Implications For Organ Donation Research Articles

Analysis of implications of organ donation on living donors in southeastern Iran: A qualitative study

Objectives: despite the annual increase in living donors and the positive and negative implications following organ donation, this issue had become a significant challenge for donors. The present study aimed to analyze the experiences and views of living donors to organ donation implications.Material and Methods. The present study was performed using qualitative content analysis. Twenty participants were selected using the purposive sampling method; data were collected by semi-structured interviews and analyzed based on Lundman and Graneheim contractual content analysis method after implementing MAX 12.Results. Data analysis elicitated 721 codes, 20 subcategories, six main categories, and two themes, including positive and negative implications of organ donation from the viewpoint of living donors. The main categories of positive effects resulting from organ donation included the «donor’s peace of mind», «fundamental strength», and «recipient’s achievements». On the other hand, the main categories of negative implications resulting from organ donation included «donor’s physical suffering», «damaged interactions», and «abandonment».Conclusion. Increasing the number of living donors makes us consider it essential to understand the efficiency of its two-way implications on many aspects of donor and recipient. Thus, managing the negative impacts of living organ donation and strengthening its positive side emphasizes the need to increase the awareness of organ donation associations, develop health policies at higher levels, and, most importantly, improve the satisfaction of live organ donors

Awareness about brain death and attitude towards organ donation in a rural area of Haryana, India.

Introduction:Awareness about brain death influences organ donation behaviour of community. There is huge gap in the demand and availability of organs in India. This study was carried out with the objective of assessing awareness about brain death and attitude towards organ donation in a rural community.Material and Methods:A community based cross-sectional study was carried out among 1050 adults in a rural area of district Faridabad, Haryana. Data were collected through a pre-tested interview schedule and analysed using SPSS v17.Results:80% of the study participants had heard about organ donation. Among them, about 40% were aware of brain death. Majority of the study participants (71.5%) were willing to donate organ irrespective of circumstances. Totally, 94.6% participants had the perspective that special facility should be there for organ donors and their families. Awareness was significantly more among men and among those educated above primary level.Conclusion:Knowledge about brain death is crucial in convincing people into organ donation. Hence more efforts should be made to educate and make people aware about brain death and its implications for organ donation.

End-of-life practices in patients with devastating brain injury in Spain: Implications for organ donation

ObjectiveTo describe end-of-life care practices relevant to organ donation in patients with devastating brain injury in Spain. DesignA multicenter prospective study of a retrospective cohort. Period: 1 November 2014 to 30 April 2015. SettingSixty-eight hospitals authorized for organ procurement. PatientsPatients dying from devastating brain injury (possible donors). Age: 1 month-85 years. Primary endpointsType of care, donation after brain death, donation after circulatory death, intubation/ventilation, referral to the donor coordinator. ResultsA total of 1970 possible donors were identified, of which half received active treatment in an Intensive Care Unit (ICU) until brain death (27%), cardiac arrest (5%) or the withdrawal of life-sustaining therapy (19%). Of the rest, 10% were admitted to the ICU to facilitate organ donation, while 39% were not admitted to the ICU.Of those patients who evolved to a brain death condition (n=695), most transitioned to actual donation (n=446; 64%). Of those who died following the withdrawal of life-sustaining therapy (n=537), 45 (8%) were converted into actual donation after circulatory death donors. The lack of a dedicated donation after circulatory death program was the main reason for non-donation.Thirty-seven percent of the possible donors were not intubated/ventilated at death, mainly because the professional in charge did not consider donation alter discarding therapeutic intubation.Thirty-six percent of the possible donors were never referred to the donor coordinator. ConclusionsAlthough deceased donation is optimized in Spain, there are still opportunities for improvement in the identification of possible donors outside the ICU and in the consideration of donation after circulatory death in patients who die following the withdrawal of life-sustaining therapy.

Death by neurologic criteria in a neonate: Implications for organ donation

We illustrate a unique case of neonatal organ donation in a full-term newborn with severe hypoxic ischemic encephalopathy (HIE) and multi-organ dysfunction that underwent therapeutic hypothermia. Prolonged hypothermia permitted adequate time for recovery of certain end-organs before such time that death by neurologic criteria was declared. Parental values aligned with the opportunity for organ donation.

Neurogenic Pulmonary Edema.

Neurogenic pulmonary edema is an underrecognized and underdiagnosed form of pulmonary compromise that complicates acute neurologic illness and is not explained by cardiovascular or pulmonary pathology. This review aims to provide a concise overview on pathophysiology, epidemiology, clinical characteristics, impact on outcome and treatment of neurogenic pulmonary edema, and considerations for organ donation. Database searches and a review of the relevant medical literature. Selected studies included English-language articles concerning neurogenic pulmonary edema using the search terms "neurogenic" with "pulmonary oedema" or "pulmonary edema," "experimental neurogenic pulmonary edema," "donor brain death," and "donor lung injury." Selected studies were reviewed by both authors, and data extracted based on author consensus regarding relevance for this review. Existing evidence is organized to address: 1) pathophysiology, 2) epidemiology and association with different neurologic diseases, 3) clinical presentation, 4) impact on outcome, 5) treatment, and 6) implications for organ donation after brain death. Neurogenic pulmonary edema occurs as a complication of acute neurologic illness and may mimic acute lung injury of other etiology. Its presence is important to recognize in patients due to its impact on clinical course, prognosis, and treatment strategies.

Cardiac dysfunction following brain death after severe pediatric traumatic brain injury: A preliminary study of 32 children.

Background:Cardiac dysfunction after brain death has been described in a variety of brain injury paradigms but is not well understood after severe pediatric traumatic brain injury (TBI). Cardiac dysfunction may have implications for organ donation in this patient population.Materials and Methods:We conducted a retrospective cohort study of pediatric patients with severe TBI, both with and without a diagnosis of brain death, who underwent echocardiography during the first 2 weeks after TBI, between the period of 2003–2011. We examined cardiac dysfunction in patients with and without a diagnosis of brain death.Results:In all, 32 (2.3%) of 1,413 severe pediatric TBI patients underwent echocardiogram evaluation. Most patients had head abbreviated injury score 5 (range 2–6) and subdural hematoma (34.4%). Ten patients with TBI had brain death compared with 22 severe TBI patients who did not have brain death. Four (40%) of 10 pediatric TBI patients with brain death had a low ejection fraction (EF) compared with 1 (4.5%) of 22 pediatric TBI patients without brain death who had low EF (OR = 14, P = 0.024).Conclusions:The incidence of cardiac dysfunction is higher among pediatric severe TBI patients with a diagnosis of brain death, as compared to patients without brain death. This finding may have implications for cardiac organ donation from this population and deserves further study.

The lack of scientific evidence in clinical practice guideline in brain death determination: Implications for organ donation and transplantation.

Human death is universally understood to be a biological phenomenon, that is, the irreversible loss of the body's ability to mitigate entropy. Technological advances in transplantation medicine created the problem of optimally managing the supply of and demand for viable organs. We have previously outlined how irreversible apneic coma was introduced as a criterion of death and was approved by the US President's Commission in 1981.[1] The Uniform Determination of Death Act (UDDA) enacted two alternative methods in death determination: (1) Irreversible cessation of circulatory and respiratory functions; or (2) irreversible cessation of all functions of the entire brain, including the brainstem.[1] Other countries have adopted the brainstem definition of death. Most jurisdictions have followed the US legislation. Existing laws already disallow the act of procurement to be the proximate cause of the donor's death, reflecting a deontological moral premise that, in the context of organ donation, is referred to as the dead donor rule (DDR). Different cultures and religions do not object to organ donation if and only if vital organs are procured from cadavers and thus, in compliance with the DDR. The legal and moral legitimacy of procuring organs after determination of death with brain-based criteria, that is, brain death (BD) is centered on its equivalency with biological death. The concept of BD has serious shortcomings in this regard: (1) equivalency with biological death cannot be substantiated by contemporary neuroscience; (2) standard practice guideline for BD diagnosis is based only on weak scientific evidence, and (3) the biophilosophical explanation to equate BD and human death lacks logical coherence.

Inhaled nitric oxide in neurogenic cardiopulmonary dysfunction: Implications for organ donation

Many cadaveric organs for transplantation come from patients dying of sudden intracranial catastrophes. Cardiopulmonary dysfunction after such neurogenic insults is a well-recognized entity. The pulmonary dysfunction usually presents as florid pulmonary edema within minutes to hours after the initial intracranial insult and may occur in isolation or co-exist with overt or subclinical myocardial dysfunction. This may result in severe hypoxia, which threatens survival and outcomes in salvageable cases and organ preservation in patients who would be potential organ donors. Thus, rapid initiation of strategies aimed at ameliorating hypoxia after an acute neurogenic insult is paramount. Strategies aimed at improving acute hypoxia include maximizing ventilator support, diuretics, and volume resuscitation. Cardiac dysfunction may require use of ionotropes. We report the case of a 16-year-old female who developed catastrophic acute posterior fossa intracranial bleeding with resulting intractable hypoxia due to neurogenic cardiopulmonary dysfunction that responded dramatically to inhaled nitric oxide (INO). The patient went on to successfully donate organs following a non-heart-beating donor protocol. This therapy, to our knowledge, has never been described previously for use in patients with hypoxia secondary to neurogenic cardiopulmonary dysfunction. Conclusions We document for the first time a dramatic response of hypoxia to INO in neurogenic cardiopulmonary dysfunction. This therapy ameliorates hypoxia, which may have vital implications in minimizing secondary brain injury in salvageable cases and optimizing organ preservation in potential organ donors with catastrophic intracranial insults.