Organ Procurement Program Research Articles

Organ Donation and Transplantation: Contributions of Professionals on Interprofessional Work in Programs

Objective: This study aimed to identify the contributions for improvement in the interprofessional working relationship pointed out by professionals involved in organ and tissue procurement and transplantation programs. Method: exploratory study with a quanti-qualitative approach conducted over a period of 21 months, with the participation of health professionals invited to complete an online questionnaire on the Google form platform. After collection, the quantitative data were organized and analyzed descriptively, and the qualitative data were categorized and submitted to content analysis. Results: 130 health professionals participated in the study, 84% were female, of which 64% said they were white, between 41-59 years old, and 31% had worked for more than 15 years in the programs. The categories identified were: working conditions; appreciation of non-medical professionals; psychological support to professionals and funding for training of professionals pointed out as improvements in the work relationship in the programs. Conclusion: the study identified that working conditions and greater valorization of the interprofessional team allied to offering psychological support to professionals are necessary and important strategies, and may bring impacts on the satisfaction of professionals, on mental health, in addition to improvements in work processes, impacting transplantation rates.

The Medical Student Transplant Organ Procurement Program

The Medical Student Transplant Organ Procurement Program

P8.018: Human Leukocyte Antigen Tissue Typing in a Guatemalan Transplant Center

Introduction: The Kidney Transplant Program at the Hospital General San Juan de Dios (HGSJDD) began in 1992, to date more than 700 transplants have been performed, of these only 15% were from cadaveric sources. The Histocompatibility and Immunogenetics Laboratory, was funded in 2012 as part of the Nephrology and Transplant Department, back in that year tissue typing was performed by Complement Dependent Cytotoxicity (CDC), spanning the last decade the laboratory implemented other tissue typing techniques and anti-HLA antibody analysis, which represented an important advance for the transplant program and the country of Guatemala, since it is the only public laboratory that performs molecular biology and Luminex techniques. Herein we present the preliminary findings of HLA-A, B, DRβ1 and DQβ1 tissue typing using an SSOP-PCR based technique in 127 patients at the HGSJDD Kidney Transplant Program. Methods: 127 patients from the HGSJDD Kidney Transplant Program were recruited from January 2018 to December 2020, unrelated to each other, without a known diagnosis of diseases mediated by the major histocompatibility complex, and 100% self-identified as mestizos, all agreed to participate; the research was approved by the ethics and research committee of the HGSJDD and was conducted in accordance with the Helsinki Declaration principles. HLA genotyping was performed using a PCR-SSOP Luminex® method. HLA-A~B~DRβ1~DQβ1 allelic and haplotypic frequencies of 127 subjects were calculated using the Arlequin® v. 3.5 software. Results: We found 194 haplotypes among the studied population, 16 of which presented a frequency greater than 1%, those 16 represent 39.7% of the total haplotype diversity. All found haplotypes had been previously described in Latin American populations, 13 of the haplotypes found had been reported in Native American populations. This is the first time that an HLA genes allele and haplotypic frequencies study has been carried out in Guatemalan mixed population. The most frequently found haplotype was HLA-A*24~B*35~DRβ1*04~DQβ1*03:02 (9.06%). The allelic and haplotypic frequencies were stored on: www.allelefrequencies.net database and can be accessed under the identification number (AFND-ID: 3743). Conclusions: The results of this study constitute a valuable tool for transplantologists in Guatemala, since knowing the immunogenetics of the Guatemalan population allows them to assess better options for patients in cadaveric source programs, in order to find a compatible donor, and to evaluate in advance the immunosuppression strategies that can benefit them, according to the immunological risk that they present. It also allows to establish the initial steps for the medium-term implementation of paired donor and/or domino program, in order to exchange organs between hospitals, that will to start organ procurement programs. There are no previous works, describing HLA genes tissue typing in mestizo Guatemalan population.

Transplant surgery departmental leaders do not represent workforce demographics especially among women and underrepresented minorities — A retrospective analysis

IntroductionThe diversity among surgical directors for liver, kidney, and pancreas transplant departments has not been previously evaluated. We aim to quantify the sex and racial demographics of transplant department leaders and assess the impact on patient outcomes. MethodsDemographics were collected for 116 liver, 192 kidney, and 113 pancreas transplant directors using Organ Procurement and Transplantation Network (OPTN) directory and program websites. Scientific Registry of Transplant Recipients (SRTR) 5-tier program outcomes rankings were obtained for each program and matched to leader demographics. A retrospective analysis of transplant recipients from 2010 to 2019 was performed using the United Network for Organ Sharing (UNOS) database. Results91.5% of transplant surgical directors were male. 55% of departments had a Non-Hispanic White leader. Asian, Hispanic and Black transplant chiefs were at the helm of 23.3%, 9%, and 5% of divisions respectively. Multivariate cox regression analysis did not identify any differences in patient outcomes by transplant director demographics. ConclusionThere is a paucity of female and URM leaders in transplant surgery. Initiatives to promote research, mentorship, and career advancement opportunities for women and URM are necessary to address the current leadership disparity.

Access to kidney transplantation in Mexico, 2007\u20132019: a call to end disparities in transplant care

BackgroundAccess to kidney transplantation is limited to more than half of the Mexican population.A fragmented health system, gender, and sociocultural factors are barriers to transplant care. We analyzed kidney transplantation in Mexico and describe how public policies and sociocultural factors result in these inequities.MethodsKidney transplant data between 2007 to 2019 were obtained from the National Transplant Center database. Transplant rates and time spent on the waiting list, by age, gender, health system, and insurance status, were estimated.ResultsDuring the study period 34,931 transplants were performed. Recipients median age was 29 (IQR 22–42) years, 62.4% were males, and 73.9% were insured. 72.7% transplants were from living-donors. Annual transplant rates increased from 18.9 per million population (pmp) to 23.3 pmp. However, the transplant rate among the uninsured population remained low, at 9.3 transplants pmp. In 2019, 15,890 patients were in the waiting list; 60.6% were males and 88% were insured. Waiting time to transplant was 1.55 (IQR 0.56–3.14) years and it was shorter for patients listed in the Ministry of Health and private facilities, where wait lists are smaller, and for males. Deceased-organ donation rates increased modestly from 2.5 pmp to 3.9 pmp.ConclusionsIn conclusion, access to kidney transplantation in Mexico is unequal and restricted to patients with medical insurance. An inefficient organ procurement program results in low rates of deceased-donor kidneys. The implementation of a comprehensive kidney care program, recognizing kidney transplantation as the therapy of choice for renal failure, offers an opportunity to correct these inequalities.

Cytochrome P450‐Derived Epoxy Lipids of N‐3 PUFAs Protect the Heart From Ischemia‐Reperfusion Injury by Regulating Mitochondrial Sirtuin 3

ObjectiveCytochrome P450 epoxygenases can metabolize dietary n‐3 polyunsaturated fatty acids (n‐3 PUFAs) to epoxy lipids, which have known cardioprotective effects; however, it remains unclear how this cardioprotection occurs. Our recent data demonstrate that cytochrome P450 epoxygenase‐derived metabolites of the n‐3 PUFA docosahexaenoic acid (DHA), 19,20‐epoxydocosapentaenoic acid (19,20‐EDP), exhibit protective effects toward cardiac mitochondria. Maintaining mitochondrial quality is essential to limit myocardial damage following ischemia‐reperfusion (IR) injury. The mitochondrial deacetylase sirtuin 3 (SIRT3) plays a pivotal role in the maintenance of mitochondrial function and cardiac energy metabolism. We hypothesize that the cardioprotective mechanism(s) of 19,20‐EDP against IR injury involve(s) stimulating mitochondrial SIRT3.MethodsLangendorff and isolated working heart perfusions were performed in male and female C57BL/6 mice to assess changes in cardiac function and energy metabolism in response to IR injury. Hearts were perfused with either vehicle, 19,20‐EDP (1 μM) and/or the SIRT3 inhibitor nicotinamide (30 μM) for a 20 min baseline perfusion, following which hearts were subjected to 30 min of global no flow ischemia and 40 min of reperfusion. Glucose and palmitate oxidation rates were measured to detect alterations in cardiac energy metabolism. Mitochondrial fractions were assessed for changes in SIRT3 activity and total lysine acetylation levels. Mitochondrial SIRT3 downstream targets were assessed in human ventricular tissues obtained from individuals with ischemic heart disease (IHD) included in the Human Explanted Heart Program and compared to non‐failing control hearts (NFC) collected from unused transplant donors through the Human Organ Procurement and Exchange Program at the University of Alberta. In addition, mitochondrial respiration was assessed in cardiac fibers isolated from the human tissues.ResultsHearts perfused with 19,20‐EDP demonstrated improved post‐ischemic functional recovery, glucose oxidation and cardiac efficiency compared to control groups. The cardioprotective effects were associated with enhanced mitochondrial SIRT3 activity and reduced global protein acetylation. We observed increased acetylation of the mitochondrial antioxidant superoxide dismutase 2 in tissues obtained from IHD human myocardium suggesting decreased antioxidant capacity. Treatment with 19,20‐EDP also markedly improved mitochondrial respiration in permeabilized human fibers obtained from IHD hearts. Importantly, the cardioprotective effects of 19,20‐EDP was abolished by the SIRT3 inhibitor nicotinamide.ConclusionWe demonstrate that 19,20‐EDP‐mediated cardioprotective mechanisms against IR injury involve preservation of mitochondrial SIRT3 activity, which results in improved cardiac efficiency.

Islet-immune interactions in type 1 diabetes: the nexus of beta cell destruction.

Recent studies in Type 1 Diabetes (T1D) support an emerging model of disease pathogenesis that involves intrinsic β-cell fragility combined with defects in both innate and adaptive immune cell regulation. This combination of defects induces systematic changes leading to organ-level atrophy and dysfunction of both the endocrine and exocrine portions of the pancreas, ultimately culminating in insulin deficiency and β-cell destruction. In this review, we discuss the animal model data and human tissue studies that have informed our current understanding of the cross-talk that occurs between β-cells, the resident stroma, and immune cells that potentiate T1D. Specifically, we will review the cellular and molecular signatures emerging from studies on tissues derived from organ procurement programs, focusing on in situ defects occurring within the T1D islet microenvironment, many of which are not yet detectable by standard peripheral blood biomarkers. In addition to improved access to organ donor tissues, various methodological advances, including immune receptor repertoire sequencing and single-cell molecular profiling, are poised to improve our understanding of antigen-specific autoimmunity during disease development. Collectively, the knowledge gains from these studies at the islet-immune interface are enhancing our understanding of T1D heterogeneity, likely to be an essential component for instructing future efforts to develop targeted interventions to restore immune tolerance and preserve β-cell mass and function.

Alterations in the Eicosanoid Profile and Mitochondrial Injury in Human Ventricular Tissue Following Myocardial Infarction

Study objectiveMyocardial infarction (MI) accounts for a significant proportion of death and disability in the ageing population. n‐6 PUFAs linoleic acid and arachidonic acid have come under investigation for their role in mediating a cardiac response following ischemic injury. CYP450 metabolism of these fatty acids results in formation of numerous metabolites, called eicosanoids, which can be further metabolised by the enzyme soluble epoxide hydrolase (sEH). These lipid mediators exhibit a wide range of cellular effects including alterations to mitochondria structure and function which may impact cardiac performance. This study investigated alterations to CYP‐derived eicosanoids and mitochondria in heart tissue obtained from individuals who experienced a previous MI.MethodsSamples were obtained from male and female individuals included in the Human Explanted Heart Program and correlated to non‐failing control hearts (NFC) collected from unused transplant donors through the Human Organ Procurement and Exchange Program at the University of Alberta. Ventricular tissues were harvested from patients who had previously experienced a LAD infarct (≥2yrs), as determined by echocardiography, ECG and coronary angiograms. Protein expression was determined by immunoblotting techniques. Mitochondrial enzymatic activities were assessed by spectrophotometric methods while mitochondrial ultrastructure and cristae density were assessed by electron microscopy. A metabolic profile in ventricular tissue was obtained by LCMS.ResultsMarked differences in both LA and AA metabolic profiles were revealed in post‐MI tissues. There were significant increases in cardiotoxic metabolites correlating with decreased cardiac function and injury. Interestingly, there was a significant increase in both sEH activity and expression in post‐MI tissues compared to NFC. Expression of mitochondrial proteins remained unchanged, however enzymatic function declined in post‐MI tissues compared to NFC correlating with marked disruption in mitochondrial ultrastructure.ConclusionsThese data provide the first evidence demonstrating a marked shift in eicosanoid metabolism in post‐MI hearts that correlates with mitochondrial structural disruption and overall decreased mitochondrial function.Support or Funding InformationSupport for this project was provided by the Canadian Institutes of Health Research.KL Jamieson is supported by funding from Alberta Innovates‐Health Solutions.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Organ Shortage: Can We Decrease the Demand?

The shortage of organs for transplant is a universal problem. The World Health Organization is urging every nation to seek self-sufficiency regarding their organ procurement program. Reaching self-sufficiency inevitably requires the provision of a well-developed deceased-donor organ procurement program. Most countries represented by the Middle East Society for Organ Transplantation still rely on living-donor organ donations. Some of these countries have been relatively successful in promoting deceased-donor donation as well. In our region, deceased-donor organs are recovered exclusively from patients who have been declared brain dead. However, with improvements in preventive and therapeutic interventions, the pool of potential brain dead donors is rapidly shrinking. This should, therefore, stimulate our interest in developing a program for recovering organs after cardiac death. However, increasing the pool of donors, even to optimal levels, may still not be enough to meet the growing demand. More resources must be invested in reducing the demand for organs. This is especially true in our region, where primary care programs aimed at slowing or containing disease progression that may lead to organ failure are lacking. This problem is compounded by limited access to such programs and, for that matter, limited access to even the most basic primary care. Continued efforts to increase the supply of donor organs must be pursued. At the same time, we must work to more effectively treat the diseases that could lead to end-stage renal disease and the increased demand for donor organs. A comprehensive approach to the problem of donor organ shortages in countries in the Middle East also must consider the relatively limited financial resources that are available.

Keys to successful organ procurement: An experience-based review of clinical practices at a high-performing health-care organization.

Organ procurement (OP) from donors after brain death and circulatory death represents the primary source of transplanted organs. Despite favorable laws and regulations, OP continues to face challenges for a number of reasons, including institutional, personal, and societal barriers. This focused review presents some of the key components of a successful OP program at a large, high-performing regional health network. This review focuses on effective team approaches, aggressive resuscitative strategies, optimal communication, family support, and community outreach efforts.

Transplantation in Africa - an overview.

Africa is underdeveloped in terms of treatment options for patients with end-stage renal failure. Economic growth and corresponding increases in health expenditures in the African region mean that we can confidently anticipate increased demand for organ transplantation within the region over the next few years. Renal failure in Africa occurs mainly due to glomerular nephropathies, hypertension, diabetes, and HIV. For the subset of the population that might be considered medically suitable for transplantation, demand for transplantation is tightly constrained by the availability of specialist physicians and surgeons, pathology facilities, capacity to achieve acceptable graft outcomes, cultural and religious attitudes towards organ donation, trust in the health system, and the extent to which patients are able to meet the costs of surgery and ongoing immunosuppression. There are currently several countries in Africa which are building up living-related-donor transplantation. Active living-donor transplantation already takes place in South Africa, Tunisia, and Sudan, but deceased donation is only available in South Africa. Whereas living-donor transplantation might be successfully driven by a motivated individual and a single institution, deceased-donor transplantation requires dialysis programs, tissue typing and crossmatching facilities, an organ procurement program, an on-call surgical team, capacity to fund this infrastructure, and an appropriate legislative framework. A significant and recurring barrier to transplantation in the African region is the high cost of transplantation and follow-up care, and, in particular, the cost of maintenance immunosuppression. A positive environment that could potentially change this scenario will have to include governmental funding, academic support to clinicians as well as a legislative framework, which is still needed in many African countries.

Implementation of China's new policies on organ procurement: an important but challenging step forward.

In the last decade, health authorities in China have made a series of policy announcements concerning organ procurement programs and changes in practice have been intermittently reported (1). The international community of transplant professionals has followed these reports closely, preoccupied with one fundamental issue: the procurement of organs from executed prisoners, a practice that for many years has provided the majority of organs transplanted in China. Sharif et al . describe this practice as “ethically indefensible” (2), an evaluation that reflects the position embraced by the international community for more than two decades (3-5). Sharif et al . express concern that whilst some transplant programs in China have ceased using organs from executed prisoners, others continue to do so, and that all organs procured from the deceased may be allocated through a collective pool as part of the new China Organ Transplant Response System, effectively “laundering” organs obtained from prisoners.

Development of a kidney transplantation program--inverted funnel approach.

The history of organ shortage has been approached differently by different countries. This review tries to discuss the inverted funnel approach of Iran. The whole history of transplants in the country can be divided in three phases of legally regulated living unrelated kidney donation, legislation of brain death donation and lastly how it has been implemented. In each phase, there have been attempts to clarify the role of each sector: the government, professionals, and the public. Based on more than 20 years of experience, it has been shown that kidney transplants from brain dead donors (BDDs) increased from 0.4 per million population (pmp) in 2000 to 2.9 pmp in 2005, 7.9 in 2010, and 15.1 pmp in 2013 and it could eventually change the rate from living source from 20.1 pmp, 24.5 pmp, 21.8 pmp, and 19.5 pmp in these years, respectively. It has been shown that the government began to take part when it was convinced that an organ procurement program from BDDs is not a luxury program but can lessen the economic burden on the health budget and be supported by legislations and budget allocation. Professionals took the responsibility not only to make decision makers and the public aware of the subject and adapt the national protocols to consider the general population concerns, but also to train as many medical teams as possible nationwide. Persistence and publishing the results can pave the way for the public to accept the program and take their own responsibilities to solve the problem of organ shortage by taking the opportunity to give life to others after the death of a loved one.

The incidence of potential missed organ donors in intensive care units and emergency rooms: a retrospective cohort

There is a shortage of organ donors in Canada. The number of potential organ donors that are not referred to organ procurement organizations in Canada is unknown. We conducted a retrospective cohort study of all deaths in ICUs and emergency rooms not referred to the Human Organ Procurement and Exchange Program in four hospitals between 1 January 2008 and 31 December 2010. The primary outcome was the number of normal and expanded criteria heart-beating donors and circulatory death (DCD) donors. Of 2,931 deaths, 64 patients were identified as having a high probability for progression to heart-beating donation (Glasgow Coma Score of 3 and three or more absent brainstem reflexes) and 130 patients were assessed for possible DCD donation. The number of potential abdominal and lung heart-beating donors ranged from 3.2 to 7.5 and 0.5 to 2.7 per million population. The number of potential DCD abdominal and lung donors ranged from 3.9 to 6.5 and 2.7 to 4.3 per million population. Potential heart-beating abdominal (p=0.04) and lung (p=0.06) donors increased after legislation mandating donation discussion. Non-pupillary brainstem reflexes were documented in fewer than 60% of records. Life-sustaining treatment was withdrawn in 19 of 46 (41.3%) cardiac arrest patients not requiring high doses of vasoactive drugs within 24h. The number of heart-beating or DCD organ donors represented by missed referrals may represent up to 7.5 donors per million population. Improved documentation of brainstem reflexes and encouraging referral of patients suffering cardiac arrest to ICU specialists may improve donor numbers.

Implementation of a National Organ Procurement Program: The Lebanese Model

Organ shortage is universal. It represents the main obstacle to organ transplantation since, despite all the scientific advances to date; the latter relies exclusively on human organs.In Lebanon, the National Organization for Organ and Tissue Donation and Transplantation-Lebanon (NOOTDT-Lb) has been working to promote organ donation by proposing a Lebanese model that comprises two complementary divisions for deceased and living donations. The deceased donation system: For the past three years NOOTDT-Lb has been implementing, with the financial help of the Spanish government through the “Agencia Espagnola de Cooperacion International para el Desarrollo” (AECID) and technical support of the “Donation and Transplant Institute - Barcelona” (DTI) a national program for organ procurement from deceased donors. Adapted from the universally successful Spanish model, this program depends on the active cooperation of the different players involved. It consists of: 1) Hospital organ procurement units with Hospital Organ Procurement Coordinators in committed hospitals, 2) Preset protocols that guide each step of the organ donation procedure; 3) a fair and transparent organ allocation system with an annual review by an allocation committee where NOOTDT-Lb and all the transplanting centers are represented; and 4) a registry for donation and transplantation. To back this system up, NOOTDT-Lb ensures continuing education programs for healthcare personnel that are intended to update their knowledge and stimulate their interest in promoting deceased donation. NOOTDT-Lb, with the help of the Donation and Transplantation Institute (DTI), also carries out regular audits of the committed hospitals. In addition, The Ministry of Health (MOH) has removed all financial disincentives to donation and is actively working to introduce the topic of organ donation into the hospital accreditation system. The living donation system:NOOTDT-Lb has tried to promote living donation as well by facilitating genetically related donation and attempting to regulate non-genetically related donation through national medical and ethical committees. A ministerial decree covering these regulations was issued in agreement with the Lebanese Order of Physicians and under the supervision of NOOTDT-Lb. In conclusion, the program is progressing slowly but steadily. Its implementation obviously requires more public awareness but after reviewing our 2010 and 2011 results it has become clear to us that full and active adherence of the healthcare professionals remains a prerequisite to a successful program.

Impact of outcomes monitoring on innovation and risk in liver transplantation

1. The reporting of liver transplant center outcomes is required by the final rule of the Department of Health and Human Services. The reported patient and graft survival outcomes are risk-adjusted for specific donor and recipient factors, and the observed survival is compared to the expected survival. Both the Centers for Medicare and Medicaid Services and the Organ Procurement and Transplantation Network flag programs for corrective action when the observed survival is significantly less than the expected survival. Both agencies can take action up to the closure of a center. In the last 5 years, the Organ Procurement and Transplantation Network has not taken an adverse action that required the closure of a liver transplant center because of outcomes. 2. Center survey data suggest that centers may try to select donors and recipients to minimize poor outcomes. This strategy may not be effective if centers stop accepting donors or recipients according to factors that are included in the risk adjustment model. For example, limiting recipients to those less than 65 years old may improve the observed outcomes, but the expected outcomes will also improve because a recipient 65 years or older is included in the model's risk adjustment. 3. For factors such as cardiovascular risk that are not included in the model, it may be reasonable to exclude patients in an attempt to improve the observed outcomes without affecting the expected outcomes. Other examples of these types of factors are smoking, nutritional status, and donor liver biopsy findings. 4. Currently, there is no exemption for patients undergoing experimental protocols. Down-staging for hepatocellular carcinoma, transplantation for human immunodeficiency virus-positive recipients, and the use of left lobe grafts with inflow modification are relatively recent areas of innovation in liver transplantation. Because innovation is frequently associated with a learning curve and, therefore, poor outcomes, the inclusion of patients in innovative protocols potentially could lead to centers being subjected to an adverse action by the Organ Procurement and Transplantation Network or the Centers for Medicare and Medicaid Services. Active consideration is being given to the exclusion of patients in innovative protocols from center-specific outcomes.

Impact of Preclinical Exposure to Organ Donation on Knowledge and Attitudes of Medical Students

Medical students receive little exposure to organ donation and procurement programs. To describe a student-run elective and its effect on participants' knowledge about and attitudes toward organ donation. Preclinical students interacted directly with donor families, organ recipients, and donation representatives; many participated in an organ procurement with the surgical team. Between 2005 and 2007, 13 students who participated in the elective and a procurement were compared with 72 students who took the elective but did not participate in a procurement and with 22 control students. Students who participated in a procurement wrote reflections about their experience. In 2010, 15 first-year students who participated in the elective and a procurement and 59 randomly selected control students completed a previously validated measure. Themes included awe, surgical procedures, learning opportunities, and brain death. Regardless of procurement participation, the elective participants from 2005 to 2007 reported higher 4-item knowledge scores (P<.001) than control students reported, but their 4-item attitude scores did not differ (P = .21). The 2010 students did not differ from control students in their number of correct responses to the 20 knowledge questions (P = .48) or their individual responses to each of the 14 attitude questions (all P>.05). Although elective participants reflected positively on their experiences and professed greater knowledge than control students via a researcher-made tool, these results were not sustained with a previously validated measure. These results point to the need for careful elective design and the need for more accurate measures to study the effectiveness of such interventions.

Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors

IntroductionTo counter the shortage of kidney grafts in France, a non heart beating donor (NHBD) program has recently been implemented. The aim of this study was to describe this pilot program for kidney retrieval from "uncontrolled" NHBD meaning those for whom attempts of resuscitation after a witnessed out-of-hospital cardiac arrest (CA) have failed (Maastricht 1 and 2), in a centre previously trained for retrieval from brain dead donors.MethodsA prospective, monocentric, descriptive study concerning NHBD referred to our institution from February 2007 to June 2008. The protocol includes medical transport of refractory CA under mechanical ventilation and external cardiac massage, kidney protection by insertion of an intraaortic double-balloon catheter (DBC) with perfusion of a hypothermic solution, kidney retrieval and kidney preservation in a hypothermic pulsatile perfusion machine.Results122 potential NHBD were referred to our institution after a mean resuscitation attempt of 35 minutes (20–95). Regarding the contraindications, 63 were finally accepted and 56 had the DBC inserted. Organ retrieval was performed in 27 patients (43%) and 31 kidneys out of the 54 procured (57%) have been transplanted. Kidney transplantation exclusion was related to family refusal (n = 15), past medical history, time constraints, viral serology, high vascular ex vivo resistance of the graft and macroscopic abnormalities. The 31 kidneys exhibited an expected high delayed graft function rate (92%). Despite these initial results transplanted kidney had good creatinine clearance at six months (66 ± 24 ml/min) with a 89% graft survival rate at six months.ConclusionsThis study shows the feasibility and efficacy of an organ procurement program targeting NHBD allowing a 10% increase in the kidney transplantation rate over 17 months. With a six months follow-up period, the results of transplanted kidney function were excellent.

Advanced Practice Organ Procurement Techniques: Insertion of Arterial Catheters

Placement of arterial catheters by organ procurement coordinators is becoming more common. Classroom and clinical training in this technique and provision of appropriate quality assurance and supportive policies/procedures by organ procurement programs will ensure the coordinators' success. This discussion reviews technical aspects of insertion of catheters into the radial, femoral, and axillary arteries, potential complications, and alternative noninvasive methods of measuring blood pressure.

Advanced practice organ procurement techniques: insertion of arterial catheters

Placement of arterial catheters by organ procurement coordinators is becoming more common. Classroom and clinical training in this technique and provision of appropriate quality assurance and supportive policies/procedures by organ procurement programs will ensure the coordinators' success. This discussion reviews technical aspects of insertion of catheters into the radial, femoral, and axillary arteries, potential complications, and alternative noninvasive methods of measuring blood pressure.