Postmortem Organ Research Articles

Brain death and postmortem organ donation: report of a questionnaire from the CENTER-TBI study

BackgroundWe aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation.MethodsInvestigators from 67 Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study centers completed several questionnaires (response rate: 99%).ResultsRegarding practices around brain death, we found agreement on the clinical evaluation (prerequisites and neurological assessment) for brain death determination (BDD) in 100% of the centers. However, ancillary tests were required for BDD in 64% of the centers. BDD for nondonor patients was deemed mandatory in 18% of the centers before withdrawing life-sustaining measures (LSM). Also, practices around postmortem organ donation varied. Organ donation after circulatory arrest was forbidden in 45% of the centers. When withdrawal of LSM was contemplated, in 67% of centers the patients with a ventricular drain in situ had this removed, either sometimes or all of the time.ConclusionsThis study showed both agreement and some regional differences regarding practices around brain death and postmortem organ donation. We hope our results help quantify and understand potential differences, and provide impetus for current dialogs toward further harmonization of practices around brain death and postmortem organ donation.

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.

Restless Feelings: Desiring Direct Contact After Postmortem Organ Donation.

This article investigates the emergence of a growing demand in the Netherlands: the wish of organ donor families and organ recipients to establish contact. Such direct contact transgresses both the anonymity and privacy long considered by many to be fundamental to organ donation. Legislation prescribes that privacy should be safeguarded, but the parties involved increasingly manage to find each other. Research is needed to provide insight into the ramifications of direct contact, which may inform mourning counseling and psychosocial support. Drawing on qualitative interviews with donor's relatives, we analyze the reasons for the desire to have direct contact. We seek to understand how meanings are constructed and contested through organs at the margins of life and death in the individualized and secularized society of the Netherlands. We find that relatives struggle with persistent restless feelings after postmortem organ donation and may develop a level of personal attachment and assign inalienability to human body parts.

Distinctive types of postzygotic single-nucleotide mosaicisms in healthy individuals revealed by genome-wide profiling of multiple organs.

Postzygotic single-nucleotide mosaicisms (pSNMs) have been extensively studied in tumors and are known to play critical roles in tumorigenesis. However, the patterns and origin of pSNMs in normal organs of healthy humans remain largely unknown. Using whole-genome sequencing and ultra-deep amplicon re-sequencing, we identified and validated 164 pSNMs from 27 postmortem organ samples obtained from five healthy donors. The mutant allele fractions ranged from 1.0% to 29.7%. Inter- and intra-organ comparison revealed two distinctive types of pSNMs, with about half originating during early embryogenesis (embryonic pSNMs) and the remaining more likely to result from clonal expansion events that had occurred more recently (clonal expansion pSNMs). Compared to clonal expansion pSNMs, embryonic pSNMs had higher proportion of C>T mutations with elevated mutation rate at CpG sites. We observed differences in replication timing between these two types of pSNMs, with embryonic and clonal expansion pSNMs enriched in early- and late-replicating regions, respectively. An increased number of embryonic pSNMs were located in open chromatin states and topologically associating domains that transcribed embryonically. Our findings provide new insights into the origin and spatial distribution of postzygotic mosaicism during normal human development.

Acceptance of post-mortem organ donation in Germany : Representative cross-sectional study

The German post-mortem organ donation rate has dropped by one third since 2010. Furthermore, 958 patients died in 2015 in Germany while waiting for an organ. To decrease organ shortage, an amendment of the transplantation law was established in 2012. An information package including an organ donor card is sent to all German citizens via the postal service. Avoluntary national transplantation register was introduced in 2016 to improve transparency in the organ donation process. The influence of several transplantation scandals starting in 2012 on organ donation rates is in question. Therefore, the objective of this article is to discuss approval and objections to post-mortem organ donation among the next of kin of potential donors and the general public in Germany. Binary logistic regression of data from the 2014 survey by the Federal Centre for Health Education on attitudes towards organ and tissue donation in Germany was conducted, aiming to identify influencing factors on the likelihood of organ donor card possession. Additionally, data of the German Organ Transplantation Foundation on post-mortem organ donations in Germany in 2014 were studied to highlight reasons for approval and objections by next of kin of potential and explanted post-mortem organ donors. Methods of documentation of the deceased's will according to data of the German Organ Transplantation Foundation were analyzed. Male gender and lack of knowledge about organ donation decrease the likelihood of having an organ donor card. Of the respondents in the survey of the Federal Centre for Health Education 71.0% would donate their own organs, whereas only one third possess an organ donor card. Health insurances and physicians are the most important providers of organ donor cards in Germany. An increase in the percentage of organ donor card possession following the amendment of the transplantation law could not be observed by 2016. Fear of organ trade and unjust organ allocation are the main reasons for rejecting organ donation among the general public. Previous transplantation scandals are aprimary reason for anegative change in attitudes. Main reasons for objection among the next of kin of potential organ donors are known objections of the deceased and the lack of knowledge about the will of the deceased. In addition, only 58.1% of all explanted organ donors documented their will in written or verbal form. Education on organ donation can be ameans to increase organ donation rates. The effects of the change in legislation and the establishment of the transplant register need to be evaluated. Further research regarding the influence of religion, especially among religious minorities, on organ donation rates in Germany needs to be conducted to identify possible obstacles. Moreover, the use of social networks to address potential organ donors has proven to increase registration numbers and could easily be implemented in Germany.

Post-Mortem Organ Weights at a Medico-Legal State Facility in the eThekwini Region

Post-Mortem Organ Weights at a Medico-Legal State Facility in the eThekwini Region

Postmortem Organ Weights at a South African Mortuary

Weighing organs at autopsy provides objective evidence of pathology. Reference ranges must be locally applicable, accurate, and regularly defined. The aims of this study were the generation of postmortem organ weight reference ranges for use in South African mortuaries, analysis of factors influencing organ weights, and comparison to international populations. This was a retrospective study of autopsy reports from the Salt River medicolegal mortuary in Cape Town, South Africa, between 2013 and 2016. Disproportionate randomized stratified sampling was used to obtain sufficient cases from men and women; white, colored, and African racial groups; and decedents older and younger than 50 years. Observations from 1262 decedents older than 18 years dying traumatic on-scene deaths were recorded, excluding organs with macroscopic evidence of disease or destructive injury. Variables collected were sex, race, age, height, and body weight. Organ weights were modeled using multiple linear regression analysis. In general, sex, race, and weight are significant predictors. In general, organs from African and colored decedents weigh less than those from white decedents, and similarly pooled South African organs are smaller than those from international populations. Ideal organ weight reference ranges are proposed, and a smartphone application is offered, which calculates individualized prediction intervals. This study provides postmortem organ weight data for a South African population.

Donation decisions after death: The case for a family veto

This paper argues that families should be able to refuse to donate the organs of their deceased relative, even when their relative was registered as an organ donor. Families generally hold important relational claims on the body of a decedent, claims which should be respected in the form of allowing families to “veto” postmortem organ donation. Current arguments for and against a “family veto” will first be addressed in order to demonstrate their insufficiency. Typical claims against a family veto either are overly utilitarian, or they appeal to the donor's autonomy and face the problem of explaining why informed consent should be respected after death. I offer a new approach for this issue, which considers relational autonomy and embodied relationships. Thus, I conclude that organ donation decisions should be balanced between the potential donor and their family in a double-veto system. Ce texte montre que des familles peuvent refuser le don d’organe de leurs défunts, même si ce dernier avait fait part de sa volonté expresse. Les familles, en général, réclament le corps de leur décédé et ce droit de réclamation devrait permettre aux familles de s’opposer à une donation d’organes postmortem. Les arguments pour ou contre ce veto des familles seront exposés dans un premier temps pour montrer leurs insuffisances. Les oppositions à un veto familial sont utilitaristes, font appel à l’autonomie du donneur et mettent en avant que le consentement éclairé doive être respecté après la mort. J’offre une nouvelle approche qui considère l’autonomie relationnelle et l’incarnation. Je conclue que les décisions de dons d’organes doivent être mises en balance entre le donneur potentiel et le veto familial par un système de double-veto.

The development of a narrative describing the bereavement of families of potential organ donors: A systematic review.

Families of potential post-mortem organ donors face various challenges in the unfamiliar hospital context and after returning home. This review of sources published between 1968 and 2017 seeks to understand their journey as a bereavement experience with a number of unique features. Grief theory was used to identify ways that staff can assist family members to tolerate ambiguities and vulnerabilities while contributing to an environment characterised by compassion and social inclusion. Staff can guide families and create opportunities for meaningful participation, building resilience and developing bereavement-related skills that could assist them in the months that follow.

An assessment of advance relatives approach for brain death organ donation.

Advance announcement of forthcoming brain death has developed to enable intensivists and organ procurement organisation coordinators to more appropriately, and separately from each other, explain to relatives brain death and the subsequent post-mortem organ donation opportunity. The aim was to assess how potentially involved healthcare professionals perceived ethical issues surrounding the strategy of advance approach. A multi-centre opinion survey using an anonymous self-administered questionnaire was conducted in the six-member hospitals of the publicly funded East of France regional organ and tissue procurement network called 'Prélor'. The study population comprised 460 physicians and nurses in the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Units and the Emergency Departments. The project was approved by the board of the Lorraine University Diploma in Medical Ethics and the Prélor Network administrators. A slight majority of 53.5% of respondents had previously participated in an advance relatives approach: 83% of the physicians and 42% of the nurses. A majority of healthcare professionals (68%) think that the main justification for advance relatives approach is the comprehensive care of the dying patient and the research of his or her most likely opinion (74%). The misunderstanding of the related issues by relatives is an obstacle for 47% of healthcare professionals and 51% think that the answer given by the relatives regarding the most likely opinion of the person regarding post-mortem organ donation really corresponds to the person opinion in only 50% of the cases or less. Time given by advance approach should be employed to help and enable relatives to authentically bear the values and interests of the potential donor in the post-mortem organ donation discussion. Nurses' attendance of advance relatives approach seems necessary to enable them to optimally support the families facing death and post-mortem organ donation issues.

The Consequences of Vagueness in Consent to Organ Donation.

In this article I argue that vagueness concerning consent to post-mortem organ donation causes considerable harm in several ways. First, the information provided to most people registering as organ donors is very vague in terms of what is actually involved in donation. Second, the vagueness regarding consent to donation increases the distress of families of patients who are potential organ donors, both during and following the discussion about donation. Third, vagueness also increases the chances that the patient's intention to donate will not be fulfilled due to the family's distress. Fourth, the consequent reduction in the number of donated organs leads to avoidable deaths and increased suffering among potential recipients, and distresses them and their families. There are three strategies which could be used to reduce the harmful effects of this vagueness. First, recategorizing the reasons (commonly referred to as 'overrules' under the current system) given by families who refuse donation from registered donors would bring greater clarity to donation discussions. Second, people who wish to donate their organs should be encouraged to discuss their wishes in detail with their families, and to consider recording their wishes in other ways. Finally, the consent system for organ donation could be made more detailed, ensuring both that more information is provided to potential donors and that they have more flexibility in how their intentions are indicated; this last strategy, however, could have the disadvantage of discouraging some potential donors from registering.

Postmortem Body and Organ Measurements in Neonates and Infants: A Review of Reference Resources Used by Ontario Pathologists (Part 1).

It is common practice in pediatric autopsies to compare the body and organ measurements of the deceased child against the existing reference data. Although a number of resources are available, many are outdated and have significant limitations. The goal of this study was to assess the reference sources currently used by the Ontario pathologists in pediatric autopsies. A survey of 14 Ontario pathologists, who do coroners' pediatric autopsies, identified 20 publications commonly referenced for body and organ measurements. Of all the cited sources, only a few had all the features regarded by the pathologists as ideal for a reference source. These features included accessibility to the source, large sample size, defined control populations, statistical analyses, and sex distinctions. The results of this study will be used to guide the development of a new reference, based on Ontario data, that will enhance measurement standards in pediatric autopsy practice.

Relationships Between Social Attitudes Toward Deceased Organ Donation and the Donation Rates in Poland, a Country With an Opting-out System.

Monitoring of attitudes toward deceased donation gives the general view of the acceptance of this treatment but does not allow for precise prediction of single person's behavior. Consistency of actions and attitudes has many determinants, personal and situational. The idea of this study was to assess and compare relationships between behaviors and attitudes toward postmortem organ donation in single districts and between larger regions of the country (west and east). Indicators calculated for the years 1996-2014 included the number of potential deceased donors (per million population [pmp]/y), the number of objections registered in the refusal registry (pmp), and the number and percentage of family refusals to donation. To assess relationships between variables, statistical and descriptive analyses were used. There were 10,731 potential donor referrals: 10 times more in the most active than in the least active province. Potential donor referrals from the western region were almost twice as high (18.3 pmp/y) as from the east (10.1). In 1,045 cases (9.7%), organs were not used owing to objections of the relatives; this index differed in each province up to 7-fold, but was almost the same in western and eastern regions. Total number of objections listed in the Refusal Registry was 28,725 (748 pmp). This index was different in each district up to 4-fold, but was not distinctly different in west and east regions. No distinct correlation (Pearson test) was found among the 3 assessed variables. Donation in Poland has much geographic differences. There is no common pattern of behavior and attitude toward donation and no correlation between these variables.

Health status and potential uptake of transgenic DNA by Japanese quail fed diets containing genetically modified plant ingredients over 10 generations

The hypothesis assumes that feed containing GMOs affects animal health and results in the transgene product accumulating in the body. Therefore, the objective of the study was to evaluate the impact of genetically modified (GM) ingredients used in poultry diets on aspects of bird health status and accumulation of transgenic DNA in eggs, breast muscle and internal organs.A total of 10 generations of Japanese quail were fed three types of diets: group A – containing GM soya (Roundup Ready) and non-GM maize, group B – containing GM maize (MON810) and non-GM soya, and group C – containing non-GM soya and maize.Bird performance traits were monitored throughout the trial. In 17-week-old animals of each generation, health examination took place on birds from each group including post-mortem necropsy and histological organ evaluation. For the purpose of transgenic DNA detection, samples of selected important tissues were taken. A molecular screening method of PCR amplification was used.The analysis of the sectional examination of birds used in the current experiment did not indicate the existence of the pathological changes caused by pathogens, nutritional factors or of environmental nature. The histopathological changes occurred in all three dietary groups and there were no statistically significant differences between the groups.There was no transgene amplification – neither CaMV35S promoter sequence nor nos terminator sequence, in the samples derived from breast muscle, selected tissues and germinal discs (eggs).According to the obtained results, it was concluded that there was no negative effect of the use of GM soya or maize with regard to bird health status or to the presence of transgenic DNA in the final consumable product.

Organ donation after circulatory death

Approximately 17 million inhabitants live in the Netherlands. The number of potential organ donors in 1999 was the lowest in Europe with only 10 donors per million inhabitants. Medical associations, public health services, health insurance companies and the government had to find common solutions in order to improve organ allocation, logistics of donations and to increase the number of transplantations. After a prolonged debate on medical ethical issues of organ transplantation, all participants were able to agree on socio-medico-legal regulations for organ donation and transplantation. In addition to improving the procedure for organ donation after brain death (DBD) the most important step was the introduction of organ donation after circulatory death (DCD). Measures such as the introduction of a national organ donor database, improved information to the public, further education on intensive care units (ICU), guidelines for end of life care on the ICU, establishment of transplantation coordinators on site, introduction of autonomous explantation teams and strict procedures on the course of organ donations, answered many practical issues about logistics and responsibilities for DBD and DCD. In 2014 the number of postmortem organ donations rose to 16.4 per million inhabitants. Meanwhile, up to 60 % of organ donations in the Netherlands originate from a DCD procedure compared to approximately 10 % in the USA. This overview article discusses the developments and processes of deceased donation in the Netherlands after 15 years of experience with DCD.

Gold nanoparticles as multimodality imaging agents for brain gliomas.

BackgroundNanoparticles can be used for targeted drug delivery, in particular for brain cancer therapy. However, this requires a detailed analysis of nanoparticles from the associated microvasculature to the tumor, not easy because of the required high spatial resolution. The objective of this study is to demonstrate an experimental solution of this problem, based in vivo and post-mortem whole organ imaging plus nanoscale 3-dimensional (3D) X-ray microscopy.ResultsThe use of gold nanoparticles (AuNPs) as contrast agents paved the way to a detailed high-resolution three dimensional (3D) X-ray and fluorescence imaging analysis of the relation between xenografted glioma cells and the tumor-induced angiogenic microvasculature. The images of the angiogenic microvessels revealed nanoparticle leakage. Complementary tests showed that after endocytotic internalization fluorescent AuNPs allow the visible-light detection of cells.ConclusionsAuNP-loading of cells could be extended from the case presented here to other imaging techniques. In our study, they enabled us to (1) identify primary glioma cells at inoculation sites in mice brains; (2) follow the subsequent development of gliomas. (3) Detect the full details of the tumor-related microvasculature; (4) Finding leakage of AuNPs from the tumor-related vasculature, in contrast to no leakage from normal vasculature.Electronic supplementary materialThe online version of this article (doi:10.1186/s12951-015-0140-2) contains supplementary material, which is available to authorized users.

Running a postmortem service--a business case and clinical experience.

The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia.

Attitudes Concerning Postmortem Organ Donation: A Multicenter Survey in Various German Cohorts.

The aim of this study was to characterize postmortem organ donation attitudes in various German cohorts. Employees of 2 German cities and 2 German university hospitals, employees of a German automobile enterprise, and members of a German Medical Society were administered a questionnaire about postmortem organ and tissue donation attitudes. Demographic data and general attitudes were questioned and focused on: I) willingness to donate organs, II) holding a donor card, and III) having discussed the topic with the family. Of 5291 participants, 65.2% reported favoring postmortem organ donation. Missing negative experiences, the idea that donation is helpful, a non-medical professional environment, excellent general health, gender, agreement with the brain-death paradigm, and age significantly influenced the participants' attitudes. Participants were more likely to possess donor cards and had discussed more often with family members if they agreed with the brain-death paradigm and considered donation to be helpful. Males and older participants were the most likely to neglect donor cards, and Catholics, Protestants, and participants with poor health were the least likely to donate organs. Interest in receiving more information was expressed by 38.1% and 50.6% of participants refusing donation of all or of specific organs, respectively, and suggested the internet (60.0%) and family doctors (35.0%) as preferred sources of information. Public campaigns in Germany should focus on males and older people as regards donor cards, and females, younger, and religiously affiliated persons as regards the general willingness to donate organs postmortem.

Non-therapeutic intensive care for organ donation: A healthcare professionals' opinion survey.

Providing non-therapeutic intensive care for some patients in hopeless condition after cerebrovascular stroke in order to protect their organs for possible post-mortem organ donation after brain death is an effective but ethically tricky strategy to increase organ grafting. Finding out the feelings and opinion of the involved healthcare professionals and assessing the training needs before implementing such a strategy is critical to avoid backlash even in a presumed consent system. A single-centre opinion survey of healthcare professionals was conducted in 2013 in the potentially involved wards of a French University Hospital: the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Unit and the Emergency Department. A questionnaire with multiple-choice questions and one open-ended question was made available in the different wards between February and May 2013. The project was approved by the board of the Lorraine University Diploma in Medical Ethics. Of a total of 340 healthcare professionals, 51% filled the form. Only 21.8% received a specific education on brain death, and only 18% on potential donor's family approach and support. Most healthcare professionals (93%) think that non-therapeutic intensive care is the continuity of patient's care. But more than 75% of respondents think that the advance patient's consent and the consent of the family must be obtained despite the presumed consent rule regarding post-mortem organ donation in France. The acceptance by healthcare professionals of non-therapeutic intensive care for brain death organ donation seems fairly good, despite a suboptimal education regarding brain death, non-therapeutic intensive care and families' support. But they ask to require previously expressed patient's consent and family's approval. So, it seems that non-therapeutic intensive care should only remain an ethically sound mean of empowerment of organ donors and their families to make post-mortem donation happen as a full respect of individual autonomy.

A phenomenological approach to the ethics of transplantation medicine: sociality and sharing when living-with and dying-with others.

Recent years have seen a rise in the number of sociological, anthropological, and ethnological works on the gift metaphor in organ donation contexts, as well as in the number of philosophical and theological analyses of giving and generosity, which has been mirrored in the ethical debate on organ donation. In order to capture the breadth of this field, four frameworks for thinking about bodily exchanges in medicine have been distinguished: property rights, heroic gift-giving, sacrifice, and gift-giving as aporia. Unfortunately, they all run into difficulties in terms of both making sense of the relational dimensions of postmortem and live organ donations and being normatively adequate in the sense of shedding light and providing guidance on ethical concerns when body parts are donated. For this reason, this article presents a phenomenological framework of giving-through-sharing, based on Maurice Merleau-Ponty's philosophy. This framework makes sense of relational dimensions of postmortem and live organ donation. It also sheds light on three highly debated concerns in organ donation ethics: indebtedness on the part of recipients, the fact that some live donors do not experience donation as a matter of choice, and the potentially painful experience of donors' relatives, who need to make decisions about postmortem organ donation at a time of bereavement. It can indirectly support what may be called a normalization of bodily exchanges in medicine.