Successful Donation Research Articles

Predictors of hemoglobin recovery or deferral in blood donors with an initial successful donation

Donation eligibility is based on hemoglobin (Hb) level among other factors. This study assesses factors that influence Hb levels among first-time (FT) donors returning for a second donation. Allogeneic FT donors who successfully donated a red blood cell (RBC)-containing donation on their index presentation and returned to donate at least once more between August 1, 2009, and July 31, 2012, were included. Interdonation intervals and delta Hb (subsequent donation - index donation value) were calculated. Multivariable logistic regression and survival analysis methods were used to determine factors associated with 1) Hb recovery to preindex donation value or 2) deferral at the second presentation. During the study, 135,040 FT donors returned to donate. Overall, 44% of donors returned with a Hb level at or above their index value (defined as recovery for this study), 48.1% for males and 39.9% for females. Logistic regression revealed that the factor most strongly associated with Hb recovery was index Hb, with lower Hb having much higher odds of recovery. Shorter interdonation intervals were associated with decreased likelihood of recovery. Certain demographic characteristics were also associated with higher odds of recovery. Factors associated with deferral were similar to the factors associated with recovery, except for donor sex. As early as the second blood donation, allogeneic donors can be differentiated into two subpopulations: those who recover to index Hb levels and those who do not. Current data routinely collected by US blood centers cannot reliably distinguish between the two groups.

Successful Donation After Rapid Reversal of Liver Steatosis with Life Style Modification in Highly Motivated Donors in Living Donor Liver Transplant Program

Background: Liver steatosis is leading cause of donor rejection in living donor liver transplantation (LDLT). Rapid weight loss is difficult to achieve in a short period of time, moreover it may worsen liver histology.

Successful Donation After Rapid Reversal of Liver Steatosis with Life Style Modification in Highly Motivated Liver Donors

Successful Donation After Rapid Reversal of Liver Steatosis with Life Style Modification in Highly Motivated Liver Donors

Isolation of Highly Suppressive CD25+FoxP3+ T Regulatory Cells from G-CSF-Mobilized Donors with Retention of Cytotoxic Anti-Viral CTLs: Application for Multi-Functional Immunotherapy Post Stem Cell Transplantation

Previous studies have demonstrated the effective control of cytomegalovirus (CMV) infections post haematopoietic stem cell transplant through the adoptive transfer of donor derived CMV-specific T cells (CMV-T). Strategies for manufacturing CMV immunotherapies has involved a second leukapheresis or blood draw from the donor, which in the unrelated donor setting is not always possible. We have investigated the feasibility of using an aliquot of the original G-CSF-mobilized graft as a starting material for manufacture of CMV-T and examined the activation marker CD25 as a targeted approach for identification and isolation following CMVpp65 peptide stimulation. CD25+ cells isolated from G-CSF-mobilized apheresis revealed a significant increase in the proportion of FoxP3 expression when compared with conventional non-mobilized CD25+ cells and showed a superior suppressive capacity in a T cell proliferation assay, demonstrating the emergence of a population of Tregs not present in non-mobilized apheresis collections. The expansion of CD25+ CMV-T in short-term culture resulted in a mixed population of CD4+ and CD8+ T cells with CMV-specificity that secreted cytotoxic effector molecules and lysed CMVpp65 peptide-loaded phytohaemagglutinin-stimulated blasts. Furthermore CD25 expanded cells retained their suppressive capacity but did not maintain FoxP3 expression or secrete IL-10. In summary our data indicates that CD25 enrichment post CMV stimulation in G-CSF-mobilized PBMCs results in the simultaneous generation of both a functional population of anti-viral T cells and Tregs thus illustrating a potential single therapeutic strategy for the treatment of both GvHD and CMV reactivation following allogeneic haematopoietic stem cell transplantation. The use of G-CSF-mobilized cells as a starting material for cell therapy manufacture represents a feasible approach to alleviating the many problems incurred with successive donations and procurement of cells from unrelated donors. This approach may therefore simplify the clinical application of adoptive immunotherapy and broaden the approach for manufacturing multi-functional T cells.

Explore the stress management of the organ donation donor families after cardiac death

Objective To explore the directively meaning of Hans Selye ’ s discovery of biological stress to ethical issues facing donor families after cardiac death , and to alleviate the anxiety of donor families and get more organs for transplantation .Methods The data from 54 patients with potential donors in the First Hospital of Jilin University were collected , and the sources of psychological pressure in the donor families were analyzed , and the effect of Hans Selye ’ s discovery of biological stress on relieving the pressure and strengthening the coping with the ethical issues facing donor families were explored .Results Thirty-five patients with potential donors in 54 cases agreed with donors , and 22 patients with potential donors were successful donation at last . Conclusions Hans Selye’s discovery of biological stress can be used in the management of donor families after cardiac death in order to provide the security for striving for more transplantable organs . Key words: Ethics; Family; Pressure theory; Cardiac death; Organ donation

Gender differences and frequency of whole blood donation in Italian donors: Even though I want to, I cannot?

Women are under-represented among blood donors and this difference is particularly strong in Italy. This study explore the reasons for the gender gap using a sample of donors who had stopped donating at least two years previously and analyzing the role of frequency of donation. No significant gender differences emerged between the reasons provided by subjects but Italy was the country with the longest prescribed interval between whole blood donations for women. The gender gap is related to the lengthy interval between successive donations of whole blood and reducing this interval could help increase the proportion of women donors.

Initial commitment for inhalation injury

26. Mehta S, Lapinsky SE, Hallett DC, et al. Prospective trial of high‐frequency oscillation in adults with acute respiratory distress syndrome. Crit Care Med. 2001;29(7):1360–1369. 27. Wrigge H, Zinserling J, Neumann P, et al. Spontaneous breathing with airway pressure release ventilation favors ventilation in dependent lung regions and counters cyclic alveolar collapse in oleic‐acidinduced lung injury: a randomized controlled computed tomography trial. Crit Care. 2005;9(6):R780–R789. 28. Yoshida T, Rinka H, Kaji A, et al. The impact of spontaneous ventilation on distribution of lung aeration in patients with acute respiratory distress syndrome: airway pressure release ventilation versus pressure support ventilation. Anesth Analg. 2009;109(6):1892–1900. 29. Putensen C, Zech S, Wrigge H, et al. Longterm effects of spontaneous breathing during ventilatory support in patients with acute lung injury. Am J Respir Crit Care Med. 2001;164(1):43–49. 30. Albert S, Kubiak BD, Vieau CJ, et al. Comparison of “open lung”modes with low tidal volumes in a porcine lung injury model. J Surg Res. 2011;166(1):e71–e81. 31. Walkey AJ, Nair S, Papadopoulos S, Agarwal S, Reardon CC. Use of airway pressure release ventilation is associated with a reduced incidence of ventilatorassociated pneumonia in patients with pulmonary contusion. J Trauma Acute Care Surg. 2011;70(3):E42–E47. 32. Maung AA, Luckianow G, Kaplan LJ. Lessons learned from airway pressure release ventilation. J Trauma Acute Care Surg. 2012;72(3):624–628. 33. Hanna K, Seder CW, Weinberger JB, Sills PA, Hagan M, Janczyk RJ. Airway pressure release ventilation and successful lung donation. Arch Surg. 2011;146(3):325–328.

Predicting blood donation maintenance: the importance of planning future donations

Interventions to retain blood donors need to target the most influential and changeable factors. This study tested antecedents of three successive donation decisions. Participants were donors who had donated for the first time 1 year previous (n = 1018). Intention to continue donating, vasovagal reactions, deferral, anxiety, and planning failure were measured. Analyses distinguished between 1) those who registered for donation after questionnaire completion, versus those who did not; 2) those who did or did not register for donation a second time after questionnaire completion; and 3) those who did or did not register for donation a third time after questionnaire completion. Three logistic regression analyses showed that the first donation decision was influenced by intention (odds ratio [OR], 1.70; 95% confidence interval [CI], 1.30-2.21), number of donations made in the first year (OR, 2.35; 95% CI, 1.81-3.06), vasovagal reactions (OR, 0.92; 95% CI, 0.87-0.97), and planning failure (OR, 0.81; 95% CI, 0.70-0.95). The second donation decision was influenced by intention (OR, 1.44; 95% CI, 1.06-1.95) and planning failure (OR, 0.67; 95% CI, 0.57-0.78), while the third decision was influenced only by planning failure (OR, 0.85; 95% CI, 0.73-1.00). This indicates that for new donors, retention efforts should focus on the promotion of a positive intention and decreasing vasovagal reactions. However, decreasing planning failure could be an even better investment since planning seems to determine long-term retention.

Differential immunoregulation in successful oocyte donation pregnancies compared with naturally conceived pregnancies

In oocyte donation (OD) pregnancies, there is a higher level of antigenic dissimilarity between mother and fetus compared with naturally conceived (NC) pregnancies. We hypothesize that a higher degree and/or a different type of immunoregulation is necessary to maintain an uncomplicated OD pregnancy. Different immunological aspects of successful OD pregnancies (n=28) were compared with those of NC pregnancies (n=51), and non-donor IVF (n=20) pregnancies. Maternal peripheral blood mononuclear cells (mPBMCs) were characterized by flow cytometry; the outcome correlated with the number of mother–child HLA mismatches. The fetus-specific alloreactivity of mPBMCs was measured in a mixed lymphocyte reaction. The percentages of CD4+CD25bright and CD4+CD25dim cells were higher in mPBMCs of OD and IVF pregnancies compared with NC pregnancies. The percentage of CD4+CD25dim cells in mPBMCs of OD pregnancies correlated positively with the number of HLA mismatches. Functional studies showed a lower proliferative response to umbilical cord blood by mPBMCs in OD pregnancies. In conclusion, we found a higher degree of peripheral immunoregulation in OD and IVF pregnancies compared with NC pregnancies. A higher number of HLA mismatches in successful OD pregnancies leads to increased percentages of activated T cells in peripheral blood, but not to a higher alloreactivity to the fetus. These studies show that immunoregulation in OD pregnancy is different from that in NC pregnancies. The antigenic dissimilarity in OD pregnancies may play a role in the pathophysiology of preeclampsia.

Factors limiting organ donation in Baden‐Württemberg

In the German state of Baden-Wurttemberg, the number of deceased donors from whom organs have been recovered has been decreasing over the past several years. We questioned whether changing donor age and/or cause of death (COD) were contributing to this trend. All potential donors who reported to our regional Baden-Württemberg organ procurement organization were reviewed (2006-2010, n = 1771). Changes in age distribution and COD were analyzed, factors we thought might have affected the conversion from potential to successful organ donation. Between 2006 and 2010, the annual number of reported cases with subarachnoid hemorrhage (SAH) as the COD decreased from 117 to 65, while the number of deaths from other reasons increased from 264 to 294. Conversion rates were higher in the SAH group (56%) compared with the other reasons group (37%). Mortality rates are changing in certain devastating brain injuries. This, and other factors, may contribute adversely to organ donation rates.

Policy perspectives: international survey of nephrologists' perceptions of and attitudes towards rewards and compensation for kidney donation

The challenge to resolve the gap between supply and demand for organs is a global phenomenon. The possible solutions can invariably involve a range of ethical and moral dilemmas. This is certainly the case when considering rewards and compensation for kidney donation. In their thought provoking study, Ghahramami et al. provide the perspectives of medical professionals on these issues. The views of nephrologists concerning rewards and compensation chime with views of the public, which have been highlighted in many previous studies. Rewards and compensation for organ donation are perceived, by some, as barriers to successful organ donation transplant programmes; whereas others view them as potential facilitators to increasing organ donation rates. It is interesting to note that two-thirds of survey respondents believe that introducing some kind of reward or offering compensation would lead to an increase in organ donation. This finding is not unique to this study and is evident in many public surveys where respondents have expressed a belief that offering some form of incentive would have a positive impact on organ donation rates. Disappointingly, the debates concerning the type of reward or compensation and its potential impact on donation rates continue to take place in a relatively 'evidence base-free' vacuum. What is abundantly clear is that many lives continue to be lost in many countries due to a lack of suitable organs for transplant. What is less clear is which forms of reward and compensation actually have an impact on donation rates and whether they positively impact the life experiences of donors, recipients and their families. This level of evidence- base is urgently required.

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.

Optimización del proceso de donación de tejidos en un hospital universitario: 10 años de experiencia

Background and objectiveThe demand of tissue for transplants requires a continuous effort in detecting potential donors and assessing the causes of death. We aimed to assess the capacity to optimise tissue donation rates with the implementation of an active detection system of hospital deaths alongside a comprehensive assessment of the causes of death according to current international and local tissue banks’ standards. Material and methodAn early and pro-active detection programme of hospital deaths was implemented in 2002. The potential increase in donation was analysed according to modified criteria: age (80 to 85 years), acceptance of corneal phacoemulsification, autoimmune diseases, and sepsis reassessment. During the 2002-2011 decade, the criteria for absolute exclusion remained the same. The conversion rate from potential donors to actual donors of one or more tissue types was analysed. ResultsA total of 16.531 cases of cardiac arrest were analysed, and 11.191 of the cases fulfilled criteria of absolute exclusion. The modification of criteria led to an increase of potential donors: 10.4% age factor, 4.5% autoimmune diseases/phacoemulsification factor, 11.8% sepsis factor (P<.00). The study indicated a total increase of 16% (P<.00). A total of 2.371 successful donations were generated. The efficiency to generate donors increased from 11 to 21% during the aforementioned decade (P<.00). ConclusionA pro-active detection system of hospital deaths combined with a continuous re-assessment of the acceptance criteria for each tissue type in the hospital setting leads to an increase in the potential donors’ rate.

Successful Abdominal Organ Donation after Brain Death in a Patient with a Biventricular Assist Device: Extending Extended Criteria

Few studies address the potential for donation after brain death (DBD) in the limited population of patients with ongoing mechanical circulatory support (MCS). A case study was conducted reviewing available records of both donor and recipient, and available literature. The donor was a young female with an acute myocardial infarction precipitating emergent off-pump 2-vessel bypass graft complicated by profound cardiogenic shock refractory to inotropes and intra-aortic balloon pump. A heparin drip was started following percutaneous placement of a left ventricular-assist device (TandemHeart?) which improved her hemodynamics to stabilize for transfer. She ultimately required surgical placement of biventricular assist device (CentraMag?) to normalize hemodynamics. Two days post-operatively, she developed a cerebellar hemorrhage and was declared brain dead. Pre-donation blood chemistry showed adequate end-organ function. Both kidneys were placed locally. The liver was rejected for two regional status 1 patients and by all other local centers. We accepted the liver for a patient with polycystic liver disease with a MELD exception score of 20. The recipient is now 4 years post-transplant with excellent graft function. Extending donor criteria to include MCS patients can result in successful transplantation and should be considered in selected circumstances once satisfactory donor end-organ function is established.

Transparent Vessels?: What Organ Donors Should Be Allowed to Know about Their Recipients

A live organ donor needs to be informed carefully about the risks and benefits of her donation for both herself and her recipient, but a key ethical question is how much the donor is allowed to know about the recipient. To decide this question, we must first decide whether, out of respect for autonomy, the donor should decide how much she wants to know, or whether the transplant team, as the professionals, should decide what information is relevant to the donor's decision. I argue that the transplant team should control the process. While the donor has the right to know enough about her recipient to assess the risk to herself and the prospects for a successful donation, she is not entitled to any further information, no matter how much she wants it. In particular, I argue that donors are not entitled to information that has not been shown to affect outcomes, but that they should be told if a recipient is HIV or that he has rejected a previous organ due to non-compliance. Donors have a right to make decisions with all the information they need, but recipients need not make their lives completely transparent.

Approaching a Donation Rate of 30 pmp - Contributing Factors to a Successful Donation Program in Norway

Approaching a Donation Rate of 30 pmp - Contributing Factors to a Successful Donation Program in Norway

Approaching a Donation Rate of 30 pmp - Contributing Factors to a Successful Donation Program in Norway

Approaching a Donation Rate of 30 pmp - Contributing Factors to a Successful Donation Program in Norway

Donor awareness: key to successful voluntary blood donation

Donor awareness: key to successful voluntary blood donation

Donor awareness: key to successful voluntary blood donation

Context: The current regulatory requirements for donor eligibility pose a challenge to blood centers in recruitment of voluntary blood donors, particularly in a developing country like India where awareness of the general population is low and myths about blood donation are prevalent. This study evaluates the reasons and rates of donor deferral in a tertiary hospital-based blood bank in western India.Aim: To find rates and reasons for deferral of voluntary blood donors in a city in western India.Settings and design: A retrospective study was done on blood donors during a 3-month period. Data collection was done by electronic records of blood donors.Materials and Methods: The study was conducted retrospectively at a tertiary care hospital in western India. All those who donated whole blood between 1st January 2011 and 31st March 2011 were included in the study. Data was collected using local blood bank software.Statistical analysis used: No statistical technique used as it is a data article.Results: 60.5% of donors were young, below 30 years of age. Donors were predominantly male (91.6%). Voluntary donors comprised 88% of the donors. Total deferral rate was 22.36%, with 17.29% permanent deferrals and 82.71% temporary deferrals. Main reasons for deferral were anemia 39.42%, low body weight 14.29%, hypertension 10.73%, age below 18 years 10.73% and history of medication 6.09%. The common causes of deferral between our study and other similar studies are the same.Conclusion: We concluded that majority of the donor population belongs to 18–30-year-old age group. This is encouraging with a voluntary blood donation initiative. Donor self exclusion and strict donor selection criteria application should be addressed by more proactive measures to make blood donation a safe and pleasurable experience.

Donor awareness: key to successful voluntary blood donation

Donor awareness: key to successful voluntary blood donation