Number Of Organ Donors Research Articles

Characteristics of postmortem organ donors in N.V. Sklifosovsky Research Institute for Emergency Medicine and the donor hospitals of FMBA of Russia (2008–2017)

Rationale.There have been only single studies conducted in the Russian Federation to characterize the posthumous donor population.Objective:Identifying the main characteristics of the donor pool in N.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department and in the State Research Center – A.I. Burnasyan Federal Medical Biophysical Center, FMBA, for the period from 2008–2017.Material and methods.The clinical records of 429 actual and effective posthumous donors were analyzed retrospectively. The following characteristics were studied: gender, age, permanent place of residence, cause of death, the duration of mechanical lung ventilation, type of donation, total number of harvested organs, and number of organs recovered per donor.Results.There were 281 male and 148 female donors. The increase in the mean age of donors from 37 to 48.5 years was noted. Cerebrovascular disease and traumatic brain injury became the main causes of death. Since 2012, the rate of cerebrovascular diseases as the cause of donor death has increased from 30% to 70%. Of 429 actual donors, the brain death was diagnosed in 366 (85.3%). Four hundred eight deceased became effective donors. A total of 1,247 donor organs (744 kidneys, 220 livers, 42 pancreas, 2 intestines, 180 hearts, 58 lungs, and 1 facial vascularized composite allograft) were obtained. The mean number of donor organs recovered per donor was 3.06.Conclusions.The results obtained can be used to develop unified protocols and results of posthumous donors and to assess the possible volume of transplant care. In the period 2008–2017 an increase in the average age of posthumous donors (from 38.1 to 48.7 years) due to the proportion of donors in the 18–29 age group (from 29 to 4%) and an increase in the proportion of donors in the age group over 60 (from 3 to 15%). From 2012 to 2017 (from 68 to 29%) due to an increase in the number of donors who died as a result of cerebrovascular diseases (from 30 to 71%). Among the posthumous donors delivered by ambulance teams directly to the intensive care units, 69% of the consciousness level was depressed to 5 and lower on the Glasgow coma scale.

Organ donation in Germany: Don't we want to? Can't we? Or are we not allowed?

Organ donation has reached anew low in Germany. The number of organ donations dropped from 1296 in 2010 to just 797organ donations in 2017. This represents adecrease of 916kidney transplants in the last six years. Thus, Germany occupies the penultimate position in the Eurotransplant association with the number of organ donors per million inhabitants. Only Luxembourg has fewer because of foreigners proportion of 47.5% and many of them lives in the neighboring european countries. However, Germany is not only far behind in the Eurotransplant association with the number of organ donors, but Germany is also at the bottom in comparison with other European countries with comparable political, ethical, religious and social structures-are we so different from our European neighbors? Germany is a country with one of the best health care systems in the world, but not in the field of organ donation. In an international comparison of organ donation, even emerging economies are in afar better position than Germany. Thus, we should ask ourselves if aflaw in the system is leading to this organ donor shortage. But what is the cause and how can we change it? There is no single and general solution to this problem. There are many different points to consider and tackle. These include educating the population, indicating of the will to donate organs or its rejection, training physicians to recognize potential organ donors, support for transplant officers, and much more. In particular, however, thought should be given to an opt-out (presumed consent) solution. It is time to question the system of organ donation in Germany and to discuss it objectively.

Predicting Expected Organ Donor Numbers in Australian Hospitals Outside of the Donate-Life Network Using the ANZICS Adult Patient Database.

BackgroundThe majority of organ donations in Australia occur in the DonateLife Network of hospitals, but limited monitoring at other sites may allow donation opportunities to be missed. Our aim was to estimate expected donor numbers using routinely collected data from the Australian and New Zealand Intensive Care Society Adult Patient Database and determine whether unrecognized potential donors might exist in non-DonateLife hospitals.MethodsAll deaths at 150 Australian intensive care units (ICUs) contributing to the Australian and New Zealand Intensive Care Society Adult Patient Database were analyzed between January 2010 and December 2015. Donor numbers were extracted from the Australian and New Zealand Organ Donor registry. A univariate linear regression model was developed to estimate expected donor numbers in DonateLife hospitals, then applied to non-DonateLife hospitals.ResultsOf 33 614 deaths at 71 DonateLife hospitals, 6835 (20%) met criteria as “ICU deaths potentially suitable to be donors,” and 1992 (6%) were actual donors. There was a consistent relationship between these groups (R2 = 0.626, P < 0.001) allowing the development of a prediction model which adequately estimated expected donors. Of 8077 deaths in 79 non-DonateLife ICUs, 452 (6%) met criteria as potentially suitable donors. Applying the prediction model developed in DonateLife hospitals, the estimated expected donors in non-DonateLife hospitals was 130. However, there were only 75 actual donors.ConclusionsIt is possible to estimate the expected number of Australian organ donors using routinely collected registry data. These findings suggest that there may be a small but significant pool of underutilized potential donors in non-DonateLife hospitals. This may provide an opportunity to increase donation rates.

Organ donation and nudging

For many, receiving an organ transplantation is the only viable way to prolong their lives and increase their quality of life. However, the demand for organs exceeds supply. Are there efficient and ethically acceptable ways of increasing the number of organ donors? Recently, nudging has been proposed as an attractive policy instrument. Nudging eschews coercing people. It affects instead the choice architecture within which people make their choices. Still, autonomy concerns arise. Accordingly, we have to make a difficult trade-off between augmenting people’s welfare, on the one hand, and respecting their autonomy on the other. An opt-out system in which people count as donors unless they state otherwise is, however, likely to increase donations considerably, and to do so at acceptable costs in terms of infringements on autonomy.

P098: Solid organ donation from the emergency department - a systematic review

Introduction: There is a significant gap between the number of organ donors and people awaiting an organ transplant; therefore it is essential that all potential donors are identified. Given the nature of Emergency Medicine it is a potential source of organ donors. The purpose of this study is to determine what percent of successful donors come from the Emergency Department (ED) and whether there are any missed potential donors. Methods: Electronic searches of EMBASE, MEDLINE, and CINAHL were performed July 7, 2017 using PRISMA guidelines. Primary literature in human adults were included if they described identification of patients in the ED who went on to become successful solid organ donors, or described missed potential donors in the ED. Data on the total population of actual or missed donors was required to allow calculation of a percentage. Studies describing non-solid organ donation, consent, ethics, survey of attitudes, teaching curricula, procurement techniques, donation outside the ED, and recipient factors were excluded. 2 authors independently screened articles for inclusion and discrepancies were resolved through consensus. Quality was assessed using STROBE for observational studies. Heterogeneity of patient populations precluded pooling of the data to conduct a meta-analysis. Results: 1058 articles were identified, 17 duplicates were removed, 800 articles were excluded based on title and abstract, and 217 full text articles were excluded, yielding 24 articles for the systematic review. For neurologic determination of death (NDD), ED patients comprised 4 44% of successful donors. ED death reviews revealed 0 84% of patients dying in the ED are missed as potential donors and hospital-wide death reviews revealed 13 80.9% of missed donors die in the ED. For donation after cardiac death (DCD), 4 20% of successful donors came from the ED and studies investigating potential donors suggest 2 36% of patients dying the in the ED could be potential DCD donors. The most common population of successful DCD organ donors was in traumatic cardiopulmonary arrest (TCPA), with 3.6 8.9% of TCPA patients presenting to the ED becoming successful donors. Conclusion: Patients dying in the Emergency Department are a significant source of both successful organ donors and missed potential donors. Emergency physicians should be familiar with their local organ donation protocol to ensure potential organ donors are not missed.

A Qualitative Analysis of South African Health Professionals' Discussion on Distrust and Unwillingness to Refer Organ Donors.

South Africa is faced with very low deceased organ donor numbers. Often, sociocultural practices, which are thought to be fundamentally opposed to deceased organ donation, are hailed as the cause. However, other factors such as context, social perceptions, and clinical environment may play a role. The aim of this article is to present research that explored communication in organ transplant and identified barriers to organ donation decisions in a province of South Africa. Qualitative methods were used. Thirty semistructured interviews with transplant professionals and 2 focus groups with transplant coordinators took place across 6 health institutions in Gauteng Province. Barriers that may prevent transplant professionals from referring potential donors were identified: The wider public and transplant professionals may be suspicious of biomedicine and have a perception that people could be killed for their organs. Organ donation was sometimes framed as "murder," "killing," or a "bunch of vultures." Doctors may be unwilling to refer brain-dead patients, as this was seen as failing in one's professional duty to cure the patient. The role of sociocultural practices was inconclusive, with the sample divided based on the extent of their influence. Low donor numbers may be a manifestation of barriers to referral in the clinical setting. These barriers interplay in a context of suspicion and are framed by a clinical transplant discourse that is sometimes loaded with negative connotation. Sociocultural practices are influential, but they may not be the overriding cause of low donor numbers.

Changing demographics of heart donors: The impact of donor drug intoxication on posttransplant survival.

Recent reports have shown an increase in the number of organ donors from drug intoxication. The impact of donor drug use on survival after cardiac transplant remains unclear. The aim of our study was to illustrate changes in donor death mechanisms and assess the impact on posttransplant survival. We queried United Network of Organ Sharing thoracic transplant and deceased donor databases to identify patients undergoing heart transplantation between 2005 and 2015. We evaluated annual trends in donor death mechanisms. Recipients were propensity matched (drug-intoxicated-non-drug-intoxicated=1:2) and posttransplant survival was compared using Kaplan-Meier curves. In total, 19384 donor hearts were used for transplant during the period (donor age 31.6±11.8years, 72% male). Use of drug-intoxicated donors increased from 2% (2005) to 13% (2015) and decreased from blunt injury (40%-30%) and intracranial hemorrhage (29%-25%). After propensity matching, posttransplant survival of drug-intoxicated donor hearts was 90%, 82%, and 76% at 1, 3, and 5years, which was similar to non-drug-intoxicated. Heart transplants using drug-intoxicated donors have significantly increased; however, they have not adversely affected posttransplant survival. Hearts from drug-intoxicated donors should be carefully evaluated and considered for transplant.

Hepatitis C transmission from seropositive, nonviremic donors to non-hepatitis C liver transplant recipients.

In this prospective cohort of non-HCV liver recipients receiving grafts from HCV antibody-positive/NAT-negative donors, the incidence of HCV transmission was 16%, with the highest risk conferred by donors who died of drug overdose; given the availability of safe and highly effective antiviral therapies, use of such organs could be considered to expand the donor pool. (Hepatology 2018;67:1673-1682).

Similar Outcomes of Kidney Transplantations Using Organs From Donors After Cardiac Death and Donors After Brain Death

BackgroundTo increase the number of cadaveric kidney transplants in Japan, it is necessary to proactively use organs from all donors. Since the revision of the Organ Transplant Law, the number of organ donors after cardiac death (DCD) has decreased but the number of organ donors after brain death (DBD) has increased; however, the number of donor organs and awareness of cadaveric transplantation have increased. MethodsAt our institution, 28 patients underwent cadaveric kidney transplantation from January 2001 to December 2016. These patients were classified into 2 groups according to DBD or DCD. Furthermore, 10 patients received transplants from expanded criteria donors (ECD) and 18 received them from standard criteria donors (SCD). ResultsKidney graft survival and engraftment were observed for all patients. There were no significant differences in renal function at 6 months for DBD and DCD transplant recipients. Renal function at 1, 3, and 5 years and serum creatinine levels were better for the ECD group. Renal function at 5 years after transplantation was significantly better for the SCD group than for the ECD group; however, there was no difference in delayed graft function between the SCD and ECD groups. Comparisons of the 3 groups showed good renal function for transplants from DBDs, but there was no significant difference in survival rates. ConclusionsResults were good for all patients. There were no significant differences in outcomes of our patients who received transplants from ECD or SCD.

Organ donation among ethnic minorities: how UK primary care can help promote it.

There continues to be a significant paucity of Asian organ donors despite numerous public education campaigns in the UK.1 The prevalence of type 2 diabetes, a major cause of renal failure, is up to six times greater among South Asians, especially within the Indian, Pakistani, and Bangladeshi communities as compared with the white population.2,3 However, the lower organ donation rates among this group result in a disproportionate number of Asian patients waiting longer for transplants.4 Promoting organ donation in this group represents one of the major challenges facing the transplant community and, despite a number of initiatives introduced in the UK, there has been little success. The role of GPs in influencing the South Asian community in the UK to improve organ donation is potentially significant. Here we reflect on our work (a PhD thesis by Agimol Pradeep — not published as yet), which sought to explore the impact of education interventions in increasing the number of organ donors …

Success Factors for Social Systems to Increase the Number of Organ Donations—From the Perspectives of Mechanisms and Organizational Behaviors

Deceased organ donation is much less prominent in Japan than it is in Western and other Asian countries. Because a shortage of organ donation is a serious social issue in Japan, various solutions to the issue have been considered. Although it was believed that the most critical factor in the organ shortage was the absence of a well-established social system, no prior studies attempted to analyze the issue from the perspective of the mechanisms and organizational behaviors. To identify common success factors of increasing organ donation, we conducted a qualitative survey in 5 countries promoting organ donations on a national level and increasing the number of organ donations. We found several important common factors: 1) to change from an explicit consent system to a presumed consent system with establishment of an appropriate in-hospital system, 2) to increase the level of job satisfaction of healthcare professionals and help them generating better results, 3) to demonstrate managements’ leadership for all staff to realize the importance of organ donations, 4) to establish an environment where medical professionals engaged in organ donations can appreciate autonomous working styles, the recognition of the importance of the work. It is suggested that these successful factors are introduced into Japan with long-, mid-term strategy to enhance organ donation.

Difficult Situation of Pancreas Transplantation in the Setting of Scarce Organ Donation

BackgroundCurrently, pancreas transplantation has been a promising strategy to restore long-term normoglycemia as well as to improve life quality for patients with insulin-dependent diabetes mellitus (DM). However, the discrepancy between the number of organs needed and the number donated for transplantation is always enormous. Under a setting of scarce organ donations, we examined our limited experience of pancreas transplantation. MethodsA retrospective review of pancreas transplantations was performed with the use of data from the Taiwan Organ Registry and Sharing Center and the Ministry of Health and Welfare. Pancreas transplantations in the Organ Transplantation Institute of Chang Gung Memorial Hospital also were reviewed. ResultsAt present, there are 5 medical centers approved for pancreas transplantation in Taiwan. Overall, a total of 156 pancreas transplantations were performed from 2005 to the end of 2016; only 9 of them were performed in the Organ Transplantation Institute of Chang Gung Memorial Hospital. Although the number of organ donations is rising, pancreas transplantation numbers remain low. More than 20 pancreas transplantations were performed in 2016, yet there remained a total of 111 patients registered on the wait list for pancreas transplantation at the end of this study. Thus the gap between organ donation and transplantation is still vast. ConclusionsWith continuing improvements in Taiwanese health policies and public education regarding organ transplantation, organ donation rates have risen steadily in recent years. Moreover, quality control and continuing evolution in organ transplantation is crucial to ameliorate the difficult situation of pancreas transplantation and other solid organ transplantation in the context of low levels of donation.

The Implications of the Shift Toward Donation After Circulatory Death in Australia.

BackgroundIn recent years, an increasing number of donor livers are being declined for transplantation in Australia. The aim of this study was to evaluate the impact of donation after cardiac death and other factors associated with organ quality on liver utilization rates in Australia.MethodsData on organ donors who donated at least 1 organ between 2005 and 2014 were obtained from the Australia and New Zealand organ donation registry. Temporal changes in donor characteristics were assessed and a logistical regression analysis was performed to evaluate their association with liver nonuse.ResultsThe number of organ donors increased from 175 in 2005 to 344 in 2014, with overall 19% being donation after cardiac death donors (P < 0.001). The percentage of livers deemed unsuitable for transplantation increased from 24% in 2005 to 41% in 2014 (P < 0.001). Donation after cardiac death was identified as the most important risk factor for nonuse with an odds ratio of 25.88 (95% confidence interval, 18.84-35.56), P < 0.001) followed by donor age, obesity, and diabetes.DiscussionThis study shows that livers donated after circulatory death are an underused resource in Australia. Better use of these currently available organs would be a highly cost-effective way of reducing waiting list mortality in liver transplantation.

Knowledge and Attitudes Toward Organ Donation in Health Care Undergraduate Students in Italy

IntroductionThe number of organ donors in Italy is increasing, but with still disappointing living donation activity and relatively frequent objection by potential deceased donors' relatives to organ recovery. Few studies have assessed health care students' knowledge and attitude on donation. MethodsWe administered a questionnaire to medical (MS) and nursing students (NS) at University of Modena and Reggio Emilia, Italy, and 749 students (406 MS and 343 NS) completed the questionnaire. ResultsAlthough 95% of students were in favor of donation, only 21.9% of NS and 24.9% of MS were registered as donors. One quarter of students reported family disagreement. MS appeared more confident with personnel involved in donation. Overall, 60% of students knew the term donation after brain death but only 40% were aware of the criteria used to define it. Barely 27.1% of NS and 15.3% of MS believed they had received sufficient information in lessons. Backward logistic regression demonstrated that students whose families agree with them and who knew the definition of donation after brain death were more likely to express the disposition of registering, and those who showed distrust in the declaration of brain death were half as likely to register as donors. DiscussionStudents expressed a lack of knowledge, controversial attitudes on donation, and strong need for education; increased awareness may help increase donation rates. The majority of educational institutions in Italy do not directly address training on organ donation and transplantation for health care students; an integrated curriculum favoring interpersonal discussion including practical aspects is urgently required.

Organ Donation in the Era of the Opioid Crisis

Organ Donation in the Era of the Opioid Crisis

Organ donation and transplantation: a binomial to be optimized

Over the years, organ transplantation has become a viable alternative for the treatment of end-stage diseases that, in the recent past, had high mortality rates. In this way, the number of people in the waiting list for organ transplantation has grown disproportionately to the number of organ donations, creating a gap that remains until now. In this article, we intend to discuss the issues that limit donation, especially family refusal, addressing the issue through the psychological bias of relatives at the time of death. In addition, we show updated numbers of donations and organ transplants in Brazil. Thus, it is concluded that an alternative to increase the donation rate is the instruction of the medical team that conducts the conversation with the relatives of the donor, as well as the awareness of the society, aiming at greater knowledge and understanding of the binomial donation and transplantation. Finally, it is discussed the project of the Academic League of Surgery and Transplantation of the FMRP- USP that, when promoting lectures in high schools, can induce discussions and solve possible doubts, in order to inform the young people about the reality of donations of organs and improve long-term donation rates.

A Semi-Centralized Retrieval Center Model

Introduction Québec has a population of 8 million dispersed over 1,677,000 km2 (mostly concentrated in 2 metropolitan areas). Over 70 hospitals serve as deceased donor identification centers. A semi-centralized system of dedicated retrieval hospitals was established, and 9 hospitals were designated as retrieval centers (including the transplant centers). Since 2013, a pilot project of dedicated intensive care, operating room and physician resources to facilitate the functioning of the system is underway at a 1 site. This report represents an analysis of 5 years of system performance since this reorganization. Methods Data on system performance were obtained from the ODO database from the years 2012-2016. Indicators reported include: number of donors, of retrieved and transplanted organs, the average number of organs transplanted per donor, adjusted for donor age and extended criteria. Results Over a 5-year period, the annual number of organ donors increased by 43% (120 to 172). Of the 781 donors, 79.8 % (623) were retrieved in 4 high volume hospitals (≥20 donors/year), while 20.2% (158) were retrieved in 14 hospitals (≤19 donor/year). 3 hospitals achieved rates of ≥ 4 organs per donor. 1 low volume site (average of 6-9 donors/year) achieved a mean of 3.94 organs per donor. During this time, family refusal of consent decreased by 30%. An increasing number of organ retrievals are happening at low volume sites (≤5 donors/year, from 2 to 8). This semi-centralized organ retrieval model presents several advantages: the development of local expertise in donor maintenance and retrieval; support for teaching and training; commitment of the donation and transplant centers; sustained engagement of local teams (ICU, ER, OR, etc.); the development of a local culture of organ donation; and the ability to count on centers of excellence with regional/supraregional mandates. Several challenges exist: maintaining the flexibility to retrieve outside of the designated hospitals when required (e.g. DCD, family refusal of transfer); developing the culture of organ donation outside of the designated retrieval hospitals. Conclusion In the Québec system, this semi-centralized model has led to improvement in several metrics, including increased numbers of donors and numbers of organs retrieved per donor, while recognizing and supporting the contributions of lower volume centers. An additional benefit is the system-wide development of the culture of organ donation.

Potential Number of Organ Donors After Euthanasia in Belgium

Organ donation after euthanasia involves patients whose request to undergo euthanasia has been granted and who voluntarily want to donate their organs after death. It requires patients to undergo euthanasia in the hospital, and organ donation is performed after circulatory death. The practice is controversial and currently only allowed in Belgium and the Netherlands. Even in these countries, it is rarely performed; as of August 2016, 43 patients undergoing euthanasia had donated organs.1 Organ donation after euthanasia has been described in a practical manual, which addresses the medical, ethical, and legal aspects of performing euthanasia and donation after circulatory death.2

Does EMS Performance Lead to a Reduced Number of Organ Donors?

Does EMS Performance Lead to a Reduced Number of Organ Donors?

First clinical experience in 14 patients treated with ADVOS: a study on feasibility, safety and efficacy of a new type of albumin dialysis

BackgroundLiver failure (LF) is associated with prolonged hospital stay, increased cost and substantial mortality. Due to the limited number of donor organs, extracorporeal liver support is suggested as an appealing concept to “bridge to transplant” or to avoid transplant in case of recovery. ADVanced Organ Support (ADVOS) is a new type of albumin dialysis, that provides rapid regeneration of toxin-binding albumin by two purification circuits altering the binding capacities of albumin by biochemical (changing of pH) and physical (changing of temperature) modulation of the dialysate.It was the aim of this study to evaluate feasibility, efficacy and safety of ADVOS in the first 14 patients ever treated with this procedure.MethodsPatients included suffered from acute on chronic LF (n = 9) or “secondary” LF (n = 5) which resulted from non-hepatic diseases such as sepsis. The primary endpoint was the change of serum bilirubin, creatinine and serum BUN levels before and after the first treatment with ADVOS. The Wilcoxon Signed Rank test for paired samples was used to analyze the data.ResultsA total of 239 treatments (1 up to 101 per patient) were performed in 14 patients (6 female, 8 male). Mean age 54 ± 13; MELD-score 34 ± 7; CLIF-SOFA 15 ± 3. Serum bilirubin levels were significantly decreased by 32% during the first session (26.0 ± 15.4 vs. 17.7 ± 10.5 mg/dl; p = 0.001). Similarly, serum creatinine (2.2 ± 0.8 vs. 1.6 ± 0.7 mg/dl; p = 0.005) and serum BUN (49.4 ± 23.3 vs. 31.1 ± 19.7 mg/dl; p = 0.003), were significantly lowered by 27% and 37%, respectively. None of the treatment sessions had to be interrupted due to side effects related to the procedure.ConclusionADVOS efficiently eliminates water- and protein-bound toxins in humans with LF. ADVOS is feasible in patients with advanced LF which is emphasized by a total number of more than 100 treatment sessions in one single patient.