Number Of Potential Organ Donors Research Articles

Evaluación y mantenimiento del donante cardíaco

Heart transplantation is currently the best treatment option to improve hope and quality of life in patients with terminal heart failure that is refractory to conventional treatment. The scarcity of donors remains a difficult problem and is the main factor limiting the number of transplants that can be performed. Given the current situation of stagnation and disparity between the number of potential organ donors, actual donors, and patients requiring transplants, we need effective strategies to reduce the differences between supply and demand and to ensure the best possible prognosis in organ recipients. These strategies should aim to ensure optimal donor selection. Likewise, it is essential to increase the number of potential donors by widening the criteria for donation and to improve our ability to take advantage of suboptimal donors. Moreover, we need to achieve acceptable physiological maintenance of donated organs. All these actions, together with the standardization of future treatments like hormone replacement therapy and genomic evaluation, will undoubtedly lead to an increase in the rate of transplants in the short and mid term, because the option of heart transplantation continues to have only slight repercussions in the high prevalence of terminal heart failure in our environment.

Procurement of organs in Sergipe and factors associated to conversion of potential donors

proCurement of orGans in serGipe and faCtors assoCiated to ConVersion of potential donors (aBSTRaCT)*. DiSSERTaTioN. aRaCaJu, 2009.EMILIA CERVINO NOGUEIRA**Background: A disproportion exists between the number of patients in wait list for transplant and the organ procure-ment, that it can be related to possible flaws in the poten-tial donor’s identification. Purpose: To estimate the number of potential organ do-nors in Sergipe; to characterize the potential donors; to de-termine the frequency of donation and to know the factors associated to the no donation.Methods: Quantitative, descriptive and retrospective study using data collected from the medical records of patients up to 65 years old dead for traumatic brain injury, cerebrovascu-lar stroke and primary brain tumor in the years 2005 to 2007 in three hospitals of Aracaju. Results: Of 766 medical records analyzed, 257 had sugges-tive registration of brain death, being 148 with the Term of Declaration filled out. Eighty five percent of the potential donors were at the Public Hospital. The median age was 33 years; prevailing the male (71.6%), the victims of traumatic brain injury (59.5%), and that in Urgency Unit (35.8%) and In-tensive Therapy Unit (34.5%). Half of them presented signs of brain death in the first two days of hospitalization. Sixteen (10.8%) potential donors completed all the exams of the pro-tocol of brain death and 12 (8.1%) became effective donors, being the absence of the diagnosis of brain death the princi-pal cause of no donation. The time between the first registra-tion and the removal of the organs was inferior at 40 hours in 50% of the donors.Conclusion: The number of potential organ donors in Ser-gipe has been underestimated due to flaws in the diagnosis and in the notification, resulting in a low donation index. The rates of family refuse and irreversible cardiac arrest suggest the need of educational actions driven to the health profes-sionals and the society in general. Key words: brain death, organ procurement, organ donors, organ transplantation, medical records.

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".

How large is the organ donor potential in Germany? Results of an analysis of data collected on deceased with primary and secondary brain damage in intensive care unit from 2002 to 2005

The number of potential organ donors depends on various factors, among which the number of deceased with primary or secondary brain damage is the most decisive. In the north-east donor region of Germany with 7.69 million inhabitants, 2019 cases of deceased with primary or secondary brain damage were reported by 136 intensive care units during 2002-2005. In a study, 64% of these deceased were identified as potential donors. This represents 40.7 potential donors per million inhabitants. It can be concluded that in the other donor regions of Germany a comparable number of potential donors exists, yet not all possible donors are being detected and referred. The conversion rate (percentage of potential donors who become effective donors) in the years 2002-2005 was 47%. The main reason for the conversion rate being so low was the large number of relatives who declined an organ donation (73%). More than 90% of the relatives in the north-east region did not know the deceased's will in the acute situation. From our point of view the high refusal rate can be decreased mainly by two measures: improvement of the family approach and integrating the topic of organ donation into schools' curricula.

More than nation and knowledge: Cultural micro-diversity and organ donation in Switzerland

Objective While recent studies of organ donation have recognized cultural factors, most analyses in developed countries have focused on awareness as the critical constraint. The present paper examines this assumption and assesses the number of potential organ donors as well as their knowledge and attitudes regarding organ donation. Methods We conducted a telephone survey of 1509 adults using a stratified random sample of the main three language groups (German, French, and Italian) in Switzerland with oversampling of the Italian language group to compensate for its relatively small size. Because our analyses are performed separately on each language group, the oversampling does not distort our findings. Results The three language groups display substantial differences with respect to patterns of knowledge, motives, and concerns underlying their willingness to donate organs—differences that persist even in the context of strong national identity, relatively homogeneous cultural background, and the public good nature of organ donation. Conclusion The results demonstrate a need to consider and address cultural factors and barriers when designing organ donation campaigns. Practice implications Centrally designed organ donation campaigns are not likely to be effective and efficient. Message strategies should rather be tailored to different (micro-) cultural groups.

Brain death diagnoses and evaluation of the number of potential organ donors in Québec hospitals

Faced with our inability to respond to the growing number of Quebec patients waiting for organ transplants, we sought to determine the number of potential organ donors (OD) in acute care hospitals. A retrospective chart review of all acute care, in-hospital deaths in Quebec in the year 2000 was undertaken. Hospital record librarians provided statistics and completed questionnaires on each chart after applying exclusion and inclusion criteria. There were 24,702 acute care in-hospital deaths reported by 83 hospitals participating in the study on a voluntary basis. Analyzing 2,067 files meeting inclusion criteria, we identified 348 potential OD (1.4% of deaths). In hospitals not providing tertiary adult trauma care, the potential donor rate was 0.99% of all deaths. There were 4.5 times more potential donors in tertiary care adult trauma centers. Brain death was formally diagnosed in 268/348 patients, and organ donation discussed as an option with 230/268 families. Consent for donation was given in 70% of cases, although not all these patients proved to be suitable after evaluation. There were 125 actual donors in Quebec in the year 2000 (18 per million population). The gap between used and potential donors can be explained by several factors including failure to approach families for organ donation, family refusal, incomplete neurological assessment of patients, and medical unsuitability of some consented donors. There is room for improvement in the identification of potential donors and in the presentation of organ donation as an end of life option to families.

Prospective Audit of Deaths at a Teaching Hospital

We undertook a prospective audit of all the deaths in the trauma unit, the emergency unit, and the intensive care units to estimate the number of potential organ donors in the hospital and identify the reasons for nonreferral of potential donors. The transplant coordinators undertook daily visits to the above units and documented all of the deaths occurring in the previous 24 hours. The patient records were reviewed, and the medical and nursing staff interviewed to determine the precise circumstances surrounding the death. Seven of the 14 deaths in the neurosurgical intensive care unit were related to the head injury, and five were certified brain dead and referred as an organ donor. Fifty-eight of 83 deaths in the trauma unit were head injury related; however, only eight were eventually certified brain dead and referred. In the emergency unit, only one of 76 patients who died was certified brain dead and referred as an organ donor. Although many of the deaths in the above units are related to a head injury or cerebral event, very few are actually certified brain dead. All potential donors who were certified brain dead were referred to the transplant team.

PROSPECTIVE AUDIT OF DEATHS AT A TEACHING HOSPITAL

We undertook a prospective audit of all the deaths in the trauma unit, the emergency unit, and the intensive care units to estimate the number of potential organ donors in the hospital and identify the reasons for nonreferral of potential donors. The transplant coordinators undertook daily visits to the above units and documented all of the deaths occurring in the previous 24 hours. The patient records were reviewed, and the medical and nursing staff interviewed to determine the precise circumstances surrounding the death. Seven of the 14 deaths in the neurosurgical intensive care unit were related to the head injury, and five were certified brain dead and referred as an organ donor. Fifty-eight of 83 deaths in the trauma unit were head injury related; however, only eight were eventually certified brain dead and referred. In the emergency unit, only one of 76 patients who died was certified brain dead and referred as an organ donor. Although many of the deaths in the above units are related to a head injury or cerebral event, very few are actually certified brain dead. All potential donors who were certified brain dead were referred to the transplant team.

Estimating the Number of Potential Organ Donors in the United States

Estimating the Number of Potential Organ Donors in the United States

Brain stem death and organ donation—11 years on

We studied previously patterns of organ donation in a teaching hospital. Eleven years later we repeated the study to investigate how patterns had changed. We also wanted to see whether non-heart beating donation was being practised in our intensive care units. All deaths were prospectively audited to identify potential heart beating and non-heart beating organ donors. The actual organ donors and reasons for not donating were identified. Overall, there was a significant reduction in the number of potential organ donors in the 11-yr period. This was accompanied by an increase in refusal rates by relatives from 10 to 29%, and a decrease in refusal rates by the coroner from 28 to 11%. In this hospital the number of potential and actual organ donors has fallen in 11 yr. This is a combination of decreasing numbers of patients becoming brain dead and increased relative refusal rate. It has only been partially offset by a more liberal attitude of the coroner and non-heart beating donors.

Estimating the number of potential organ donors in the United States.

As the need for transplantable organs increases, waiting lists of patients become longer. We studied the size and composition of the national pool of brain-dead organ donors during a three-year period and, on the basis of these data, considered ways to increase the rate of donation. We reviewed hospital medical records of deaths occurring in the intensive care unit from 1997 through 1999 in the service areas of 36 organ-procurement organizations to identify brain-dead potential organ donors. We examined data on characteristics of the potential donors, the processes of referral to organ-procurement organizations and of requesting donations, and the hospitals. We identified a total of 18,524 brain-dead potential organ donors during the study period. The predicted annual number of brain-dead potential organ donors is between 10,500 and 13,800. The overall consent rate (the number of families agreeing to donate divided by the number of families asked to donate) for 1997 through 1999 was 54 percent, and the overall conversion rate (the number of actual donors divided by the number of potential donors) was 42 percent. Hospitals with 150 or more beds were more likely than smaller hospitals to have potential donors and actual donors (P<0.001); 19 percent of hospitals accounted for 80 percent of all potential donors. Calculations of the number of donors per million persons in the general population did not correlate well with the performance of organ-procurement organizations as measured by the conversion rate. Lack of consent to a request for donation was the primary cause of the gap between the number of potential donors and the number of actual donors. Since potential and actual donors are highly concentrated in larger hospitals, resources invested to improve the process of obtaining consent in larger hospitals should maximize the rate of organ recovery. The performance of organ-procurement organizations can be assessed objectively through the comparison of the number of actual donors with the number of potential donors in the given service area.

Location of in-house organ procurement organization staff in level I trauma centers increases conversion of potential donors to actual donors.

Of 5810 acute care hospitals in the United States, only 3.9% (231) are Level 1 Trauma Centers (L1TCs). L1TCs have a significant number of potential organ donors (PODs). Placement of Organ Procurement Organization (OPO) staff, In House Coordinators (IHCs), directly within the L1TC to increase the number of families who consent to donate and to provide system management for the trauma center's donation program, was evaluated. Four OPO staff, IHCs, were placed in offices inside two L1TCs in Houston, Texas. The IHCs were responsible for development of a donation system, donor surveillance, management, and most importantly, family support. Calendar year 2000 data on conversion of PODs to actual donors were compared between the L1TCs with IHCs (IHC-L1TC) (n=2) and trauma centers without IHCs (n=4) within the OPO's service area. IHC-L1TCs converted 44% more of the PODs to actual donors. Furthermore, the IHC-L1TCs were compared with 85 L1TCs (37% of U.S. L1TCs) without IHCs. IHC-L1TCs had a 28% greater donor consent rate and a 48% greater conversion rate of PODs to actual donors than the national L1TCs. L1TC status is the America College of Surgeons' highest level of verification for trauma care. To be certified as a L1TC, hospitals must meet strict criteria in both services and patient care. The donation process is often profoundly affected by the burden of demands made on the resources of these institutions and from divergent responsibilities between specialty services within the facility. Dedicated IHCs (OPO staff) are needed to provide early family intervention and to orchestrate the donation process to maximize organ recovery.

How local transplant coordinators might increase the number of potential donors: our experience in lower silesia

RENAL transplantation is the treatment of choice for end-stage diseases of the kidney, but it is limited by a shortage of organ donors. In the early 1990s, organ donations were in a state of crisis, and not only in Poland. National organ-sharing organizations and health services try to resolve this problem in various ways. Fortunately, some organizations, such as the Spanish one, have found a proper solution by developing a system of local transplant coordinators. Now we can speak of the “Spanish model” as one that is worth imitating. The first cadaveric renal transplantation in Poland occurred in 1965 in Wroclaw, the capital of Lower Silesia, and a regular kidney transplant program was begun in Wroclaw in 1983. It was limited by a small number of potential organ donors (PODs) reported to our Transplant Center (TC). Therefore, from 1983 to 1992 only 197 potential organ donors (mean 19.7/year) were reported to our TC from the Lower Silesia region, and only 87 harvesting procedures (mean 8.7/year) were performed during that time. A dramatic decrease in organ retrievals occurred between 1993 and 1996 (in 1993, 31 PODs were reported and 11 were harvested; in 1994, 24 PODs were reported and 5 were harvested; in 1995, 22 PODs were reported and 10 were retrieved; and in 1996, 23 were reported and 6 were retrieved), resulting in a small number of transplanted kidneys and therefore in a growing waiting list. Thus, in such situations we have tried to apply a modified “Spanish model” of organ donation in our region. Since the end of 1996, transplant coordinators have been situated in 31 local hospitals. Twice a year they have a special training session with psychologists in management of donors’ families. This has resulted in an increase of reported PODs in 1997 and 1998. In 1997, 40 PODs were reported to our TC from Lower Silesia and 28 organ retrievals were done. By the end of 1998, 43 PODs were reported to our TC and 28 harvesting procedures were performed (Fig 1). The multiorgan harvesting rate was 67.8% in 1997 and 57.1% in 1998. During that period we sent six livers to Germany and two livers to Austria. To increase the number of detected PODs, we developed a Donor Action program in two local hospitals in 1999.

Brain death and organ donation in Germany: analysis of procurement in a neurosurgical unit and review of press reports.

A prospective study was undertaken to determine the number of potential organ donors in a neurosurgical intensive care unit and to record the actual number of organ donations. The reasons for refusal of organ donations were analysed with respect to the controversial public discussion of the brain death concept and the transplantation law in Germany. From 1994 to 1997, the number of cases of brain death, and the number of cases in which relatives consented or refused to organ donation as well as the number of actual organ explantations was recorded. Over the same period, press reports of 5 German language newspapers were analysed with regard to the authors' position on brain death and transplantation law, their qualification, intention, and mode of presentation. Annually, about 70 deaths occurred on the department's intensive care unit of which almost 30% of the patients were determined to have suffered brain death without any obvious contraindications against organ donation. The refusal rate of relatives rose from 56% up to 78%, and the rate of organ donors thus decreased from 5% in 1994 to 4% presently in the department. About 100 reports were published each year in the analysed newspapers, of which about 90% voiced approval of organ transplantation. During the review period, the depiction became more objective (57% in 1994 to 82% in 1997) and the suspicious attitude toward the technique of brain death diagnosis declined. Whereas 50% of the articles rejected the brain death concept in 1994, this figure decreased to 39% in 1997 and conversely the concept of consent rose from 33% in 1994 to 56% in 1997. In Germany, the relatives refusal rate in organ donation is continuously high, presumable due to a depressing 39% of press reports rejecting the brain death concept, and resulting in a very low number of organ donations. There is hope that the transplantation law which has finally passed German parliament in 1997, confirming the brain death concept as well as the legal principle of prior consent by the donor or consent by the relatives will eventually result in an increase of organ donation especially when supported by an educational campaign which is embodied in the transplantation law.

Availability and limits of intermediate cardiovascular technology.

Cardiovascular technology has been applied in the treatment of various diseases in Indonesia since its development in the late 1970s. Medical experts who have completed their training abroad began to implement their knowledge in cardiovascular service while a multifactorial limitation occurred in the country. The major limiting factor is still the country's infrastructure, which should support the treatment measures in modern cardiovascular technology. Other limiting factors concern nonmedical subjects, e.g., ethics, beliefs, religion, and the financial and basic organization of organ transplantation. Organ replacement started with artificial kidney/hemodialysis in the late 1970s, and was successfully carried out together with the further commencement of living related donor renal transplantation. Development of cardiac surgery with extracorporeal circulation gave rise to the stimulation of animal trials of cardiac transplant, pancreas transplant, and other subsets of organ transplantation. With the increasing modus of modernization, major hospitals in 3 large cities have shown increasing needs for organ transplant, and, parallel to that, the increasing number of potential organ donors, the cause of death dominated by brain death resulting from traffic accidents. The emerging need for liver and cardiopulmonary transplants has also been observed during the last 5 years, despite the improvement of general health care. However, similar to many Asian countries, because of religious and cultural considerations, it may be difficult to find donors whose relatives are willing to donate organs from their deceased relatives, especially for heart, lung, liver, and pancreas transplants. Alternative methods for artificial organs should receive more emphasis. We present the activities which have been established so far and how we should cope with the question of how present technology brings answers to the needs of organ transplant and artificial organs. Some innovative steps that we have made will be outlined.