Number Of Potential Donors Research Articles

Demography of brain stem death and factors leading to successful consent for organ donation

BackgroundThere is a widening gap between the patients requiring transplants in proportion to the availability of organs donated. After brain stem death (BSD), counselling for consent is mandatory and if successful, and viable organs are recovered. A low consent rate for donation results in failed donation in a number of potential donors. Many potential donors fail to make a donation due to various social and familial reasons resulting in a poor consent rate. The aim of this study was to identify the variables that lead to donation denials. MethodsThis retrospective study, carried out from Jan 2009 to Dec 2021 at a tertiary centre with an active transplant and donation programme, analysed BSDs and their counselling outcomes. ResultsA total of 10998 patients were admitted to the intensive care unit, with 2401 (21.8%) deaths. BSD was diagnosed in 8.5% of all deaths, with donor suitability seen in 77.1% (n = 158) cases. After counselling, 55.7% families consented for organ donation. Amongst the families declining consent, most had multiple reasons. The commonest reasons were a difference of opinion among the family members (70%) and unclarity of BSD concept (44.3%). Other reasons included fear of mutilation, religious beliefs, and hope of a miracle. ConclusionAs most reasons of denial are social and related to public awareness, a meticulous transplant program with enthusiastic coordinators coupled with augmentation of public awareness, responsible media reporting, and improved doctor–patient–relative communication would result in enhanced rates of consent.

The State Support of Grant Activities in Ukraine

The notion “grant project” is elaborated on, with investigating the types of state support to grant activities in Ukraine. It is argued that the number of grant programs in Ukraine has been constantly increasing. This type of targeted financing can be received as part of national initiatives and from private companies or international organizations.
 It is substantiated that the importance of grants in the war and postwar time will be rising, which is quite logical given the increasing scopes and complexity of problems in economic and social sphere. Grants offer a good way of facing these problems: the competitive approach allows for selecting the best, the most promising and productive entrepreneurs capable to achieve the goals in an efficient manner. The number of potential donors and funds allocated for them continue growing. It should be noted that grants are a conventional and widespread practice of funding in EU. It means that businesses have to carefully consider this potential channel of funding. 
 The following programs for support of Ukrainian business were implemented in IV quarter 2023: micro-grants for creating one’s own business; grants to operate a processing factory; funds to operate a greenhouse facility; grants for a startup; grants for veterans and their family members. The peculiarity of each of the above programs are analyzed. 
 The program eRobota (eWork) launched 1 July, 2022 and aimed at stimulation of entrepreneurial activities and job creation proved to be a most ambitious one: its total funding in 2023 amounted to 1,800,000,000 UAH.
 The principal requirements to grant recipients are highlighted: absence of business activities on the temporarily occupied territories and in the Russian Federation, not being a sanctioned entity, absence of bankruptcy procedures and debts to the state. The overwhelming majority of recipients got micro-grants that were invested in acquisitions of equipment required for business operation. The most demanded sectors where grant recipients operate are wholesale and retail trade, repair of automobile vehicles, temporary accommodation and meals, manufacturing industry, medical and social aid.

SOCIAL REPRESENTATION OF THE NURSE IN THE ORGAN DONATION PROCESS

Brazil is a world reference in the field of transplants and has the largest public transplant system in the world. It is known to a large part of the population that thousands of people live with the hope of carrying out the transplant, however, the reality shows a discrepancy between the number of people waiting for an organ and the number of potential donors. Objective: to identify the importance of organ donation and the role of nurses (a) in front of a multidisciplinary team in the process of capturing organs and tissues for donation and transplantation. Materials and method: This is a narrative bibliographic review study. And it had as inclusion criteria the search for material published in the period from 2019 to 2022, in Portuguese and English languages in virtual databases such as BVS and Bireme. Eighteen publications were selected for data collection. Results: three subjects were listed in category format, such as Brazilian guidelines for organ donation; Biovigilance in organ donation; Social representation of nurses in organ donation. Conclusion: It is essential to look at the professional with the aim of offering constant and systematic technical and emotional support, which contributes to the care provided to family members.

Impact of the Covid-19 Pandemic on Organ Donation and Transplants at Hospital de Base and in the State of São Paulo, Brazil

Abstract: The Covid-19 pandemic had severe impacts on various sectors of society, especially in the area of medicine. In this area, one segment of activity that was greatly impacted was transplantation, which at first had to be halted in numerous centers, for various reasons. The objective of this article was to analyze, in a comparative way between the years 2019 and 2020, the impact of the Covid-19 pandemic in the numbers of transplantations in a district hospital (DH), a national reference in transplantations, and in the state of São Paulo, as well as in the number of donations from these locations. The method used in this work was the comparative analysis using data obtained from the Brazilian Transplant Registry, the Brazilian Association of Organ Transplantation and the State Transplant System. The following organs were analyzed in the DH and in the state of São Paulo: heart, liver, lung and kidney. Pancreas was analyzed only in the state. Through the analyses, it was observed that in the DH there was a decrease in the numbers of transplantations for all organs analyzed, and in the state of São Paulo, in the numbers of lung and kidney transplantations, maintaining the number of pancreas transplantations and increasing the numbers of heart and liver transplantations. Regarding donors, there was a decrease in the number of potential donors, but an increase in the number of actual donors, due to a decrease in the family refusal rate.

Organ donation by Maastricht-III pediatric patients: Recommendations of the Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP) and Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF) Part I: Ethical considerations and family care

The French Transplant Health Authority (Agence de la Biomédecine) has broadened its organ- and tissue-donation criteria to include pediatric patients whose death is defined by circulatory criteria and after the planned withdrawal of life-sustaining therapies (WLST) (Maastricht category III). A panel of pediatric experts convened to translate data in the international literature into recommendations for organ and tissue donation in this patient subgroup. The panel estimated that, among children aged 5 years or over with severe irreversible neurological injury (due to primary neurological injury or post-anoxic brain injury) and no progression to brain death, the number of potential donors, although small, deserves attention. The experts emphasized the importance of adhering strictly to the collegial procedure for deciding to withdraw life support. Once this decision is made, the available data should be used to evaluate whether the patient might be a potential donor, before suggesting organ donation to the parents. This suggestion should be reserved for parents who have unequivocally manifested their acceptance of WLST. The discussion with the parents should include both the pediatric intensive care unit (PICU) team under the responsibility of a senior physician and the hospital organ- and tissue-procurement team. All recommendations about family care during the end of life of a child in the PICU must be followed. The course and potential challenges of organ donation in Maastricht-III pediatric patients must be anticipated. The panel of experts recommended strict compliance with French recommendations (by the Groupe Francophone de Réanimation et Urgences Pédiatriques) about WLST and providing deep and continuous sedation until circulatory arrest. The experts identified the PICU as the best place to implement life-support discontinuation and emphasized the importance of returning the body to the PICU after organ donation. French law prohibits the transfer of these patients from one hospital to another. A description of the expert-panel recommendations regarding the organization and techniques appropriate for children who die after controlled circulatory arrest (Maastricht III) is published simultaneously in the current issue of this journal..

Various approaches for accessing the influence of human leukocyte antigens disparity in haploidentical stem cell transplantation.

We investigated the association of HLA on clinical outcomes in our cohort of patients in the haplo-HSCT program using the HLAMatchmaker (EM) and PIRCHE score (PS) algorithms. The group comprised 64 patients (male=35-54.7%, female 29-45.3%; median age 43years) and their related haplo-HSCT donors (male=30-46.9%, female 34-53.1%). HLA-A/B/C/DRB1/DQB1/DPB1loci were analyzed. Multivariate analysis of the association between different HLA or patient/donor-related parameters and clinical outcome revealed the following associations with statistical significance: GvHD and HLA class I PS in the GvH direction (p=.0420) and relapse with diagnosis (p=.0163). For OS, the only variable showing a tendency of association was the source of HSCT (p=.0965). Combined results of univariate and multivariate analysis suggest that the patients awaiting the selection of the best haplo-HSCT donor could benefit the most from the combination of all three approaches, in cases when a suitable donor can be chosen from a number of potential donors.

Organ donation in the time of COVID-19: the Israeli experience one year into the pandemic\u2014ethical and policy implications

PurposeTo present the response of the Israel National Transplantation Center (NTC) to the evolving challenge of COVID-19, the impact on deceased organ donation and living organ kidney donation during 2020, and resultant policy and ethical implications.MethodsData collected included (i) for deceased donors, the total number of potential organ donors, if hospitalized in ICU or general ward, cause of death, number of family authorizations and refusals, number of actual donors, number of organs transplanted/donor and total number of transplants performed; (ii) for living-kidney-donors (related or altruistic), the number of procedures performed; and (iii) the number of patients registered on the national organ waiting-list.ResultsFollowing the first case (February 2020), deceased organ donation continued uninterrupted. The total number of potential donors was similar to 2019 (181 vs. 189). However, the number of families approached for donation decreased significantly (P = 0.02). This may be attributed to COVID-19-imposed limitations including fewer brain death determinations due to limited possibilities for face-to-face donor coordinator-donor family interactions providing emotional support and visual explanations of the medical situation. Fewer donors were admitted to ICU (P = 0.1) and the number of organs retrieved/donor decreased (3.8/donor to 3.4/donor). The overall result was a decrease of 24.2% in the number of transplant procedures (306 vs. 232). Living kidney donation, initially halted, resumed in May and the total number of procedures increased compared to 2019 due to a significant increase in altruistic donations (P < 0.0001), while the number of related-living donations decreased.ConclusionThis study of organ donation during a crisis has informed the introduction of policy changes in the NTC including the necessity to mobilize rapidly a “war room”, the use of innovative virtual tools for contact-less communication, and the importance of cooperation with hospital authorities in allocating scarce health-care resources. Finally, the pandemic highlighted and intensified ethical considerations, such as under what circumstances living kidney donation be continued in the face of uncertainty, and what information to provide to altruistic donors regarding a prospective recipient, in particular whether all options for related living donation have been exhausted. These should be addressed now.

Impact of Donation Physicians on Deceased Organ Donation: A Systematic Review.

Background:An emerging strategy to increase deceased organ donation is to use dedicated donation physicians to champion organ donation. We sought to conduct a systematic review of the effectiveness of donation physicians in improving organ donation outcomes.Objective:A systematic review was conducted following Cochrane principles. MEDLINE, Embase, and CINHAL databases were searched from inception to March 26, 2020.Methods:Quantitative studies examining the effects of donation physicians on all deceased organ donation outcomes were considered for inclusion. Review articles, editorials and opinion articles, and case studies were excluded. Study selection was completed independently by 2 team members; all discrepancies were resolved by consensus. Two team members independently extracted data from studies.Results:A total of 1017 studies were screened, and 12 met inclusion criteria. Included studies were published between 1994 and 2019. Half used an interrupted time series design (n = 6; 50%), 3 (25%) were cohort studies, and 3 (25%) used a before-and-after study design. Outcomes (reported in greater than 50% of included articles) included consent/refusal rate (n = 8; 67%), number of potential donors (n = 7; 58%), and number of actual donors (n = 7; 58%). Across studies and design types, there was an increase in potential organ donors ranging from 8% to 143% (Mdn = 33%), an increase in actual organ donors from 15% to 113% (Mdn = 27%), an increase in donor consent rate from −3% to 258% (Mdn = 12%), and an increase in deceased donor transplants from 13% to 24% (Mdn = 19%) following the introduction of donation physicians.Conclusions:Donation physicians have the potential to significantly improve deceased organ donation. Further implementation and evaluation of donation physician programs is warranted. However, implementation should be undertaken with a clear plan for a methodologically rigorous evaluation of outcomes.

HLA Matching Status Among Patients Requiring Hematopoietic Stem Cell Transplant: The Need for a National and Regional Stem Cell Bank.

Hematopoietic stem cell transplant is a strategic treatment for many malignant and nonmalignant blood diseases. Finding an HLA-matched donor is a requirement for a successful transplantation. The aim of the current study was to explore indications, demographics, and HLA patient-donor matching status among Bahraini patients requiring this transplant. Records of 100 patients who required hematopoietic stem cell transplant at the Salmaniya Medical Complex, Ministry of Health tertiary hospital in Bahrain were retrospectively studied. Data were analyzed and compared with data from similar studies. For the 100 patients, 294 potential donors were HLA typed. Indications for transplant included malignant diseases (50%) and hereditary blood diseases (50%). For those in the 0- to 5-year age group, the main indication was acute lymphoblastic leukemia, whereas acute myeloid leukemia was the main indication for those who were >5 years old. Sex distribution showed that 55% of patients were males and 45% were females. With regard to age distribution, 22% of patients were less than 5 years old, 30% were 5 to 17 years old, and 48% were 18 years and older. Patient-donor HLA matching status was 50% HLA identical, 32% haploidentical, 15% more than haploidentical, and 3% less than haploidentical. The number of potential donors per patient ranged from 1 to 11 typed for each patient (average of 2.94 ± 1.86). The rate of finding a family member as HLA-matched donor for hematopoietic stem cell transplant in our study on Bahraini patients was higher than reports in western countries yet close to other reports from countries with almost similar family sizes. We recommend forming a national Bahrain registry in addition to a regional Eastern Mediterranean stem cell bank to increase the success rate of finding an HLA-matched donor.

Practitioner availability rather than surgical quality impacts the utilization of liver transplantation for hepatocellular carcinoma

BackgroundLiver transplantation (LT) provides better outcome than surgical resection (SR) although both are acceptable surgical options for hepatocellular carcinoma (HCC). It is unclear whether non-clinical factors drive treatment decisions. Our goal is to identify factors that may affect treatment decisions. MethodsPatients aged 18–74 with T2 HCC undergoing either LT or SR in Surveillance, Epidemiology, and End Results Database from 2004 to 2014 were included. Healthcare resources data were analyzed to assess factors that predict utilization of LT versus SR, adjusted for demographic, clinical outcomes, and socioeconomic factors. Results51% of patients (Total N = 2616) received LT, with a substantial state-level variation in LT rates (0.0%–66.9%). Higher LT center density [OR = 1.04 per 1% increment, P < 0.01], male gender (OR = 1.38, P = 0.02), and numbers of potential donors (OR = 1.19, P = 0.03) were positively associated with LT utilization. Conversely, higher incidence of chronic liver disease/cirrhosis (OR = 0.41 per one additional case per 100,000 populations, P = 0.001) and minority populations were negatively correlated with LT utilization. Notably, short-term surgical outcomes (in-hospital LT & SR mortality) were not associated with LT utilization. ConclusionLiver transplant center density and organ availability, but not surgical outcomes, affect utilization of LT. Future studies should focus on increasing availability of resources.

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.

Retrospective analysis of selected aspects of public blood transfusion service as a starting point for assessment of the status of transfusion medicine in Poland Part 1: Demographic characteristics of the donor population reporting for blood donation

Background: The ongoing demographic changes in Poland affect the number of donors and donations with direct impact on provision of blood and blood components for transfusion. With predicted population-decline, the number of potential donors is likely to decrease while the demand for blood is bound to increase as more people will require blood therapy. The structure of the Polish donor population reporting for blood donation is not uniform, moreover it has undergone additional changes within the study period. So it seems justified to perform in-depth analysis of the dynamics of changes in the number and structure of donor group as well as determine the direction and intensity of these changes in spatial and temporal terms. Identification of the possible causes of change is also important. Aim: presentation of the structure characteristics of the donor group who reported at the Polish regional blood transfusion centers (RBTCs) in the period 2005–2017 with the intention of donating blood/ blood components. Materials and methods: Analyses of available data-sets — annual reports from 21 Polish RBTCs forwarded to the IHTM. The following tools were used for statistical analysis: Microsoft Office: Access and Excel, Microsoft Power Business Intelligence (Power BI) software and STATISTICA version 13.3 software (TIBCO Software Inc.). Results: In 2005–2017 the total number of donors amounted to 8 691 611 including 2 542 621 (29.3%) women and 6 148 990 (70.7%) men. Voluntary non-remunerated donors were estimated at 8 684 069 (99.9%). The average annual number of donors per RBTC was 31 837 and included 31 809 voluntary non-remunerated donors; 22 524 men and 9314 women. Countrywide, the highest number was reported for the period 2011–2013; 701 882 (8.08%), 707 578 (8.14%) and 706 246 (8.13%) for respective years and for the period 2015–2016 the numbers were 718 887 (8.27%) and 706 476 (8.13%) respectively. The highest number for the period was reported by 5 RBTCs: Warsaw (951 068 — 10.94%), Katowice (748 841; 8.62%), Poznan (702 087; 8.08%), Krakow (651 057; 7.49%) and Wroclaw (556 357; 6.40%). In the number of 2 352 099 donors who have recently reported for blood donation at the RBTCs the 25–44 age group was the largest (48%). The least numerous was the 45–65 age group — 548 885 (ca. 11%). There were 2 030 692 donors in the 18–24 age category ( > 41% of the total donor-population).Trend-analysis demonstrated an upward tendency for the category of 25–44 age donors and a downward one for the 18–24 age category. No explicit trend was observed for the 45–65 age group. Conclusion: The number of blood donations in Poland has recently reached the limit of approximately 1 200 000 donations per year. To exceed this limit will be no easy task. All efforts must therefore be focused on promoting people’s willingness to donate blood. The analysis indicates a falling tendency for the 18–24 age group and a rising one for higher age groups, which only raises concern for the future. The priority is therefore to motivate people of all agegroups to donate blood and become multiple donors with special emphasis however on the very young people as they are the potential source for many years to come. Promotion of voluntary non-remunerated blood-donation among children is equally important; in several years’ time transfusion medicine will depend on their willingness to donate blood.

COVID-19: A global transplant perspective on successfully navigating a pandemic.

The COVID‐19 pandemic has rapidly evolved and changed our way of life in an unprecedented manner. The emergence of COVID‐19 has impacted transplantation worldwide. The impact has not been just restricted to issues pertaining to donors or recipients, but also health‐care resource utilization as the intensity of cases in certain jurisdictions exceeds available capacity. Here we provide a personal viewpoint representing different jurisdictions from around the world in order to outline the impact of the current COVID‐19 pandemic on organ transplantation. Based on our collective experience, we discuss mitigation strategies such as donor screening, resource planning, and a staged approach to transplant volume considerations as local resource issues demand. We also discuss issues related to transplant‐related research during the pandemic, the role of transplant infectious diseases, and the influence of transplant societies for education and disseminating current information.

Doação de órgãos e tecidos em hospital público de Pernambuco

Resumo O objetivo desta pesquisa foi realizar levantamento sobre a frequência das doações de órgãos ou tecidos no Hospital Regional do Agreste, Caruaru/PE. Trata-se de estudo descritivo, retrospectivo, com base nos dados de 439 prontuários que registraram as doações realizadas no hospital entre janeiro de 2011 e dezembro de 2014. As doações oscilaram no período considerado e diminuíram no último ano da série, ficando sempre muito abaixo do número de potenciais doadores. Além disso, a doação de tecido foi muito superior à de órgãos. Os resultados demonstram que é imprescindível criar medidas públicas permanentes para conscientizar a população sobre a importância do tema. Aprovação CEP-Unifavip CAAE 42440515.3.0000.5666

Kidney Donors with Cleared Hepatitis C Infection Did Not Transmit Infection

Due to either natural clearance or successful treatment of hepatitis C virus (HCV) infection, an increasing number of deceased potential organ donors

P-176 – Pneumopathies acquises sous ventilation mécanique en réanimation pédiatrique

The French Transplant Health Authority (Agence de la Biomédecine) has broadened its organ- and tissue-donation criteria to include pediatric patients whose death is defined by circulatory criteria and after the planned withdrawal of life-sustaining therapies (WLST) (Maastricht category III). A panel of pediatric experts convened to translate data in the international literature into recommendations for organ and tissue donation in this patient subgroup. The panel estimated that, among children aged 5 years or over with severe irreversible neurological injury (due to primary neurological injury or post-anoxic brain injury) and no progression to brain death, the number of potential donors, although small, deserves attention. The experts emphasized the importance of adhering strictly to the collegial procedure for deciding to withdraw life support. Once this decision is made, the available data should be used to evaluate whether the patient might be a potential donor, before suggesting organ donation to the parents. This suggestion should be reserved for parents who have unequivocally manifested their acceptance of WLST. The discussion with the parents should include both the pediatric intensive care unit (PICU) team under the responsibility of a senior physician and the hospital organ- and tissue-procurement team. All recommendations about family care during the end of life of a child in the PICU must be followed. The course and potential challenges of organ donation in Maastricht-III pediatric patients must be anticipated. The panel of experts recommended strict compliance with French recommendations (by the Groupe Francophone de Réanimation et Urgences Pédiatriques) about WLST and providing deep and continuous sedation until circulatory arrest. The experts identified the PICU as the best place to implement life-support discontinuation and emphasized the importance of returning the body to the PICU after organ donation. French law prohibits the transfer of these patients from one hospital to another. A description of the expert-panel recommendations regarding the organization and techniques appropriate for children who die after controlled circulatory arrest (Maastricht III) is published simultaneously in the current issue of this journal..

Strategies to Increase Living Kidney Donation: A Retrospective Cohort Study

BackgroundLiving kidney transplantation (LKT) offers the best medical outcomes for organ recipients. Historically, our centre had a low rate of LKT. In 2009, in an effort to increase living organ donation (LOD), a dedicated team was created. Its mandate was to promote LOD at our centre and at referring centres, to coordinate assessments of living organ donors, to facilitate the process, and to ensure long-term follow-up after the donation. In November 2010, our centre joined the national living donor paired exchange registry (LDPE).ObjectiveTo document the impact of the LOD team and LDPE registry on LOD rates at our centre.DesignRetrospective cohort studySettingSingle center study in a university hospital with an adult kidney transplant programPatientsUsing our electronic database, we included all potential living organ donors who contacted our centre from 01/01/2005 to 31/12/2008 and from 01/01/2009 to 31/12/2012. Follow-up was conducted until 31/12/2013.MeasurementsNumber of transplantations from living donors, number of potential donors who contacted the centre, donor and recipient characteristics.MethodsWe compared the number of transplantations from living donors performed and the number of potential donors who contacted the centre before and after the creation of the LOD team and participation in the LDPE.ResultsA total of 50 renal transplantations were performed using organs from living donors during the first time period, whereas this increased to 73 in the 2009-2012 cohort (incidence rate difference (IRD): 0.030, 95% confidence interval (CI) 0.003-0.056). We also observed a significant increase in the number of individuals who contacted our centre to donate a kidney. During the 2005–2008 period (cohort 1), 191 individuals interested in donating a kidney contacted our centre, whereas this figure was 304 during the 2009–2012 period (cohort 2) (IRD: 0.143, 95% CI 0.091-0.196).LimitationsSingle center study, relatively low sample sizeConclusionThe implementation of a LOD team, combined with our participation in the LDPE registry, was associated with a significant increase in the actual number of living kidney transplantations performed. These data support initiatives such as the creation of dedicated LOD teams and LDPE registry to increase LKT.

Regional Variation in Organ Donation in Saudi Arabia

IntroductionThere is marked regional variation in organ donation among the different regions of Saudi Arabia. Our aim was to study the dominating factors for these variations to improve organ donation in low-donation areas. Materials and MethodsThis study was a retrospective review of the Saudi Center for Organ Transplantation data for cadaveric organ donation from 2006 to 2012, with the number of cases reported, documented, consented, and harvested in various regions (northern, southern, eastern, western, and central). The region, number, and size of contributing intensive care units (ICUs), overall donation rate, and transplanted rate (potential donor and those harvested, respectively) were also reviewed. ResultsBetween 2006 and 2012, a total of 512 cases were procured and analyzed from Saudi Arabia. From the central region, 393 were acquired, representing 76.7% of the total consented cases. These 393 cases came from 30 of 97 contributing ICUs (31%). The eastern region was ranked second, followed by the western region. The conversion rate for all regions followed a similar trend. ConclusionsThere is marked variation with regard to organ donation in different regions throughout Saudi Arabia, from 1.9% in the southern region to 76.7% in the central region. This finding is related to the presence of a Mobile Action Donor Team in the central region. The number of potential donors and the contributing ICUs were strong predictors of the number of actual donors. We suggest that having a mobile donor team in each region will increase the number of donors by at least 3 times within the next 3 to 5 years.

Management of the Potential Organ Donor in the ICU

There is a major gap between supply and demand of organs for transplantation. Organ donation after neurological death is increasing in the United States, and there is potential for this gap to be minimized by focused medical management of the potential donor in the ICU. Increasing organ yield requires early potential donor identification and early referral to organ procurement organizations, and understanding the medical issues specific to the brain-dead patient, such as hemodynamic instability requiring vasopressors, coagulopathy, diabetes insipidus, renal failure, and acute lung injury/acute respiratory distress syndrome. Intensive care with treatment focused on these issues has the potential to increase both the number of potential donors and the number of organs transplanted per donor.

Benefit of a single recruitment maneuver after an apnea test for the diagnosis of brain death

IntroductionMany potential lung transplants are lost because of hypoxemia during donor management. We hypothesized that the apnea test, necessary to confirm the diagnosis of brain death in potential lung donors, was involved in the decrease in the ratio of partial pressure of arterial O2 to fraction of inspired O2 (PaO2/FiO2) and that a single recruitment maneuver performed just after the apnea test can reverse this alteration.MethodsIn this case-control study, we examined the effectiveness of the recruitment maneuver with a comparison cohort of brain dead patients who did not receive the maneuver. Patients were matched one-to-one on the basis of initial PaO2/FiO2 and on the duration of mechanical ventilation before the apnea test. PaO2/FiO2 was measured before (T1), at the end (T2) and two hours after apnea test (T3).ResultsTwenty-seven patients were included in each group. The apnea test was associated with a significant decrease in PaO2/FiO2 from 284 ± 98 to 224 ± 104 mmHg (P < 0.001). The decrease in PaO2/FiO2 between T1 and T3 was significantly lower in the recruitment maneuver group than in the control group (-4 (-68-57) vs -61 (-110--18) mmHg, P = 0.02). The number of potential donors with PaO2/FiO2 > 300 mmHg decreased by 58% (95% CI: 28-85%) in the control group vs 0% (95% CI: 0-34%) in the recruitment maneuver group (P < 0.001).ConclusionsThe apnea test induced a decrease in PaO2/FiO2 in potential lung donors. A single recruitment maneuver performed immediately after the apnea test can reverse this alteration and may prevent the loss of potential lung donors.