Number Of Organ Donors Research Articles

Presumed consent for organ donation: a case against

The number of organ donors in the UK is approximately 13 per million population (PMP) per year and has been gradually reducing for most of the last decade. Attempts have been made by transplant surgeons to improve rates of transplantation by using more marginal donors, splitting livers for two recipients and the increasing use of deceased after-cardiac-death donors; the only success has been with the use of living related transplantation and this is largely confined to the recipients of kidneys. For the majority awaiting solid organ transplantation the number of donated organs remains the limiting factor in the number of transplants performed in the UK. The UK donation rate is now one of the lowest in the developed world while the US consistently achieves organ donation rates of in excess of 25 PMP and Spain approximately 35 PMP. At the same time the need for solid organ transplantation is growing, with rises in the number of patients on the waiting lists of at least 8% per year. Evidence suggests that the UK population is supportive of organ donation, with 90% in favour during a UK survey carried out in 2003, and there are currently more than 16 million people signed up to the organ donor register. The UK, however, was not always lagging behind and in 1989 organ donation rates in the UK were leading the world at 16 PMP but between 1989 and 2009 the rates of donation in the UK have declined while elsewhere in Europe and the rest of the world they have raced ahead.

The D&T Report

The D&T Report

Donor conversion rates depend on the assessment tools used in the evaluation of potential organ donors

PurposeIt is desirable to identify a potential organ donor (POD) as early as possible to achieve a donor conversion rate (DCR) as high as possible which is defined as the actual number of organ donors divided by the number of patients who are regarded as a potential organ donor. The DCR is calculated with different assessment tools to identify a POD. Obviously, with different assessment tools, one may calculate different DCRs, which make comparison difficult. Our aim was to determine which assessment tool can be used for a realistic estimation of a POD pool and how they compare to each other with regard to DCR. MethodsRetrospective chart review of patients diagnosed with a subarachnoid haemorrhage, traumatic brain injury or intracerebral haemorrhage. We applied three different assessment tools on this cohort of patients.ResultsWe identified a cohort of 564 patients diagnosed with a subarachnoid haemorrhage, traumatic brain injury or intracerebral haemorrhage of whom 179/564 (31.7%) died. After applying the three different assessment tools the number of patients, before exclusion of medical reasons or age, was 76 for the IBD-FOUR definition, 104 patients for the IBD-GCS definition and 107 patients based on the OPTN definition of imminent neurological death. We noted the highest DCR (36.5%) in the IBD-FOUR definition.ConclusionThe definition of imminent brain death based on the FOUR-score is the most practical tool to identify patients with a realistic chance to become brain dead and therefore to identify the patients most likely to become POD.

Application of microtechnologies for the vascularization of engineered tissues

Recent advances in medicine and healthcare allow people to live longer, increasing the need for the number of organ transplants. However, the number of organ donors has not been able to meet the demand, resulting in an organ shortage. The field of tissue engineering has emerged to produce organs to overcome this limitation. While tissue engineering of connective tissues such as skin and blood vessels have currently reached clinical studies, more complex organs are still far away from commercial availability due to pending challenges with in vitro engineering of 3D tissues. One of the major limitations of engineering large tissue structures is cell death resulting from the inability of nutrients to diffuse across large distances inside a scaffold. This task, carried out by the vasculature inside the body, has largely been described as one of the foremost important challenges in engineering 3D tissues since it remains one of the key steps for both in vitro production of tissue engineered construct and the in vivo integration of a transplanted tissue. This short review highlights the important challenges for vascularization and control of the microcirculatory system within engineered tissues, with particular emphasis on the use of microfabrication approaches.

Effect of a Lung Protective Strategy for Organ Donors on Eligibility and Availability of Lungs for Transplantation

Many potential donor lungs deteriorate between the time of brain death and evaluation for transplantation suitability, possibly because of the ventilatory strategy used after brain death. To test whether a lung protective strategy increases the number of lungs available for transplantation. Multicenter randomized controlled trial of patients with beating hearts who were potential organ donors conducted at 12 European intensive care units from September 2004 to May 2009 in the Protective Ventilatory Strategy in Potential Lung Donors Study. Interventions Potential donors were randomized to the conventional ventilatory strategy (with tidal volumes of 10-12 mL/kg of predicted body weight, positive end-expiratory pressure [PEEP] of 3-5 cm H(2)O, apnea tests performed by disconnecting the ventilator, and open circuit for airway suction) or the protective ventilatory strategy (with tidal volumes of 6-8 mL/kg of predicted body weight, PEEP of 8-10 cm H(2)O, apnea tests performed by using continuous positive airway pressure, and closed circuit for airway suction). The number of organ donors meeting eligibility criteria for harvesting, number of lungs harvested, and 6-month survival of lung transplant recipients. The trial was stopped after enrolling 118 patients (59 in the conventional ventilatory strategy and 59 in the protective ventilatory strategy) because of termination of funding. The number of patients who met lung donor eligibility criteria after the 6-hour observation period was 32 (54%) in the conventional strategy vs 56 (95%) in the protective strategy (difference of 41% [95% confidence interval {CI}, 26.5% to 54.8%]; P <.001). The number of patients in whom lungs were harvested was 16 (27%) in the conventional strategy vs 32 (54%) in the protective strategy (difference of 27% [95% CI, 10.0% to 44.5%]; P = .004). Six-month survival rates did not differ between recipients who received lungs from donors ventilated with the conventional strategy compared with the protective strategy (11/16 [69%] vs 24/32 [75%], respectively; difference of 6% [95% CI, -22% to 32%]). Use of a lung protective strategy in potential organ donors with brain death increased the number of eligible and harvested lungs compared with a conventional strategy. clinicaltrials.gov Identifier: NCT00260676.

Mesenchymal stem cell therapy for chronic renal failure

Importance of the field: Chronic kidney disease (CKD) has become a worldwide public health problem. Renal transplantation is the treatment of choice for end-stage renal disease, but is limited by a small number of organ donors and the immune barrier. To overcome these problems, new therapeutic strategies for tissue repair have recently emerged.Areas covered in this review: We discuss the therapeutic potential of mesenchymal stem cells (MSCs) in kidney injury and examine the latest reports providing evidence supporting MSC efficacy in the treatment of chronic renal failure (CRF).What the reader will gain: MSCs improve histological and functional outcomes in various CRF model systems. Paracrine effects rather than transdifferentiation might result in the prevention of progressive renal failure. In addition, MSCs can reprogram kidney cell differentiation, and modulate neo-kidney transplantation in CRF.Take home message: Although many practical problems remain to be addressed, treatment with MSCs will enter the mainstream of CRF treatment.

Current trend of surgical management for end-stage heart disease

The prevalence of heart failure is increasing，and the prognosis of end-stage heart failure remains dismal. The gold-standard therapy in end-stage heart failure remains cardiac transplantation at the present time ，but there is a great excess of eligible candidates compared with the number of donor organs. Advances in mechanical support， the development of the left ventricular assist device (LVAD)，and the total artificial heart has reduced mortality and morbidity in patients awaiting transplantation，and LVADs are now approved as a strategy for destination therapy. Minialurlzalion， increased device durability，and complete implantabilily may render LVADs an option in earlier stages of heart failure，as a bridge to myocardial recovery or even as a viable alternative to Transplantation. Alternative strategies under investigation are cell therapy and xeno-transplantation. ln the present article，current and potential future therapeutic options ln end-stage heart failure are reviewed.

Deceased Donor Management and Demographic Factors Related to Kidney Allograft Rejection and Graft Survival

Background There is agreement that the number of organ donors and the number of organs recovered per donor are not maximized despite promotion of awareness and new guidelines for transplant teams. A single standard for donor management does not exist, in part because there is no consensus with respect to donor factors and management effect on transplant outcomes. Methods This retrospective study analyzed the long-term outcomes of 402 deceased donor kidney transplant recipients with respect to donor factors. This study differed from previous studies in that all recipients were treated with the same selection and immunosuppressive protocols. Results Factors associated with improved graft survival included cause of death, more organs donated, and lower peak sodium ( P < .01). Delayed graft function (DGF) decreased if more organs were donated, but increased when the donor was given dopamine. Recipients of donor kidneys with higher final creatinine values were more likely to show DGF ( P < .01). A decrease in acute rejection episodes was observed among patients whose donors had received dopamine, donated more organs, and had a shorter time between incision and cross clamp ( P < .05). Kidneys from donors with a higher final creatinine displayed fewer rejection episodes; those with a higher peak creatinine experienced more rejection episodes ( P < .05). Conclusion The effect of donor variables on kidney transplant outcomes is important and may not be consistent with traditional expectations. Additional data collection and assessment of both short- and long-term transplant outcomes are critical to improve our understanding of the impact of deceased donor factors and management.

The potential for non-heart beating organ donation within a paediatric intensive care unit

ObjectiveIn the UK, the number of patients waiting for an organ transplant has increased by 30% since 2001. Non-heart beating organ donation (NHBD) programmes are advocated as a means of...

Increasing Organ Yield through a Lung Management Protocol

Gift of Life Michigan determined that the largest gap between the number of organ donors and the number of organs transplanted has been in the number of lungs transplanted. The literature was reviewed for lung donor management strategies and other organ procurement organizations were surveyed for existing donor management guidelines to improve lung function. On the basis of pulmonary physiology and the knowledge gained from the literature search, Gift of Life Michigan developed a lung donor management protocol that has been very effective. In 4 years, the number of lungs transplanted has increased from 37 to 135, representing a 265% improvement.

Device Therapy and Cardiac Transplantation for End-Stage Heart Failure

The prevalence of heart failure is increasing, and the prognosis of end-stage heart failure remains dismal. The gold-standard therapy in end-stage heart failure remains cardiac transplantation at the present time, but there is a great excess of eligible candidates compared with the number of donor organs. Advances in mechanical support, the development of the left ventricular assist device (LVAD), and the total artificial heart has reduced mortality and morbidity in patients awaiting transplantation, and LVADs are now approved as an strategy for destination therapy. Miniaturization, increased device durability, and complete implantability may render LVADs an option in earlier stages of heart failure, as a bridge to myocardial recovery or even as a viable alternative to transplantation. Alternative strategies under investigation are cell therapy and xenotransplantation. In the present article, current and potential future therapeutic options in end-stage heart failure are reviewed.

Metaphors of organ donation, social representations of the body and the opt‐out system

Organ donation is the only available treatment for end-stage failure of organs such as liver, lung, and heart and therefore increasing the number of organ donors is a priority for most countries. One measure that could be taken by a country to increase the number of organ transplants is to introduce the opt-out system of organ donation. Public opinion is divided on this issue and policy makers need to tread with caution before introducing legislation. This paper proposes that understanding the social representations the public has of organ donation is important in taking the right policy decisions. We propose here that an in-depth study of the views held by people on the issue is essential in this regard and that this can best be done by investigating the metaphors people use to describe organ donation, interpreted within the theory of social representation. In this study, the social representations of organ donation were investigated through five focus groups with 57 participants living in Malta. Analysis of the transcriptions of these focus groups yielded pertinent issues related to organ donation. Moreover, metaphors of organ donations and how these were related to social representations of the body and attitudes towards the opt-out system are discussed. It is being suggested that these findings could be of relevance to the present discussion on the opt-out system in the UK and in other countries.

Deceased Donor Kidney Transplantation from Donors with Acute Renal Failure due to Rhabdomyolysis

With the current shortage of solid organs for transplant, the transplant community continues to look for ways to increase the number of organ donors, including extending the criteria for donation. In rhabdomyolysis, the byproducts of skeletal muscle breakdown leak into the circulation resulting in acute renal failure in up to 30% of patients. In nonbrain dead patients, this condition is reversible and most patients recover full renal function. Seven potential donors had rhabdomyolysis with acute renal failure as evidenced by the presence of urine hemoglobin, plasma creatinine kinase levels of greater than five times the normal and elevated creatinine. One donor required dialysis. At our institution, 10 kidneys were transplanted from the seven donors. Two grafts had immediate function, five grafts experienced slow graft function and three grafts had delayed graft function requiring hemodialysis. At a mean of 8.7 months posttransplant (2.4-25.2 months), all patients have good graft function, are off dialysis and have a mean creatinine of 1.3 (0.7-1.8). In conclusion, our experience suggests that rhabdomyolysis with acute renal failure should not be a contraindication for donation, although recipients may experience slow or delayed graft function.

Utilidad del MELD (Model for End-stage Liver Disease) para asignar prioridades en el trasplante hepático

Liver transplantation is the most effective treatment for many patients with chronic end-stage liver disease. The discrepancy between the number of donor organs and potential recipients causes marked pre-transplantation mortality and consequently optimal rationalization of organ allocation is essential. The Model for End-Stage Liver Disease (MELD) is an objective and easily reproducible prognostic index of mortality based on three simple analytical variables: bilirubin and serum creatinine and the prothrombin time/International Normalized Ratio (INR) of protrombine time. The implementation of MELD as an organ allocation system has reduced mortality on the waiting list without affecting post-transplantation survival. Nevertheless, this model has some limitations and consequently further investigations should be performed to improve the organ allocation policy in liver transplantation.

Clinical Leads for Organ Donation: Making it Happen in Hospitals

The report from the Organ Donation Taskforce into the relatively poor rates of donation in the UK called for a complete overhaul of the processes that currently support the identification, referral and management of potential organ donors dying in our hospitals. Although some of the specific recommendations of the Taskforce refer to the responsibilities of national bodies such as the Department of Health or NHS Blood and Transplant, at the very heart of the Taskforce report are those recommendations that are concerned with how the option of donation is made available to patients when they die. Thus, the Taskforce recommended that donation should be a component of end-of-life care, that brainstem death should be diagnosed wherever possible and that potential donors should always be referred according to defined minimum criteria and regardless of apparent donation potential. However, it was recognised that this was unlikely to happen unless every hospital had a team to make it possible - the Donation Committee - that was chaired and driven by a non-clinical champion, enhanced by a donor transplant co-ordinator and lead by a clinician. This paper develops these themes and describes, by focusing on a collaborative relationship between donor transplant co-ordinators and clinical leads for organ donation, how real improvements in the number of organ donors might be achieved.

Understanding Public Skepticism Toward Organ Donation and Its Commercialization: The Important Role of Reciprocity

We explored ideas and motives behind public attitudes toward organ donation and its commercialization in the context of recent academic and political debates on attempts to increase the number of donor organs by means of financial incentives. We analyzed 4 focus group discussions (FGs) conducted in Germany between 2005 and 2008 with various participants: (1) recipients of a cadaveric donation, (2) recipients of a living donation, (3) living organ donors, and (4) lay people (N((a-d)) = 30). In our analysis we used the method of qualitative content analysis to extract the major argument classes and moral viewpoints about organ donation and its commercialization. We found a thorough concordance in the critical assessment of most commercial strategies over the 4 groups of participants. Slight deviations between groups were most likely due to different perspectives resulting from the various ways the groups were affected. Overall, we observed a strong tendency to assess the practice of organ procurement in terms of reciprocity. The current political and legal discourse neglects the central role of reciprocity for lay people and patients. Targeted legal and practical solutions should (re) consider strategies to integrate the highly valued idea of reciprocity in organ donation practice: for example, the club model and the paradigm of anonymity in cadaveric organ allocation.

Lower Rate of Family Refusal for Organ Donation in Non–Heart-Beating Versus Brain-Dead Donors

Family refusal is an important factor that limits the number of organ donors. Cultural and religious factors as well as perception of brain death are the principal reasons for these refusals. We examined whether the type of potential donor, that is brain-dead or non-heart-beating, had an influence on family refusal. In July 2005, we initiated a program of non-heart-beating donors who had died in the street or at home. We compared family refusals among these potential donors with those among potential brain-dead donors from July 2005 to October 2008. The mean time of stay in the hospital was significantly greater for brain-dead donors than those who were non-heart-beating: 4 +/- 2 versus 0.23 +/- 0.01 days (P < .01). The rate of family refusals was significantly greater among the families of potential brain-dead donors, that is 24% (24/99) than non-heart-beating donors, that is, 4% (2/47; P < .01). Donor age was similar in both groups. The rate of family refusals among potential non-heart-beating donors was significantly lower than that among families of brain-dead individuals. Greater understanding of death because the heart is not beating, less time of uncertainty about death, and shorter hospital stay could explain this difference.

More and better donors for cardiac transplantation

Cardiac transplantation is unrivalled as a treatment for end-stage heart failure. Nothing else offers the degree of improvement in both symptoms and survival. Whilst transplantation can never be the solution to the epidemic of advanced heart failure, for the fortunate few recipients it is very effective, and outcomes continue to improve. The inexorable decline in transplant activity is thus doubly frustrating. In the EuroTransplant area there were 782 cardiac transplants in 1997, falling to 577 ten years later. Lung, liver, kidney, and pancreas transplants all increased in this period.1 Over the same time period there was an almost catastrophic fall in UK activity, from 220 to 127.2 Overall numbers of organ donors remain largely unchanged, but the demographics—age and disease profile—are unhelpful to cardiac transplantation. In 2009 the typical donor is a middle-aged female dying of an intracerebral haemorrhage perhaps related to untreated hypertension. Concomitant left ventricular hypertrophy and coronary artery disease exclude use of the heart when other organs will still function well after transplant. As the proportion of donors with usable hearts falls below 20%, optimization of as many ‘marginal’ organs as possible is essential. To an extent, because of the damaging effects of brainstem death and subsequent ischaemia and reperfusion, all donor hearts are ‘marginal’—they all show some dysfunction. Primary graft failure is by far the most common cause of early death after a transplant, and is difficult to manage satisfactorily. There is therefore benefit … *Corresponding author. Tel: +44 (0) 191 223 1450, Fax: +44 (0) 191 223 1152, Email: j.h.dark{at}ncl.ac.uk

Impact of a pediatric donation after cardiac death program

To determine the impact of a pediatric donation after cardiac death (DCD) program on organ donation. Retrospective case series. A free-standing children's hospital. All ventilated pediatric intensive care unit patients who died between September 1, 2005 and April 30, 2007. Institution of a DCD program. Data collected included clinical features, medical eligibility and consent for organ donation, as well as outcome for donation among eligible patients. One hundred ten patients who died in the pediatric intensive care unit and were treated with mechanical ventilation immediately before death were identified. Thirty-one patients met exclusion criteria, 26 patients were not referred, and 53 patients were evaluated for potential DCD by the organ procurement agency. The majority of patients had anoxia or trauma as their primary diagnosis. Family members initiated discussions regarding donation in 17% of evaluations. Sixty-eight percent of patients were deemed medically ineligible by the organ procurement agency. Of the 17 medically eligible patients, consent for donation was given in 9 cases (53%). Of these, 7 patients (41%) successfully donated; accounting for 37% of organ donors during the study period. Two families gave consent for donation which did not occur; one child did not die within the required time period and one could not be matched with any recipients. Although a small percentage of dying patients are eligible for and will undergo DCD, such a program can markedly increase the number of organ donors at a children's hospital.

Levertransplantasjon i Norge gjennom 25 år

In Norway, liver transplantation has been the treatment of choice for irreversible acute and chronic liver failure for 25 years. The aim of this article is to present a summary of the results obtained. All liver transplants performed in Norway in the period 25.02.84-31.12.08 have been reviewed retrospectively with respect to patient and donor epidemiology, survival and recurrence. 651 transplants have been performed in this period. The annual number of transplants increased gradually up to the year 2000 (31), and more steeply afterwards - to 79 in 2008. Also the number of organ donations has increased and reached 98 (20 pr. million inh.) in 2008. 5-year patient survival was 53 % in the period 1984-1994. In the period 2001-2008, 1-year survival was 90 % and 5-year survival was 83 %. The gradual improvement of results should be interpreted in light of improvements within transplant surgery, medicine and anaesthesiology and the increased local experience due to the increasing number of transplants performed. The transplant centre at Rikshospitalet has developed into being among the largest of its kind within the Nordic Countries and the results compare well with the best international data.