Number Of Organ Donors Research Articles

Temporal trends in organ donation among cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation

AimsThis study explores the evolution of organ donation from patients treated with extracorporeal-cardiopulmonary-resuscitation (ECPR) for refractory out-of-hospital-cardiac-arrest (OHCA) and evaluates the public health benefits of a mature ECPR program. MethodsThis retrospective, single-center study included OHCA patients (2016–2023) who had mostly initial shockable rhythms and were treated with ECPR. Organ donation rates from non-survivors through these years were analyzed. The public health benefit of ECPR was determined by the ratio of the sum of survivors with Cerebral Performance Category 1–2 and non-survivors who donated at least 1 solid organ, to the total ECPR patients. Temporal trends were analyzed yearly using linear regression. ResultsOut of 419 ECPR patients presenting with refractory OHCA over the study period, 116 survived neurologically intact (27.7%). Among non-survivors (n = 303), families of 41 (13.5%) consented to organ donation (median age 51 years, 75.6% male) and organs from 38 patients were harvested, leading to 74 organ transplants to 73 recipients. The transplanted organs included 43 kidneys (58.1%), 27 livers (36.5%), 3 lungs (4%), and 1 heart (1.4%), averaging 2.4 ± 0.9 accepted organs/donor. The number of organ donors and successful transplants correlated positively with the years since the ECPR program’s initiation (ptrend = 0.009, ptrend = 0.01). Overall, 189 patients (116 survivors, 73 organ recipients) benefited from ECPR, achieving organ-failure-free survival. The cumulative public health benefit of ECPR, considering the 116 survivors and 38 donors was 36.8%. ConclusionThe public health benefits of an established ECPR program extend beyond individual ECPR patient survival, forming a new, previously under-recognized source of transplant donors.

Impact of routine extracorporeal cardiopulmonary resuscitation service on the availability of donor organs

In refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation may increase the survival chance. However, in cases of unsuccessful treatment, extracorporeal cardiopulmonary resuscitation may additionally provide an important source of organ donors. Therefore, we hypothesized that implementing extracorporeal cardiopulmonary resuscitation service into a high-volume cardiac arrest center's routine would increases organ donors' availability. MethodsOur retrospective observational study analyzed out-of-hospital cardiac arrest patients admitted to the General University Hospital in Prague between 2007 and 2020.The following groups were analyzed regarding the recruitment of donors: before and after extracorporeal cardiopulmonary resuscitation implementation. We assessed the number of donors referred, the number of organs harvested, and the organ's survival. ResultsWe analyzed the results of 1158 patients after out-of-hospital cardiac arrest. In the conventional approach period, 11 donors were referred, of which seven were accepted. During the extracorporeal cardiopulmonary resuscitation period, the number of donors increased to 80, of whom 42 were accepted. The number of donated organs was 18 and 119 in the respective periods, corresponding to 3.6 vs. 13.2 (p = 0.033) harvested organs per year. One-year survival of transplanted organs was 94.4% vs. 99.2%, and five-year survival was 94.4% vs. 95.9% in relevant periods. Conventional and extracorporeal cardiopulmonary resuscitation did not affect donor organ survival. ConclusionEstablishing a high-volume cardiac arrest centre providing an extracorporeal cardiopulmonary resuscitation service may increase not only the number of prolonged cardiac arrest survivors but also the number of organ donors. In addition, the performances of donated organs were high and comparable between both treatment methods.

Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant.

With an ongoing demand for transplantable organs, optimization of donor management protocols, specifically in trauma populations, is important for obtaining a high yield of viable organs per patient. Endocrine management of brain-dead potential organ donors (BPODs) is controversial, leading to heterogeneous clinical management approaches. Previous studies have shown that when levothyroxine was combined with other treatments, including steroids, vasopressin, and insulin, BPODs had better organ recovery and survival outcomes were increased for transplant recipients. To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients. A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed. Exclusion criteria included patients who were not solid organ donors, patients who were not declared brain dead (donation after circulatory death), and patients who did not receive steroids in their hospital course. Levothyroxine and steroid administration, the number of organs donated, the types of organs donated, and demographic information were recorded. Univariate analyses were performed with P < 0.05 considered to be statistically significant. A total of 88 patients met inclusion criteria, 69 (78%) of whom received levothyroxine and steroids (ST/LT group) vs 19 (22%) receiving steroids without levothyroxine (ST group). No differences were observed between the groups for gender, race, pertinent injury factors, age, or other hormone therapies used (P > 0.05). In the ST/LT group, 68.1% (n = 47) donated a high yield (3-5) of organ types per donor compared to 42.1% (n = 8) in the ST group (P = 0.038). There was no difference in the total number of organ types donated between the groups (P = 0.068). This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population. Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria. This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.

Vývoj indikací k transplantaci jater

Summary: Liver transplantation has been considered the standard treatment method for patients with life-threatening liver disease for more than 40 years. In the initial period, it was mainly indicated for patients with a clearly unfavorable prognosis. Longer survival of recipients was thanks to the improvement in surgical techniques, intensive care, and immunosuppression leading to the targeting of patients with the perspective of long-term survival, i.e. shift away from oncological indications to patients with cirrhosis. The growing disparity between the need for transplantation and the number of donor organs has brought about the necessity of a stricter selection, which, in addition to purely medical considerations, also includes ethical issues of equal access to transplantation and the need to achieve the greatest possible transplant benefit for the widest possible range of recipients while utilizing limited resources. Changes in the epidemiology of liver diseases as well as advances in their treatment affected the development of indications. There has been a significant decrease in the representation of previously dominant viral hepatitis C. Worldwide, the number of patients transplanted for non-alcoholic steatohepatitis and alcoholic liver cirrhosis is increasing. Great development has been noted in the last decade in the field of liver cancer, especially for the indications of hepatocellular carcinoma, which is currently the most common indication in many programs. For about a decade, liver transplantation has been performed standardly for hilar cholangiocellular carcinoma and experimentally for unresectable liver metastases of colorectal cancer. These indications are closely related to the dynamics of the local waiting list. Key words: liver transplantation – indications – liver cirrhosis – viral hepatitis – hepatocellular carcinoma – MASLD – acute alcoholic hepatitis

A First Experience of Distant Lung Preservation for Transplantation in the Russian Federation.

Lung transplant is an effective method of treating patients with end-stage respiratory diseases, but problems such as the imbalance between the number of donor organs and the number ofrecipients needing organs still play a leading role. From a transplant point of view, a multiorgan donor is considered of greatest efficiency, so that all organs that can potentially be used should be transplanted. The combination of the vast geographical territory of Russia, the shortage of actual donors, and the relatively small number of transplant centers has led to the need to transport donor lungs by air over long distances. There were already precedents in the world for remote preservation of donor organs for transplant. In this study, we have described the unique experience of remote evaluation of donor lungs with their subsequent air transportation and transplantation, which is the first such description in Russia to our knowledge. The donor lungs for lung transplant were brought from medical institutions of the Samara region to Moscow. During remote evaluation, all information was transmitted to the transplant center by providing access to the automated information system "Organ Donation," which was used at that time by the service and contained all information about a potential donor in real time. The 2 transplant candidates had end-stage cystic fibrosis and severe respiratory failure; both patients underwent organ implantation from donors located outside their regions. In conditions of shortages of donor organs, long-distance transportation is a reasonable, feasible, and safe procedure.

The circulatory death that saves lives-Intensive care nurses' conceptions of participating during 'donation after circulatory death': A phenomenographic study.

To describe intensive care nurses' conceptions of participating during the donation after circulatory death (DCD) process in intensive care units in Sweden. A qualitative design with a phenomenographic approach. In total, 12 semi-structured interviews were conducted in April 2022 with intensive care nurses from three hospitals. Data were analysed using a phenomenographic approach. Conceptions of participating during the DCD process varied. Four main themes emerged: DCD as a system; Intensive care nurses' role in the situation; Life to death to life; The essence of DCD. Variations emerged regarding what the informants talked about and how they talked about the what. Variations were based on informants' perspective of their role in relation to the structure and the team, and their conceptions of care for patients and their relatives. The findings illustrated success factors and challenges. Knowledge, experience, distinct structure, and relationship with relatives, among other factors, were described as success factors, while a lack of experience, difficulty in prognosing death, and organisational obstacles emerged as challenges. Furthermore, the findings showed that intensive care nurses play an important role in optimising the outcome of the DCD process. Their work related to DCD was conceived as being meaningful to fulfil more peoples' wishes to donate organs. People on the waiting list for organ transplantation are dying due to a shortage of organs. The implementation of DCD, as a complement to Donation after Brain Death (DBD), contributed to an increase in the number of organ donors, and intensive care nurses play an important role during the DCD process. Previous research manifests the complexity concerning their role. There is a lack of nursing research regarding intensive care nurses' conceptions of what it means to participate in the DCD process, which emphasises the significance of this study. This study is reported using consolidated criteria for reporting qualitative research (SRQR). No patient or public contribution.

Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka

AbstractLiver diseases lead to 1.3 million deaths per year around the world, the majority of which are secondary to cirrhosis. In the management of liver diseases in chronic and acute conditions, liver transplant (LT) plays a major role in improving the survival and quality of life of patients. LT programmes require the technical capabilities in performing the pre‐transplant evaluation, transplant surgery and post‐transplant care supported by adequate infrastructure and a set of trained teams. Globally, there were 28,000 deceased donor LTs, and 14,000 living donor LTs were performed in 2021. In the South Asia region, India, Pakistan and Sri Lanka conducted 2998 LTs in 2021. Many countries report sociocultural, religious and legislative barriers to acquiring adequate donor livers. We describe the challenges in LT programmes in low‐ and middle‐income countries and experiences from Sri Lanka. Sri Lanka carried out its first LT in 2010, and the service is provided free of charge in the state health sector. In Sri Lanka, the common indications for LT in adults are non‐alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and alcoholic liver disease. In children, the indications are biliary atresia, hepatocellular carcinoma and Wilson disease. The common challenges include a lack of an adequate number of doctors and post‐transplant team members, a low number of organ donors and a long waiting list, all of which can be disadvantageous for transplant programmes. To continue providing LT services, there is a need to adopt multimodal strategies in the areas of providing additional skills training to the operating team and promoting organ donation culture in the background of supportive organ donation legislation. With the adoption of the national strategic plan for organ, tissue and cell transplantation, the country hopes to strengthen its capacity of providing transplant services to its people.

Organ Donation: Behaviour and Beliefs in Sweden.

Barely one-fifth of people in Sweden have expressed their will regarding organ donation in the national Swedish Donor Registry, and the number of organ donations in Sweden remains low. The aim of this study was to map behaviour and beliefs regarding organ donation in Sweden. In a descriptive cross-sectional survey following a quantitative approach and 600 questionnaires were issued to randomly selected individuals across Sweden. Of them, 206 (36.3%) were completed. Data were analysed using descriptive statistics and presented as frequencies and percentages. Analytical statistical testing involved Pearson chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis tests. The results indicate a discrepancy between positive opinion about organ donation in Sweden and the number of people enrolled in the Swedish Donation Registry. The most common argument for not wanting to donate organs was the notion of being too old to. Although self-rated knowledge about organ donation was admittedly low, so was interest in interest in learning more about it. Younger patients more frequently wanted information than older patients did. Not wanting to donate organs due to age and/or illness may indicate a misconception. Making one's will known does not involve assessing one's health status or age but solely concerns the wish to do so. The findings thus raise an important question: How can people's interest in learning more about organ donation be induced in ethical ways?

The kidney distribution system for transplantation in Chile explained according to Game Theory: How theoretical generosity is transformed into real selfishness

Context: There is a huge mismatch between demand and supply of organs for transplantation, particularly kidneys. Their allocation system in Chile delivers one kidney to the procuring institution and the second to another national institution; policy designed seeking to stimulate procurement in transplant institutions. Objectives: Evaluate whether this policy has been effective for increasing nationwide organ donation and procurement rates in procuring centers, whether their behavior is aligned with the local / pool kidney allocation system, and whether the policy has contributed to increasing equity in access to kidney transplantation. Methods: We obtained the origin of all organ donors between 2010-2020 from public records, separating them by private or public institutions, and matched those organs with the corresponding information from the centers that implanted them, and used descriptive statistics, t-student tests, and linear regressions over time for analysis. We performed an economic analysis of the costs of procuring a kidney for transplantation, for which we gathered the public static prices, and a sample of the 5 largest private transplantation facilities’ prices. Results: We found no significant increase in the total number of organ donors in the country during the studied period, and the mild increase observed was due to the addition of new public centers to the system. We observed that private institutions are increasing their participation in the transplant market and they do so at the expense of public institutions and without increasing their contribution of organs to the system, because of the high cost of procuring compared to the cost of transferring a kidney. Conclusions: This behavior can be framed within the Game Theory, specifically the Tragedy of the Commons, describing that the players maximize their benefit at the expense of the rest without considering the subsequent consequences, which leads to an imbalance between demand and supply of organs for transplantation that worsens over time and lengthens waiting lists.

PULM4: Silicone-Based Hollow Fiber Membrane Lungs For Long-Term Extracorporeal Respiratory Supports: Initial Results From A Pilot Study Using A Goat Model

Background: There has been an increasing demand of organs for lung transplant to save those who suffer from end-stage lung disease. However, the number of organ donations have never matched that of candidate recipients, leading to a high mortality rate on the waiting period for transplant. One potential approach to decrease the wait-list mortality is to develop an artificial gas-exchange device that can support lung function until the time of transplantation. We’ve started to develop a gas-exchange system that consists of silicone-based membrane lungs with methacryloyloxyethyl phosphorylcholine (MPC) polymer coating and tubing system for a longer-term use. Objective: The purpose of this study was to evaluate the long-term durability, oxygenation, and pressure loss of newly developed artificial lungs using a large animal model. Materials and methods: The surface area of the membrane lung is approximately 2 m2. Central ECMO from the pulmonary artery to the left atrium was introduced to a healthy female goat via left thoracotomy under general anesthesia (N=3). Unfractionated heparin infusion was utilized for anticoagulation (target activating clotting time: 150-200 sec). After recovery from the surgery, blood gas and flow pressure before and after the artificial lung with flow rates of 1, 2, and 3 L/min were tested weekly. Daily physiological data, regular blood biochemistry and coagulation tests, and histopathological findings after autopsy were also evaluated. Thrombus adhesion to the silicone membrane was evaluated using an electron microscopy after the experiments. Results: Durations for testing the artificial lungs were 53, 58, and 100 days. The experiments were terminated due to an accidental tubing event, a sudden cardiac complication, and massive renal hemorrhage. Averages of oxygen transfer rates (ml/min) and oxygen pressure gradients (mmHg) at each flow rate were 63.3 and 466.5 at 1 L/min, 118.3 and 291.3 at 2 L/min, and 152.7 and 138.2 at 3 L/min. Averages of flow pressures through the artificial lungs at each flow rate were 21.7 mmHg at 1 L/min, 44.7 at 2 L/min, and 66.9 at 3 L/min. No significant increase of pressure loss or decrease of oxygenation was observed throughout the experimental periods. Thrombus at the inlet of the membrane was mainly observed, but those inside and near the outlet were minor, indicating the long-term antithrombotic property of the polymer coating. Electron microscopical examinations revealed minimal thrombus formation on the hollow fiber membrane inside the lung. At autopsy, although micro-infarction and thrombus were observed in the heart and kidney, native lungs were well maintained without appreciable congestion. Conclusion: The newly developed MPC polymer-coated silicone-based lungs could be used stably for more than 50 days. Improving the oxygenation in higher blood flow rates with reduced pressure loss is our ongoing subject to work on.

Advances in Extracorporeal Support Technologies in Critically Ill Children.

The field of pediatric heart failure is evolving, and the patient population is growing as survival after complex congenital heart surgeries is improving. Mechanical circulatory support and extracorporeal respiratory support in critically ill children has progressed to a mainstay rescue modality in pediatric intensive care medicine. The need for mechanical circulatory support is growing, since the number of organ donors does not meet the necessity. This article aims to review the current state of available mechanical circulatory and respiratory support systems in acute care pediatrics, with an emphasis on the literature discussing the challenges associated with these complex support modalities.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals.

Lung Transplantation in India: a Brief Review, Landmarks, Indian Scenario, and our Experience.

Lung transplantation is gaining widespread acceptance as the preferred therapeutic option for selected cases of end-stage lung disease in India. The indications of lung transplantation are increasing, with better post-operative survival, including the COVID affected lung, if we choose our patients well. The national acceptance of expanded criteria in lung donation, streamlining of the process of lung transplantation by governmental, and non-governmental organizations and significant increase in the number of organ donations in India have strengthened the lung transplantation program within the country. Through this article, we describe a brief history, the process, and our experience of lung transplantation since we started our program in 2017 until date.

Retrospective Analysis of Patients Diagnosed with Brain Death in Our Hospital in the Last 15 Years.

Retrospective analysis of cases diagnosed with brain death in our hospital in the last 15 years. The files and computer records of the cases diagnosed with brain death in the intensive care units of our hospital between January 2008 and January 2023 were evaluated retrospectively. The demographic data of the cases, the primary disease leading to brain death, the complementary tests used in the diagnosis of brain death, the day on which brain death was diagnosed in the intensive care unit, and the donor status were examined. A total of 228 cases diagnosed as brain death were detected. Seven patients with missing data were excluded from the study. 61.99% of the cases were male, 38.01% were female, 14.02% were under 18 years old, 68.34% were between 18 and 65 years old, 17.64% were over 65 years old. Brain death was diagnosed in 69.69% of the patients admitted to the intensive care unit in the first 7 days, 22.17% in 7-14 days, and 8.14% after 14 days. The primary disease causing brain death was found to be 47% hemorrhagic cerebral injury, 21% traumatic hemorrhagic injury, 18% ischemic cerebral injury, and 14% hypoxic cerebral injury. No ancillary testing was used in 38% of the cases. Carotid doppler ultrasound was used in 36%, computed tomography angiography was used in 22%, and transcranialdoppler was used in 4%. Families agreed to be organ transplant donors in 28.95% of the cases. 71.05% family members refused to be organ transplant donors. The number of organ donations and the diagnosis of brain death has decreased rapidly with the covid-19 pandemic. In order to increase organ donation, we think that the necessary education should be given at an early age to increase organ donation awareness and social awareness.

COVID-19 in Renal Transplant Patients – A Narrative Review

Abstract The World Health Organisation declared the novel coronavirus known as severe acute respiratory syndrome coronavirus 2 a pandemic in March 2020. This virus has led to the deaths of more than 6 million people worldwide. Besides causing pneumonia, COVID-19 is linked to multiple organ dysfunction, including the kidneys, especially in individuals whose immune systems are already compromised. Consequently, individuals who are currently on a waiting list for a kidney transplant or who have recently received a kidney transplant are at a significantly increased risk for developing acute kidney injury and are severely impacted by the COVID-19 infection. The pandemic has negatively affected the transplantation process and led to a decrease in the number of organ donations as well as the volume of renal transplants. This review summarises the outcomes of COVID-19 infection in renal transplant patients, its pathophysiology, the challenges faced by the transplant community, and the management of immunosuppression.

Design and fabrication of a bioreactor for the proliferation of mesenchymal stem cells

Currently, the number of organ donors is low and there are different methods to deal with this situation, including cell cultures, decellularization and bioreactors, which play an important role in helping the required processes to be carried out in a faster and more optimized way. The objective of this work is to make the cell proliferation process efficient using a bioreactor as an alternative, in which flow simulations can be made to previously analyze how it works. The radial flow hydraulic circuit was designed and simulated in SOLIDWORKS solving Navier-Stokes equations to verify that we have a non-turbulent laminar flow and simulate cell detachment without damaging the cell matrices. The design was printed with additive printing techniques, using photosensitive resin. Bioreactors also play a part in tissue engineering, as they allow for changes that can be monitored and reproduced in particular environmental factors. This article shows the successful design of a bioreactor to proliferate mesenchymal stem cells printed and subjected to simulations, whose results lead to the conclusion that there is non-turbulent laminar flow in the behavior of the system without subjecting the cells to a possible stress that causes damage.

Organ bioprinting: progress, challenges and outlook.

Bioprinting, as a groundbreaking technology, enables the fabrication of biomimetic tissues and organs with highly complex structures, multiple cell types, mechanical heterogeneity, and diverse functional gradients. With the growing demand for organ transplantation and the limited number of organ donors, bioprinting holds great promise for addressing the organ shortage by manufacturing completely functional organs. While the bioprinting of complete organs remains a distant goal, there has been considerable progress in the development of bioprinted transplantable tissues and organs for regenerative medicine. This review article recapitulates the current achievements of organ 3D bioprinting, primarily encompassing five important organs in the human body (i.e., the heart, kidneys, liver, pancreas, and lungs). Challenges from cellular techniques, biomanufacturing technologies, and organ maturation techniques are also deliberated for the broad application of organ bioprinting. In addition, the integration of bioprinting with other cutting-edge technologies including machine learning, organoids, and microfluidics is envisioned, which strives to offer the reader the prospect of bioprinting in constructing functional organs.

Differential donor management of pediatric vs adult organ donors and potential impact on pediatric lung transplantation

Despite clinical progress over time, a shortage of suitable donor organs continues to limit solid organ transplantation around the world. Lungs are the organs most likely to be assessed as unsuitable during donor management among all transplantable organs. Although the number of lung transplants performed in children is limited, death on the wait list remains a barrier to transplant success for many potential transplant candidates. Optimizing organ donor management can yield additional organs for transplant candidates. We accessed the Donor Management Goal (DMG) Registry to evaluate the efficiency and efficacy of donor management in the procurement of lungs for transplantation. Further, we stratified donors by age and compared pediatric age cohorts to adult cohorts with respect to attainment of donor management target goals and successful pathway to transplantation. We utilized recipient data from the Organ Procurement Transplantation Network (OPTN) to put this data into context. The DMG bundle consists of nine physiologic parameters chosen as end-points guiding donor management for potential organ donors. The number of parameters fulfilled has been regarded as an indication of efficacy of donor management. We noted a markedly lower number of organ donors in the pediatric age group compared to adults. On the other hand, the number of donors greatly exceeds the number of infants, children and adolescents who undergo lung transplantation. Organs transplanted per donor peaks in the adolescent age group. At initial donor referral, DMG bundle attainment is lower in all age groups and improves during donor management. With respect to oxygenation, there is less overall improvement in younger donors compared to older donors during donor management. When donors who yield lungs for transplantation are compared to those whose lungs were not transplanted, oxygenation improved more substantially during donor management. Furthermore, improved oxygenation correlated with the total number of organs transplanted per donor. In the face of continued wait list mortality on the pediatric lung transplant wait list, the number of young donors may not be a limiting factor. We believe that this dataset provides evidence that management of young pediatric donors is not as consistent or efficient as the management of older donors, potentially limiting the number of life-saving organs for pediatric lung transplant candidates. Across all ages, optimizing donor lung management may increase the potential to transplant multiple other organs.

S1363 Utilization of Palliative Care Service in Patients With Liver Cirrhosis in an Underserved Area, 2015-2019

Introduction: Palliative care is a service with a very wide vision and potent tool. Palliative care applies early in the course of terminal illness in conjunction with therapies intended to prolong life; it is not limited to end-of-life care. Patients with liver cirrhosis only have one healing treatment, a liver transplant, but the limitation in the number of donor organs and eligibility criteria reduces the number of transplants. The MELD-Na score provides validated mortality prognostic for the next 90 days in patients with liver cirrhosis. This study aimed to determine if palliative care services are underutilized and could be more evident in uninsured or undocumented patients. Methods: Objective: Describe the use of Palliative Care service in patients with liver cirrhosis stratified by MELD Na score. Data retrieved from Valley Baptist Medical Center in Harlingen Cerner included all patients 18 years or older with diagnoses of fibrosis or liver cirrhosis on admission or made during the hospital stay from January 2015 to December 2019. The total number of patients was 150. Results: Distribution by sex, male 83 (55.33%), female 67 (44.67%). The mean age was 63.07 years. Predominant etiology of cirrhosis was alcoholism 64(42.67%), NASH 11 (7.33%), Viral 5 (3.33%), Other 15 (10%), and unknown 55 (36.67%). With legal status 140 patients (93.33%), and without 10 patients (6.67%). Patients with insurance 131 (87.33%) and without 19 (12.67%). Patients underwent palliative care services 16 (10.67%). A total of 50 (33.33%) patients underwent EGD. A total of 31 (20.6%) patients underwent paracentesis. (Figure) Conclusion: Our result showed that the number of patients with palliative care consultations was under the expected percentage. In an external study, of 59,687 hospitalized adults with terminal decompensated cirrhosis, 29.1% received palliative care. In multiple studies, palliative care was associated with a lower procedure burden after adjusting for other factors; it was associated with a cost reduction of $8892. In our study, the cost was not evaluated, but it is expected that the patient with palliative care consults will reduce hospitalization costs. Most of the patients had insurance and legal status. The dispersion of the MELD-Na score was similar in patients with and without palliative care consultations. Our patients had a high number of EGD and paracentesis for ascites. (Table) Table 1. - Palliative care/Hospice consult Yes % No % Total Female 11 68.75 56 41.79 67 Male 5 31.25 78 58.21 83 Total 16 10.67 134 89.33 150 Figure 1.: MELD-Na score in patients divided by palliative care consult.

P11.34: Tissue Donation Indicators in Latin American and European Countries. A Way to Measure the Efficiency of the Organizational System

Introduction: The demand for corneas is increasing in the world. Organizational aspects of the health system and procurement are decisive to improve the number of corneal donors. There are no corneal donation indicators at the international level that allow results to be compared other than the total number and donation rate. Objectives: Analyze the corneal donation situation worldwide, defining indicators related to the deceased in the country. Compare the donation indicators defined in countries of both continents: Latin America and Europe. Material and methods: The following data in Latin America and Europe were analyzed: number of corneal donors/ pmp (Dc/ pmp), number of organ donors/ pmp (DO/ pmp), corneal donors in PCR/ pmp, and total number of deceased from the country. The relationship between the total number of corneal donors in each country and the number of deaths in 2019, grouped by continent, was analyzed. Indicator: Cornea donors/Deceased in the country. The relationship between the number of corneal donors in PCR and the total number of corneal donors of all countries grouped by continent was also analyzed. Indicator: Corneal donors in PCR/Total corneal donors. The data was obtained from the Newsletter Transplant 2019 and the number of deceased at https://ourworldindata.org/. Results: In Latin America, the average number of Cornea donors/deceases per country is 0.51%, with Brazil being the most efficient with 2.1%. In Europe, the average number of Cornea donors/deceased is 0.48%, where Italy, France and the Netherlands stand out with 1%, 1.4% and 1.3%. In the Latin American countries analyzed, the average number of Cornea donors in PCR/ total cornea donors is 69% and in European countries it is 59%. Conclusions: We believe that the indicator Corneal donors/deceased in a country or hospital is a strong indicator that can be used to define the effectiveness of corneal procurement work and compare results in different countries. Analyzing the percentage of donors of corneas in PCR, we can evaluate the work as a country in the procurement of this tissue in PCR to improve the organizational level in the detection of donors of PCR.