HCV and 24 for HIV) were confirmed as positive by serological and NAT methods. ConclusionThe manual magnetic bead-based extraction in combination with real-time PCR detection can be used to routinely screen blood donation for viremic donors to further increase the safety of blood products.

Iranian blood donors' motivations and their influencing factors

One of the challenges faced by blood transfusion services is the motivation of blood donors. The purpose of this study was to define the motivations of Iranian donors. A total of 16 955 volunteers were studied to evaluate their motivation for blood donation in 2003 and 2004. A questionnaire was designed covering socio-demographic characteristics, history of blood donation and a list of reasons for donating. The donor physician determined the donor's motivation after an interview. Motivation was classified as internal (altruistic and religious beliefs) and external motives. The main motivations were 6629 (39.1%) altruistic, 6552 (38.6%) good for one's health and 1931 (11.4%) religious beliefs. It was shown that 8560 volunteers (50.5%) had internal motivations and 8395 (49.5%) had external motivations. Internal motivations were significantly higher in women, regular and educated donors. This study showed that internal motives are the main reason for blood donation in Iranian donors, especially in female, regular and high-educated donors. Thus, altruistic and religious messages can be emphasized in recruiting and retaining donors, particularly in this group. Nearly half of the donors were motivated by external factors--mainly to improve their own health status, especially in older donors. This may be due to a psychological impact in which they feel improvement in their general health. As voluntary non-remunerated blood donation is defined without considering the motivational factor, one might consider a new term such as 'internal motivated voluntary blood donors' in accordance with their motivation and efforts could be centered about recruiting these specific donors.

Acceptable Residual Renal Function after Retroperitoneoscopic Kidney Donation in Elderly Donors

Recent studies suggest that the overall survival and risk of end-stage renal disease among renal transplant donors are similar to those of the general population, but few studies focused on elderly donors. Among 88 donors who underwent retroperitoneoscopic live donor nephrectomies; 20 (22.7%) were elderly, namely, older than 65 years. Perioperative characteristics, such as sex, donor kidney side (left or right), body mass index, operative time, blood loss, and complication rate were not significantly different among groups classified by age: young (<50), middle (50–65), or elderly (>65). One month after kidney donation, the serum, creatinine values in the young, middle, and elderly groups increased to 1.05 ± 0.25, 0.96 ± 0.24, and 1.06 ± 0.15 mg/dL ( P = .103) and the estimated glomerular filtration rate (eGFR) decrease to 63 ± 10, 63 ± 14, 56 ± 8 mL/min/1.73m 2, respectively ( P = .037). At three months and at three years after donation these parameters showed the same degree of improvement in all groups. Percentage of eGFR (% eGFR) of its pre-donation value in the young and middle groups improved up to 21% and up to 9%, respectively, until four years after donation, whereas that of the elderly group remained unchanged below 1%. In conclusion residual renal function after retroperitoneoscopic kidney donation in elderly donors was stable and acceptable during mid-term observation. Our retroperitoneoscopic approach was safe.

Long-Term Outcomes After Living-Donor Liver Transplantation for Alagille Syndrome: A Single Center 20-Year Experience in Japan

Long-Term Outcomes After Living-Donor Liver Transplantation for Alagille Syndrome: A Single Center 20-Year Experience in Japan

Isoagglutinin adsorption in ABO-incompatible transplantation

As the demand for kidney transplantation is constantly growing methods to expand the donor pool have become increasingly important. ABO-incompatibility has hitherto been regarded as an absolute contraindication to living donor donation. However, as ABO-incompatibility has accounted for the majority of living donor exclusions, efforts have been made to overcome this immunologic barrier. Successful desensitization protocols thus far, have combined plasmapheresis for antibody removal with splenectomy to reduce the antibody producing B-cell pool, in addition to quadruple immunosuppression. Although good graft function has been achieved, the high risks involved have been deterrent. We have developed a protocol for ABO-incompatible kidney transplantation based on antigen-specific immunoadsorption and rituximab, in combination with standard maintenance immunosuppression (tacrolimus, mycophenolate mofetil and corticosteroids). We hypothesized that the anti-A/B antibodies could be effectively eliminated and good graft function achieved, without the complications of coagulopathy and transfusion reactions associated with plasmapheresis. Furthermore, we hypothesized that the substitution of splenectomy with a single dose of the anti-CD20 antibody rituximab would further reduce surgical risk as well as the risk of infectious complications. In 2001 the program for ABO-incompatible kidney transplantation was started at our center. To date 50 ABO-incompatible kidney transplantations have been performed according to the protocol based on antigen-specific immunoadsorption and rituximab. Safety and efficacy of the protocol has been evaluated in several studies, all showing that the antigen-specific immunoadsorption is well tolerated and without any serious side effects. Patient and graft survival as well as kidney function have been comparable to that of ABO-compatible living donor kidney transplantation and the incidence of antibody-mediated rejection 0%. We conclude that AB0-incompatible kidney transplantation using a protocol based on antigen-specific immunoadsorption and rituximab, in combination with triple immunosuppressive therapy is safe and effective. ABO-incompatibility following this protocol does not have a negative impact on graft function. ABO-incompatible kidney transplantation is equivalent to standard ABO-compatible living donor kidney transplantation.

Summaries of Nursing Rare-Related Systematic Reviews from the Cochrane Library: Bone marrow harvest versus peripheral stem cell collection for haematopoietic stem cell donation in healthy donors

Summaries of Nursing Rare-Related Systematic Reviews from the Cochrane Library: Bone marrow harvest versus peripheral stem cell collection for haematopoietic stem cell donation in healthy donors

Thyroid nodule and thyroid cancer management pre- and post-cardiac transplantation

Thyroid nodules are common in the adult population. Widespread use of sensitive imaging studies often leads to their incidental discovery. Recent guidelines recommend thyroid-stimulating hormone determination and ultrasonography during initial nodule evaluation. Fine-needle aspiration is often performed to detect malignancy. However, the management of thyroid nodules in cardiac transplantation patients has not been directly addressed by recent guidelines. Confounding medications such as amiodarone and anti-coagulants present a management dilemma. The timing of fine-needle aspiration is crucial because (1) malignancy diagnosed pre-operatively usually precludes organ transplantation, and (2) patients undergoing solid-organ transplantation are at increased risk of developing de novo malignancies, including thyroid. With the rising incidence of thyroid cancer, donor-related malignancy will likely become a more prominent issue. This review addresses thyroid nodule management in the cardiac transplant population and provides recommendations for organ donation and transplantation in donors and recipients with thyroid cancer.

Attitudes Toward Living Kidney Donation in Transplant Hospitals: A Spanish, Mexican, and Cuban Multicenter Study

Introduction Living donor kidney (LKD) transplantation provides better results than deceased donor donation, involving minimum risk for the donor. However, LKD donation rates are low in most countries. We analyzed attitudes toward LKD in transplant hospitals in Spain, Mexico, and Cuba. Materials and methods Data were obtained from five transplant hospitals through the International Collaborative Program “Proyecto Donante Vivo, Murcia” in three countries: Spain ( n = 1168), Mexico ( n = 903), and Cuba ( n = 202). The random sample (2273 employees) was stratified according to job category. The instrument used to evaluate attitude was a validated questionnaire. Statistical analysis included Student t test, the χ 2 test, and multivariate analysis. Results Eighty eight percent ( n = 2002) of Spanish, Mexican, and Cuban transplant hospital personnel were in favor of related LKD and 24% nonrelated LKD ( n = 555). Attitudes were more favorable among centers in Cuba 97% ( n = 195), followed by Mexico 88% ( n = 793) and by Spain 87% ( n = 1014; P < .001). According to job category, 91% ( n = 617) of physicians were in favor, 88% ( n = 543) of nurses, 85% ( n = 198) of health care assistants, and 85% ( n = 198) of auxiliary personnel. Attitudes were related to variables of: attitude toward deceased donation ( P < .001), discussion about organ donation and transplantation ( P < .001), concern about body mutilation after donation ( P = .001), a possible need for a transplant in the future ( P < .001), and attitude toward living liver donation ( P < .001). Conclusions Attitudes toward LKD in Hispanic/Latin Transplant Hospitals were favorable and could encourage an increase in LKD in the coming years assuming suitable sociopolitical and economic condition, as well as support from nephrologists.

Nursing personnel faced with living kidney donation in a Spanish hospital with a living‐donor kidney transplant program

AbstractOBJECTIVETo analyze attitudes toward living‐kidney donation among nursing personnel in a Spanish hospital with a living kidney transplant program and to analyze the influence of different types of variables on such attitudes.METHODSThis was a descriptive transversal study. The study was carried out in a Spanish third‐level hospital with an organ transplant program (kidney, liver, pancreas, and heart) and a living‐donation program (kidney and liver). A random sample (n = 305) was taken and was stratified by type of service among nursing personnel. Attitude was evaluated using a validated survey. It was completed anonymously and was self‐administered.RESULTSThe questionnaire completion rate was 95% (n = 289). Of these respondents, 86% (n = 248) were in favor of living‐related kidney donation. The following were found to be factors that were significantly related to attitude toward living kidney donation: (1) attitude toward deceased donor donation (p = .002); (2) a respondent's belief in the possibility of needing a transplant in the future (p = .002); and (3) a respondent's willingness to accept a living donated kidney (p &lt; .0005).DISCUSSIONOur hospital nursing personnel have a favorable attitude toward living‐related kidney donation, and this attitude is mainly determined by reciprocity.

Donor-Derived Disease Transmission Events in the United States: Data Reviewed by the OPTN/UNOS Disease Transmission Advisory Committee

Donor-derived disease transmission is increasingly recognized as a source of morbidity and mortality among transplant recipients. Policy 4.7 of the Organ Procurement and Transplantation Network (OPTN) currently requires reporting of donor-derived events. All potential donor-derived transmission events (PDDTE) reported to OPTN/UNOS were reviewed by the Disease Transmission Advisory Committee (DTAC). Summary data from January 1, 2005-December 31, 2007, were prepared for presentation. Reports of PDDTE have increased from 7 in 2005, the first full year data were collected, to 60 in 2006 and to 97 in 2007. More detailed information is available for 2007; a classification system for determining likelihood of donor-derived transmission was utilized. In 2007, there were four proven and one possible donor-derived malignancy transmissions and four proven, two probable and six possible donor-derived infectious diseases transmissions. There were nine reported recipient deaths attributable to proven donor transmissions events arising from eight donors during 2007. Although recognized transmission events resulted in significant morbidity and mortality, transmission was reported in only 0.96% of deceased donor donations overall. Improved reporting, through enhanced recognition and communication, will be critical to better estimate the transmission risk of infection and malignancy through organ transplantation.

A phenomenographic study of ICU-nurses’ perceptions of and attitudes to organ donation and care of potential donors

There is a lack of organs for transplantation and the number of potential organ donors is limited. Several studies indicate that the most crucial factor is the attitude to organ donation among intensive care staff. The aim of this study was to describe intensive and critical care nurses' (ICU-nurses) perceptions of organ donation based on their experience of caring for potential organ donors. A phenomenographic method was chosen. Nine nurses from three different Swedish hospitals were interviewed. All were women; aged 36-53 years, with 3-27 years' ICU experience. The analysis revealed the crucial perception "nothing must go wrong". The findings can be described in three parts: organ donation as a situation, organ donation as a phenomenon and different attitudes to organ donation. various perceptions adopted by ICU nurses might influence the chances of a potential donor becoming an actual donor. This study demonstrates that nurses who promote organ donation strive to fulfil the will of the potential donor by taking responsibility for the perception that "nothing must go wrong".

A 15-Year Review of ABC, CBS, and NBC News Coverage of Organ Donation: Implications for Organ Donation Campaigns

This content analysis represents news coverage of organ donation from January 1990 to December 2005. Specifically, ABC, CBS, and NBC news broadcasts were examined to gain a greater understanding of organ donation coverage on TV. Overall this investigation revealed that organ donation received modest coverage (N = 1,507). Although the majority of coverage was positive, attention to the need for organs and the process of becoming a potential organ donor received modest exposure. In addition, non–living donor and living-donor donations received approximately equal coverage. Results are discussed with a focus on message design for practitioners and advocates of organ donation.

Bone marrow harvest versus peripheral stem cell collection for haemopoietic stem cell donation in healthy donors

Haemopoietic stem cells can be collected from a donor either as a bone marrow harvest or by peripheral blood collection. Both techniques have risks for the donor. The aim of this review was to identify the adverse effects of haemopoietic stem cell donation and to compare the tolerability and safety of the two methods. We searched bibliographic databases including the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library 2008, issue 2), MEDLINE and EMBASE up to May 2008. We also searched reference lists of articles and contacted experts in the field. Randomised controlled trials enrolling haemopoietic stem cell donors and evaluating the different methods of donating haemopoietic stem cells were eligible. Two authors independently screened studies for inclusion. We extracted data and evaluated methodological quality. Quantitative analysis was not possible for most outcomes, but where used we preferred random-effects models due to the variability between the included studies. Six trials (807 donors) were eligible: all were substudies, or constituent parts of, larger randomised controlled trials of bone marrow and peripheral blood stem cell allogeneic transplantation. No included trial was designed solely to measure and assess the experience of stem cell donors. The donors in all studies were related to the stem cell recipient. Overall, both types of donors experienced pain subsequent to donation, and psychological morbidity. The trend was for bone marrow donors to experience more pain at the donation site, more overall adverse events, and more days of restricted activity. They were also more likely to require hospitalisation than peripheral blood stem cell donors. In contrast, peripheral blood stem cell donors experienced more pain prior to donation, which may be related to the pre-donation administration of granulocyte colony stimulating factor (G-CSF). The methodological quality of the studies was poor and indicated limitations due to the risk of selection and attrition bias. The proportion of donors from the parent trial not included in the donor substudies was also inadequately explained. The different short-term morbidities associated with each type of haemopoietic stem cell donation were clear, with bone marrow donors experiencing more pain and more restriction post-donation than peripheral blood donors. However, the studies were limited by their methodological quality, failure to provide long-term follow up (for which larger numbers of donors would be required) and a failure to apply consistent measures of quality of life in a way which allows more meaningful evaluation across studies.

Blood safety strategies for human T‐cell lymphotropic virus in Europe

To prevent the blood transmission of human T-cell lymphotropic virus (HTLV), different countries have introduced anti-HTLV blood screening. Furthermore, leucoreduction of blood components has been implemented to preclude the transmission of infectious agents present in white blood cells. To evaluate the current European strategies adopted to ensure the blood safety for HTLV, a European investigation spanning a period from 2003 to 2008 was carried out. In 2003, of the 23 included countries, 11 performed anti-HTLV screening, four of which (Scandinavian countries) only did it on first-time donors. Norway and Finland stopped it in 2007 and 2008, respectively. Two groups may be defined according to increasing prevalence rates per 10 000 donations in first-time donors: Scandinavia and Ireland (0 to 0.17), France, the Netherlands and UK (0.45 to 0.48); Romania was clearly apart from all other participating countries (5.33). HTLV-positive donors (88.6%) either come from endemic areas (82.3%) or declare to have a sexual partner coming from endemic areas (6.3%). Of the 283 HTLV-positive donations that could be characterized, 6.6% were HTLV-II. Fourteen of 22 countries currently use systematic leucoreduction, at least in cellular blood components. Six countries perform both universal anti-HTLV screening and blood cell leucoreduction. The implementation of leucoreduction did not modify the blood HTLVscreening policy, except for Norway and Finland. Several screening strategies in low endemic countries performing leucoreduction were discussed. However, the withdrawal of anti-HTLV screening should be decided after assessing the remaining HTLV transfusion risk.

Early complications and their treatment after heart transplantation in Hungary – experiences of the first 16 years

Heart transplantation is the most successful current long-term therapy of end stage cardiac failure. In order to improve the results of the Hungarian heart transplantation activity, all data from the first 16 years were retrospectively examined and matched with the relevant literature. Between January 1992 and December 2007, 127 heart transplantations were performed in 125 patients in Hungary. Above the documentation of the Department of Cardiovascular Surgery, Semmelweis University, the archives of the Institute of Forensic Medicine, Semmelweis University, the Registry of Hungarian National Blood Transfusion Service, Organ Coordination Office and the data of the Gottsegen György National Institute of Cardiology were used. Early mortality has been approaching the international level recently. Graft failure was the primary cause of death in the Hungarian practice as well, followed by infection, uncontrollable bleeding during surgery and multiorgan failure. In one case successful acute retransplantation was performed, but the most effective, ventricular assist device therapy is completely missing from the armamentarium. Excellent results were achieved with medical treatment against acute rejection such as written in the international literature. For the sake of developing, regular usage of assist device therapy in Hungary is a prominent task. Development and application of standard protocols providing better quality in organ donor treatment and donation management have to be pressed.