Pool Of Potential Organ Donors Research Articles

Organ Donation in the Emergency Department: Awareness and Opportunities.

Background The only cure for end-organ failure is transplantation. Unfortunately, there are fewer organ donors than patients. Currently, the majority of organ donations come from live or brain-dead donors. In order to expand the pool of potential organ donors, the emergency department should be utilized effectively. Objectives The primary goal of this research is to determine emergency physicians' knowledge, awareness, and attitude about organ donation. Methodology A cross-sectional study was conducted through different hospitals in Saudi Arabia. It includes 106 physicians in the adult emergency departments. Results The majority (84.9%) of the participants never reported any case in the emergency department as a potential case for organ donation. In addition, 54.8% of the participants report having little to no knowledge of the ethical issues of organ donation. Furthermore, 66.1% of respondents claim to have little to no knowledge of the goals and duties of the SCOT (Saudi Center for Organ Transplantation). It was interesting to see that 96.2% of the participants reported that their organizations do not have any policies or procedures in place regarding organ donations. Regarding education, 99 (93.4%) physicians did not participate in any organ donation course, training, or teaching program about organ donation. At the same time, 67 (63.2%) physicians concurred that participation in a training program is essential. Moreover, 68 (64.2%) physicians believed that organ donation should be a part of every end-of-life case. In order to improve the donation process in the emergency department, 88 (83%) physicians would want a well-established program with defined policies and procedures. Conclusion According to our findings, the emergency physician has inadequate expertise and information on organ donation rules and procedures, which has resulted in a missed opportunity to recruit more potential donors. We recommend instituting clear policy and procedures and educating the physicians and all emergency medicine staff to have better outcome.

Abstract 158: Exploring the Potential for Kidney Donation in Out-of-Hospital Cardiac Arrest Cases With No Chance of Survival

Introduction: The global kidney shortage can potentially be addressed through the implementation of the uncontrolled donation after circulatory death (uDCD) pathway. However, the current Termination-of-Resuscitation (TOR) rules, although effective in identifying futile resuscitation, do not consider the potential benefits of organ donation. Objective: This study aims to assess the potential pool of uDCD kidney donors among patients with resuscitation attempts by Emergency Medical Services (EMS) who meet TOR criteria. Methods: Retrospective analysis was conducted using data from the Paris Sudden Death Expertise Center (SDEC) registry spanning from 2011 to 2020. TOR criteria evaluation and identification of potential organ donors were performed using established selection criteria from previous protocols on TOR rules and uDCD. Incidence rates (per patient-years) were calculated using data from the National Institute of Statistics and Economic Studies. Results: Out of 19,976 cases of Out-of-Hospital-Cardiac Arrest (OHCA) with resuscitation attempts by EMS, 12,890 (64.5%) did not achieve sustained Return of Spontaneous Circulation (ROSC). Among patients with no successful ROSC, the annual number and incidence of patients with no chance of survival varied across different TOR rules, ranging from 626 to 1081 cases and from 8.14 to 10.04 per 100,000 patient-years. The proportion of OHCA patients meeting both TOR criteria and extended kidney criteria ranged from 67.8% to 73.6% of total cases of OHCA who did not achieve sustained ROSC. Conclusion: Our findings demonstrate that the implementation of a uDCD program, in cases where TOR rules indicate no chance of survival, has the potential to significantly increase the pool of potential organ donors.

Anatomy of the left ventricular subvalvular apparatus of the Eurasian wild boar

Xenotransplantation consists in transplanting an organ from one species to another. Despite the fact that currently, the biggest dilemma of heart transplants are issues related to the field of immunology, we should start our search with the basic science of comparative anatomy of animals. The Eurasian wild boar (Sus scrofa) is an ancestor of the domestic pig (Sus domestica) and an invasive species currently not covered by European protection programs. The growing wild boar population is a pool of potential organ donors, as well as a research facility for developing comparative anatomy of animals and other areas of broadly understood zoology. The research material consisted of seventy-one Wild boar hearts. Following the research methodology provided by the team of Kustrzycki et al. (2000), determined the number of bellies of papillary muscles of the left ventricle and the type of connection between the muscles and the wall of the left ventricle. The height of the departure of the muscle from the ventricular wall was also determined, and the morphological regularity of the papillary muscle was assessed. The tendinous cords extending from the papillary muscles were also investigated. The materials analysis shows similarities and differences in the anatomy of the hearts of living organisms, focusing on the normal anatomy of the left ventricular subvalve apparatus of the Eurasian wild boar. Our research broadens the knowledge of the comparative and normal anatomy of the myocardium of the Suina in comparison with selected individuals of other species.

Implementing of Active Brain-Dead Donor Identification Strategy in a Single Donor Center: One Year Experience.

Background and objectives: Organ shortage is considered to be a major limitation for increasing transplantation rates. Brain-dead donors (DBDs) are an important source of organs, but up to 50% of potential DBDs might not be identified. An active brain-dead donor search could potentially increase a deceased donor pool. The aim of this study was to evaluate the effectiveness of an active potential DBD identification program and to evaluate one year impact on the potential organ donor pool in Lithuania‘s biggest medical institution. Materials and Methods: An organ donor coordinator service was established and active DBD search strategy was implemented in the hospital of LSMU Kauno Klinikos, and retrospective data analysis was performed between December 2016 and December 2017. Collected data was compared to the available data of the previous year in the same center and to the donation dynamics of the whole country. Results: A total of 6734 patients were treated in all intensive care units (ICU), and 234 (3.5%) of them were identified as possible donors. No increase in potential donor’s number was observed in study year (n = 34) compared to remote year (n = 37). No significant difference in potential donor’s demographic data, cause of death, family refusals and medical contraindication rates. Cerebral angiography (CA) repeated in 20% of potential donors in order to confirm brain death diagnosis. More potential donors for whom CA was repeated had decompressive craniectomy done (66.7% vs. 33.3%, p = 0.018). Decompressive craniectomy statistically significantly increases the rate of repeated CA (OR 12.7; 95% CI, 1.42–113.37; p = 0.023). Active search strategy increased length of hospital stay of potential donors comparing to previous year (3.97 ± 4.73 vs. 2.51 ± 2.63, p = 0.003). An optimal time of the first four days of hospitalization to identify a potential donor was observed during our study (OR 10.42; 95% CI, 4.29–25.34; p = 0.001). Conclusions: We were not able to demonstrate active donor identification strategy superiority over the passive strategy during a short one year period; nevertheless, valuable knowledge was gained in brain death diagnostics, new terminology was implemented, and the stability of actual donor numbers was observed in the experimental donor center in the light of decreasing national results. Long-term strategy is required to achieve sustainable results in organ donation.

At the heart of organ donation. Case reports of organ donation after cardiac death in two patients with successfully repaired AAST grade V cardiac injuries

BackgroundTrauma victims could be an important source of organs. This article presents two cases of successful organ donation and transplant, after Maastricht category III cardiac death in patients with successfully repaired AAST grade V traumatic cardiac injuries.Case presentationThe first donor was an adult patient with self-inflicted heart stab wound and non-survivable burn injury. The second one was an adult patient with blunt cardiac and abdominal trauma and an anoxic brain injury due to a car accident. The cardiac injury was promptly repaired in both patients. In the first case, adequate organ perfusion ante-mortem was achieved thanks to venoarterial extracorporeal membrane oxygenation and intensive care unit support. The above procedure allowed successful organ donation and transplantation even after Maastricht category III cardiac death. This is the first case reported where, for organ donation purposes, it was made necessary first thing to avoid the immediate death of the patient, due to a rare and frequently not survivable cardiac injury. The challenge of preserving organ perfusion, due to major burn injury effects, was faced afterwards.ConclusionsThe outcomes of these two cases suggest that a repaired heart injury should not be considered as an absolute contraindication to organ donation, even if it is associated with non-survivable major burns. Therefore, cardiac death could provide an opportunity for these kinds of patients to contribute to the pool of potential organ donors.

Factors associated with organ donation by trauma patients in Nova Scotia.

Trauma patients represent a significant pool of potential organ donors (PODs), and previous research suggests that this population is underutilized for organ donation (OD). Our objective was to assess factors associated with OD in the trauma population. We retrospectively analyzed OD in Nova Scotia over a 7-year period (2009-2016) using data from the Nova Scotia Trauma Registry and Nova Scotia Legacy of Life Donor Registry. All trauma patients who died in the hospital were included. Multiple logistic regression was used to assess factors associated with donation. We also evaluated characteristics, donation types, and reasons for nondonation among trauma PODs. There were 689 trauma-related deaths in all hospitals in NS during the study period, of which 39.8% (274 of 689) met the Nova Scotia Trauma Registry definition of a POD. Data on OD were available for 108 of these patients who were referred to the Legacy of Life Program. The conversion rate was 84%. Compared with nondonors, organ donors were significantly younger, had a higher Abbreviated Injury Scale head score and a lower scene Glasgow Coma Scale score, were more likely to suffer ischemia from drowning or asphyxia and to require air transport, and were less likely to have comorbidities. Regression analysis showed that donation was associated with younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.95-0.99) and lower Glasgow Coma Scale score at the scene (OR, 0.76; 95% CI, 0.66-0.88). Odds of donation were increased with air transport compared with land ambulance (OR, 8.27; 95% CI, 2.07-33.08) and injury within Halifax Regional Municipality compared with injury outside Halifax Regional Municipality (OR, 4.64; 95% CI, 1.42-15.10). Among the 60 referred PODs who did not donate, family refusal of consent was the most common reason (28 [46.7%] of 60). Younger age, greater severity of injury, and shorter time to tertiary care were associated with OD in trauma patients. Prognostic and Epidemiological, Level III.

How Big is Too Big? An Analysis of Morbidly Obese Heart Donors in the UNOS Database

Purpose As the population becomes increasingly obese, so does the pool of potential organ donors. However, many centers are hesitant to accept hearts from morbidly obese donors, limiting the donor pool. We hypothesized that utilization of hearts from obese donors would not impact recipient outcomes. . Methods Single-organ first-time adult heart transplants from 2003 to 2017 were evaluated from the UNOS database and stratified by donor BMI ≥ 40 (morbid obesity). Univariate analysis compared characteristics and short-term outcomes between groups. Kaplan-Meier analysis evaluated long-term survival. Cox regression assessed the risk-adjusted impact of donor obesity on mortality. Sensitivity analyses evaluated donor BMI cutoffs of 30, 35, and 45. Results A total of 26,532 transplants were evaluated, of which 939 (3.5%) had donors with BMI ≥ 40. Transplants from morbidly obese donors increased over time (2.2% in 2003, 5.3% in 2017). Obese donors were more likely to have diabetes (10.4% vs. 3.1%) and hypertension (33.3% vs. 14.8%, p 130% of recipient). Short-term outcomes were similar, including primary graft dysfunction (1.7% vs. 2.7%, p=0.06), pacemaker need (3.8% vs. 3.3%, p=0.34), dialysis requirement (9.4% vs. 10.0%, p=0.34) and one year survival (10.6% vs. 10.7%, p=0.93). Unadjusted survival was equivalent for those with morbidly obese donors (Log-rank p=0.67), and obesity did not impact survival in risk adjusted analysis (Table). Sensitivity analyses for donor BMI ≥ 30, 35, or 45 and analysis of BMI as a continuous variable demonstrated similar results. Conclusion We demonstrate donor obesity did not impact post-transplant outcomes. Evaluation of hearts from morbidly obese donors has the potential to expand the critically low donor pool.

Organ donation by patients with and without trauma in a Canadian province: a retrospective cohort analysis.

People who experience trauma represent a large pool of potential organ donors. Our objective was to describe organ donation by patients with and without trauma in Nova Scotia. We performed a retrospective cohort study of all patients with trauma in the Nova Scotia Trauma Registry who were injured between Apr. 1, 2009, and Mar. 31, 2016, and died in hospital, as well as all potential organ donors captured in the Nova Scotia Legacy of Life Donor Registry over the same period. We compared characteristics of the 2 groups with respect to organ donation and identified reasons for nondonation. Overall, 940 patients were included in the analysis, of whom 689 (73.3%) had experienced trauma. Patients with trauma accounted for 37.2% (48/129) of donors. A total of 274 (39.8%) of the patients with trauma were identified as potential organ donors, and 48 (7.0%) donated organs. Only 108 (39.4%) of the 274 were referred to the Legacy of Life Program. The conversion rate (proportion of potential donors who went on to donate an organ) was 84.2% (48/57) among patients with trauma and 83.5% (81/97) among those without trauma. Donation after circulatory death occurred in 8 patients (17%) with trauma and 13 (16%) of those without trauma. Family refusal (28/60 [47%]) and medical unsuitability (16/60 [27%]) were the most common reasons for nondonation among patients with trauma. In Nova Scotia, 40% of patients with trauma who died in hospital were potential organ donors, yet only 39% of these patients were referred for donation. More work is required to improve organ donation within the trauma population.

Organ donation in trauma victims: A systematic review and meta-analysis

Although trauma patients represent a large pool of potential organ donors (PODs), the donor conversion rates (DCRs) in this population are unclear. Our primary objective was to synthesize published evidence on DCRs in trauma patients. As a secondary objective, we investigated factors that affect organ donation (OD) in the trauma population. We searched four electronic databases (PubMed, Embase, Web of Science, and Cochrane Library) and gray literature for articles on OD in trauma patients (PROSPERO 2017: CRD42017070388). Articles were excluded if it was not possible to calculate the DCR (actual organ donors divided by PODs). We pooled DCRs and performed subgroups analysis by trauma subpopulation, patients' age, and study publication date. We identified 27 articles with a total of 123,142 participants. Cohorts ranged in size from 28 to 120,512 patients (median, 132), with most studies performed in the United States. Conversion rates among individual studies ranged from 14.0% to 75.2% (median, 49.3%). All 27 studies were included in the meta-analysis. We found a pooled DCR of 48.1% using the random effects model. There was a high level of heterogeneity between studies (I = 97.4%). Upon subgroup analysis, we found DCRs were higher in head trauma patients compared with traumatic cardiac arrest patients (45.3% vs 20.9%, p < 0.001), in pediatric patients compared with adults (61.0% vs 38.0%, p = 0.018), and in studies published after 2007 compared with those published before (50.8% vs 43.9%, p < 0.001). Few studies assessed for factors associated with OD in trauma patients. We found variation in DCRs among trauma patients (range, 14.0-75.2%) and estimated a pooled DCR of 48.1%. Our results are limited by heterogeneity across studies, which may be attributable to differences in study design and population, definitions of a POD, and in the institutional criteria and processes regarding OD. Systematic reviews and meta-analyses level III.

Donation after Cardiac Death in Non-Survivable Burns

Major burns have previously been considered a contraindication to solid organ donation. We present two cases of successful organ donation and transplantation, after Maastricht category III cardiac death in adult patients with non-survivable burns injury. The implications of the outcome of these cases are that major burns should not be considered a contraindication to organ donation, and that cardiac death provides opportunity for patients with non-survivable burns to contribute to the pool of potential organ donors.

The Role of the Medical Toxicologist in Organ Transplantation

In our roles both in our primary specialties and as medical toxicologists (LRG and RBR), we appreciate the importance and complexity of achieving an adequate quality and quantity of organs for those who are in need of transplantation. Approximately 110,000 Americans are on the waiting lists for organs despite annual removal of more than 10,000 of these individuals who either die or become too sick to receive transplantation. A recent report from the Institute of Medicine emphasized the potential benefit from pursuing Uncontrolled Donation after Circulatory Determination of Death (UDCDD) as a means to substantially increase the pool of potential organ donors [1]. This approach is utilized extensively in Spain [2, 3] and France [4]. It involves rapidly initiated and prolonged high-quality resuscitations, and if despite such efforts, a determination of death is made, immediate institution of preservation measures ensues allowing the deceased to remain a candidate for organ donation. As most cardiac arrests occur outside the hospital, employment of UDCDD in these countries significantly reduced waiting lists for organ recipients, yet this approach is almost never used elsewhere. In the USA, donation follows Neurologic Determination of Death (DNDD), Controlled Donation after Circulatory Determination of Death (CDCDD), and Live Donation. Both DNDD and CDCDD almost invariably occur following care in hospital intensive care units. UDCDD, as practiced in France and Spain, would expand the pool of potential donors and organs available for transplant. Several UDCDD pilot projects have been initiated in the USA with funding from the Division of Transplantation of the Health Resources Services Administration [5]. One UDCDD study designed in New York proposed to employ extracorporeal membrane oxygenation (ECMO) in the emergency department to optimize organ preservation in the newly deceased, a similar strategy funded by the National Institutes of Health, is being tested in Michigan [5]. One of the major limitations to prehospital organ preservation is the low number of enrollees in Organ Donor Registries. The European approach has been that of preservation without need for prior consent and subsequent transplantation after informed consent is obtained from authorized parties, a concept which is not currently practiced nor supported in the USA [6, 7]. For UDCDD programs to be successful in the USA, citizens in each state must designate their donor status prior to death in a manner that is legally recognized as binding and dually executed. The establishment of centralized advanced directives can assist medical providers and family in the rapid initiation of preservation in hospital settings. For those dying in the Emergency Department (ED), if first-person consent does not exist, the model also permits the use of third-party consent as is employed in determinations following DNDD. As toxicologists, we have a special role. Understanding that xenobiotics can lead to death is our field of expertise, just as is the knowledge that the initial resuscitation and supportive toxicologic care will usually lead to successful resuscitation. If despite our efforts, failure occurs, a deceased patient often can become a donor after neurologic or circulatory determination of death. Although some tissue injuries associated with toxins such as acetaminophen will limit liver transplantation due to hepatotoxicity, most other organs in the same individual can be subsequently utilized [8]. Other examples such as carbon monoxide [9–12] or cyanide [13–17] poisoning may lead to transplantation of many organs following death. There are many available examples of detailed reviews on the subject of successful organ donation of corneas, hearts, kidneys, livers, lungs, pancreas, and skin following lethal poisoning from a broad spectrum of xenobiotics [18–22]. As toxicologists, we may advocate that our hospitalized patients receive donated organs as may occur following acetaminophen overdose. We must assure the highest ethical standards in our commitment to our patients, maintaining proper boundaries between the needs of the poisoned patients we attend, and the needs of potential transplant recipients where our unsalvageable patients can become potential donors. Our knowledge of the xenobiotic involved in the fatal poisoning and its impact on various organs will be of great value to assure that we can preserve the option of donation for those dying following overdose, just as we do for those dying from other causes whether intentional or unintentional. Ideally, protocols should be in place so that there is no potential or perceived conflict of interest when such decisions are made. What is evident is that the current organ donation system in the USA allows 18 patients on the organ waiting list to die every day. Toxicologists have significant responsibility to discuss organ donation with our families, coworkers, and patients and to consider becoming organ donors, when culturally permissible, to set an example for those considering registration. Our personal involvement in education, innovative research, critical decision making, and altruism can make a substantial difference in expanding the pool of potential organ donors. Toxicologists can attempt to save lives by the current neurologic or circulatory determination of death approaches. But if we wish to advocate for all impacted by these untimely deaths, we need to consider supporting and offering insight into the effect of the toxin and collaborating with programs that can provide opportunities for donation in the emergency department regardless of whether death is from neurological determination, expected as in CDCDD, or unexpected as in UDCDD. We are skilled at resuscitation, and we can advocate for ED-based organ preservation techniques such as ECMO that may preserve the right of the deceased to fulfill a personal wish to become an organ donor, if registered previously, or may offer family a chance to provide positive meaning to an otherwise emotionally traumatic event. If successful, we can contribute significantly to the pool of solid organs for those in desperate need, so that waiting for solid organs may become an anachronism.

Insulin-Like Growth Factor-II Is Increased in Systemic Sclerosis-Associated Pulmonary Fibrosis and Contributes to the Fibrotic Process via Jun N-Terminal Kinase- and Phosphatidylinositol-3 Kinase-Dependent Pathways

Systemic sclerosis (SSc)-related pulmonary fibrosis, for which there are few effective therapies, is the most common cause of SSc-related mortality. We examined insulin-like growth factor (IGF)-II expression in explanted lung tissues from control and SSc patients to determine its role in the pathogenesis of fibrosis. IGF-II levels in vivo were detected using immunohistochemistry. Primary lung fibroblasts were cultured from lung tissues, and IGF-II mRNA was measured using reverse transcriptase-polymerase chain reaction. Western blot analysis measured extracellular matrix (ECM) production and phosphorylated signaling molecules. Immunostaining revealed increased IGF-II expression in fibroblastic foci of SSc lungs. Furthermore, primary SSc lung fibroblasts had a fourfold increase in IGF-II mRNA and a twofold increase in IGF-II protein compared with normal lung fibroblasts. IGF-II mRNA in SSc lung fibroblasts was expressed primarily from the P3 promoter of the IGF-II gene, and IGF-II induced both a dose- and time-dependent increase in collagen type I and fibronectin production. IGF-II triggered the activation of both phosphatidylinositol-3 kinase and Jun N-terminal kinase signaling cascades, the inhibition of which diminished IGF-II-induced ECM production. Our study demonstrates increased local IGF-II expression in SSc-associated pulmonary fibrosis both in vitro and in vivo as well as IGF-II-induced ECM production through both phosphatidylinositol-3 kinase- and Jun N-terminal kinase-dependent pathways. Our results provide novel insights into the role of IGF-II in the pathogenesis of SSc-associated pulmonary fibrosis.

Heart valve donation in two small infants

The shortage of small donor heart valves forces surgeons to use mechanical heart valves as the second-best option for valve replacement in infants. This shortage of small donor heart valves originates primarily in the unawareness of physicians of the possibility of heart valve donation in infants [2]. In view of the current shortage of small donor heart valves we report here on two cases of heart valve donation in small infants in an attempt to increase physicians’ awareness of the problem. Case 1 was a 6-month-old male infant who developed a septic shock during screening for orthotopic liver transplantation for end-stage liver failure due to biliary atresia. He was admitted to the pediatric intensive care unit, where he eventually died of ongoing sepsis. In light of their son’s possible liver transplantation the parents had studied the matter of donation extensively and requested that his heart valves be harvested for donation. They were aware that bacterial cultures would have to be performed and that the valves would have to be discarded if a micro-organism was cultured. Cultures remained negative, and 8-weeks later the pulmonary valve was successfully implanted in a 5-weekold male infant. Case 2 was a 5-week-old male infant with a history of severe neonatal epilepsy who was admitted to the pediatric intensive care unit because of respiratory failure. Severe brain damage without the possibility of meaningful recovery was diagnosed on the basis of the clinical picture and electroencephalograms (EEG’s). Intensive care was withdrawn, and the infant died. Having become aware of the possibility of tissue donation in infants by the parents of the infant described in case 1, we asked the parents to consider heart valve donation. They agreed under the condition that the heart would be returned in time for the funeral. After consultation with the Bio Implant ServicesFoundation (BIS-Foundation), which is the intermediary in the donation and allocation of human tissues for The Netherlands, Belgium, Germany, Slovenia and Austria, we were able to provide this guarantee. Ten weeks later the aortic valve was successfully implanted in a 10-day-old female infant. Most people who die are able to donate tissue, and in this respect tissue donation differs substantially from organ donation. Organ donation remains primarily restricted to the Intensive Care Unit (ICU), despite the recent development of non-heart-beating organ donation. For this reason, the pool of potential tissue donors is much larger than the pool of potential organ donors. However, despite this large pool, shortage of donor tissues exists [1, 2]. Tissue donation involves the cornea, skin, bone and heart valves. In children, tissue donation is limited to the cornea (in children over 2 years of age) and heart valves. Because of size and maturation issues, the donation of skin, cartilage and bone is only possible in individuals over 16 years of age. In infants the main indications for valve replacement are critical aortic valve stenosis and right outflow tract abnormalities (i.e. pulmonary atresia, truncus arteriosus and severe tetralogy of Fallot). In critical aortic stenosis, the Ross procedure is the operative technique of choice: the patient’s own pulmonary valve serves as an autograft for the stenotic aortic valve, and an appropriately sized pulmonary or aortic valve allograft is used to replace the pulmonary valve [5]. Autografts are preferred because they J. K. Kieboom (*) Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands e-mail: j.k.w.kieboom@bkk.umcg.nl Tel.: +31-50-3614294 Fax: +31-50-3614235

Extracorporeal Support for Organ Donation after Cardiac Death Effectively Expands the Donor Pool

We sought to evaluate the effect on short-term outcomes of normothermic, extracorporeal perfusion (ECMO) for donation of abdominal organs for transplantation after cardiac death (DCD). Study parameters included increase in number of donors and organs, types of organs procured, and viability of kidneys transplanted. We retrospectively reviewed medical record data for all patients enrolled in our ECMO-supported DCD donor protocol between 10/1/2000 to 2/01/2004. We also reviewed the records for all patients undergoing organ donation after brain-death (DBD) during the study period at our institution. Recipient data were obtained and analyzed for all kidneys procured from both groups. Twenty patients were enrolled in our DCD protocol and underwent attempted organ donation. Fifteen patients completed the protocol; 3 maintained cardiac function throughout the prescribed 60 minutes after withdrawal of life support, and two patients' organs were deemed unsuitable for transplantation. Fourteen (70%) of the DCD donor patients originated on the trauma service and six (30%) were from other clinical services. The DCD program increased the potential donor pool by 33% (61 versus 81 patients) and the number of kidneys transplanted by 24% (100 versus 124). A total of 24 kidney, 5 liver, and 1 pancreas transplants were performed with these organs. Two of 24 (8.3%) DCD kidneys had delayed graft function. There were no perioperative rejection episodes or deaths. The implementation of a DCD protocol using extracorporeal perfusion increased the potential organ donor pool at our institution by 33%. This was accomplished without short term adverse effect on organ function compared with kidneys transplanted from DBD donors.

Philosophical debates about the definition of death: who cares?

Since the Harvard Committee's bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committee's proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead.

Potential organ donor pool for renal transplantation in the intensive care unit and emergency room

Potential organ donor pool for renal transplantation in the intensive care unit and emergency room

RENAL TRANSPLANTATION AFTER IN VIVO EXCISION OF AN ANGIOMYOLIPOMA FROM A LIVING UNRELATED KIDNEY DONOR

No AccessJournal of UrologySOCIETY OF UROLOGIC ONCOLOGY: Case Reports1 Jun 2000RENAL TRANSPLANTATION AFTER IN VIVO EXCISION OF AN ANGIOMYOLIPOMA FROM A LIVING UNRELATED KIDNEY DONOR ANDREW CHEN, DOUGLAS SCHERR, and J. FRANCOIS EID ANDREW CHENANDREW CHEN More articles by this author , DOUGLAS SCHERRDOUGLAS SCHERR More articles by this author , and J. FRANCOIS EIDJ. FRANCOIS EID More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)67561-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "RENAL TRANSPLANTATION AFTER IN VIVO EXCISION OF AN ANGIOMYOLIPOMA FROM A LIVING UNRELATED KIDNEY DONOR." The Journal of Urology, 163(6), p. 1859 References 1 : Successful living related kidney transplantation despite renal angiomyolipoma in situ. J Urol1999; 162: 480. Abstract, Google Scholar 2 : The natural history of renal angiomyolipoma. J Urol1993; 150: 1782. Link, Google Scholar 3 : Renal transplantation from living related donor after excision of angiomyolipoma of the donor kidney. J Urol1993; 150: 174. Link, Google Scholar From the Department of Urology, New York Presbyterian Medical Center-Cornell University Medical College, New York, New York© 2000 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byLaguna M (2020) Re: Transplanting Kidneys from Donors with Small Renal Masses—A Strategy to Expand the Donor PoolJournal of Urology, VOL. 204, NO. 2, (382-382), Online publication date: 1-Aug-2020. Volume 163Issue 6June 2000Page: 1859 Advertisement Copyright & Permissions© 2000 by American Urological Association, Inc.Keywordskidney transplantationliving donorkidneyangiomyolipomaMetricsAuthor Information ANDREW CHEN More articles by this author DOUGLAS SCHERR More articles by this author J. FRANCOIS EID More articles by this author Expand All Advertisement PDF downloadLoading ...

The potential organ donor pool: International figures

By understanding the size and characteristics of the potential donor pool, the concentration and location of the potential donors and factors influencing low rates of donation, it is possible to identify opportunities to improve the organ donation system. The exact donor gap needs to be established for each hospital/area, as published figures do not necessary reflect local potential. Nevertheless, marked differences with respect to the minimum standards in the number, location, and characteristics of organ donors should be considered as suggestive of low performance. The first stage where potential donors are lost is the detection of people who can be diagnosed as brain dead and, hence, could be considered a potential organ donor. Improving the donor identification implies the development of donor detection programmes. That and other initiatives to improve the donation rate need to be started in hospitals after the assessment of the local potential and local factors specifically implicated in the local performance.

Trauma Registries and Organ Transplantation-Reply

In Reply. — We appreciate Dr Evans' interest in trauma registries and his suggestion that registry data could be useful in estimating the size of the potential organ donor pool. Although Evans et al 1 and others 2 have provided point estimates using data abstracted from medical records, organ procurement agencies require ongoing surveillance of the potential and actual donor pools. 3 Trauma registries are used for ongoing surveillance of the quality of trauma care. The expansion suggested by Dr Evans could increase the value of the database, but not all registries are equipped to capture these additional data. A variety of practical obstacles, including insufficient staff and resources, impede the use of many registries for trauma care surveillance. Overcoming these obstacles is of paramount importance if registries are to serve their primary purpose and additional purposes, such as surveillance of potential organ donors. Data fields for the primary and

Trauma Registries and Organ Transplantation

<h3>To the Editor.—</h3> I read with great interest the recent article on trauma registries by Drs Pollock and McClain.¹It would seem that such registries could beextremely valuable to those of us who are involved in organ transplantation. For many years, I have bemoaned the fact that existing national data sets, including the National Hospital Discharge Survey and the National Death Index, both maintained by the National Center for Health Statistics, do not include data on the diagnosis of brain death. Such information would be invaluable in efforts to estimate the size of the potential organ donor pool. Thus far, we have only been able to derive such estimates crudely, and they are the subject of much uncertainty.^2-6 Since many organ donors are the victims of traumatic death, it is evident that trauma registries could be very helpful in estimating the size of the potential donor pool.