Organ donation and transplantation in migrants: Piedmont reality from 2004 to 2011.

BACKGROUND: Over the last 20 years, an increasing number of people have immigrated into Italy. On January 1, 2011, there were 4,570,317 foreign residents in Italy, including 398,910 in the Piedmont region (Italian National Statistics Institute data). The Romanian community was the largest, followed by the Moroccan and Albanian ones. The numbers are even layer if we consider illegal immigrants. As a result, the number of foreign people with brain death has increased, as well as the number of foreign people needing organ transplantations. METHODS: The Piedmont Regional Coordination Agency of Tissue and Organ Procurement has analyzed our 1781 brain death situations between January 2004 and December 2011, including 126 (7%) in people not born in Italy (migrants). RESULTS: Non-refusal for donation occurred in 79 cases (62.7%). The agency also analyzed each community looking at number of brain deaths and non-refusals of donation. We utilized 61 donors, for 174 transplantations. Migrants in Italy are not only potential tissue and organ donors, but also potential tissue and organ recipients. Between 2004 and 2011, 222 patients who had not been born in Italy had been transplanted with: a liver (n = 66), a kidney (n = 130), a heart (n = 21) or a lung (n = 5).

Extracorporeal membrane oxygenation as a bridge to organ donation: a case report.

Hemodynamic instability is a frequent complication in potential organ donors. Despite maximal medical therapy, it can lead to cardiac arrest with consequent loss of organs. In this study we present the use of extracorporeal membrane oxygenation circulation (ECMO) as a bridge to organ procurement in a potential donor with hemodynamic instability. A 14-year-old girl who drowned in a pool experienced cardiorespiratory arrest with prolonged resuscitation. In the intensive care unit (ICU), she displayed hemodynamic instability requiring high doses of inotropis agents. After 60 hours for ICU admission clinical diagnosis of brain death, was established and consent for organ donation obtained. During the observation period, the hemodynamic instability worsened, requiring ECMO which was continued during transport to the operating room and during organ retrieval, totaling 3 hours. We retrieved liver, kidneys, heart valves and cornea. Liver and kidney transplantations were successfully performed in 3 recipients, all of whom displayed appropriate organ functions after 15 months. In conclusion, ECMO support of potential donors can be used to prevent cardiac arrest, preserve organs, and thus increase the number of potential donors.

Similarity between the suprasystolic wideband external pulse wave and the first derivative of the intra-arterial pulse wave.

BACKGROUND: Wideband external pulse (WEP) monitoring, using a broad bandwidth piezoelectric sensor located over the brachial artery under the distal edge of a sphygmomanometer cuff, can be used for evaluating the contour of the arterial pressure pulse wave. The pulse contour contains valuable information relating to cardiovascular function which may be of clinical use in addition to blood pressure measurements. The aim of this study was to compare the shape of the WEP signal during inflation of the cuff to suprasystolic pressure, with intra-arterial pressure waves, after the administration of vasoactive drugs. METHODS: Radial intra-arterial and suprasystolic WEP waveforms were recorded in 11 healthy men (mean 23 yr) before and at the end of infusion of glyceryl trinitrate, angiotensin II, norepinephrine, and salbutamol. Waveform similarity was assessed by comparing the timing and pressure of incident and reflected waves and by root mean square error (RMSE). RESULTS: The WEP signal was found to closely resemble the first derivative of intra-arterial pressure. The WEP signal could be used to derive an arterial pressure wave with minimal bias in the timing of incident [- 8 (18) ms, mean (SD)] and reflected [- 1 (24) ms] waves. Augmentation index was underestimated by WEP [- 7 (18)%]. WEP also provided a measure of compliance which correlated with pulse wave velocity (r = - 0.44). RMSE values after the administration of each of the four drugs mentioned earlier were 12.4 (3.8), 17.7 (5.0), 22.1 (11.7), and 28.9 (22.4) mm Hg, respectively. Changes in derived WEP signals were similar to those measured by arterial line with all drugs. CONCLUSIONS: The suprasystolic WEP signals can be used to derive arterial pressure waves which, although not identical, track changes in the intra-arterial pulse wave induced by vasoactive drugs.

Impact of highly active antiretroviral therapy in HIV-positive patients with cardiac involvement.

OBJECTIVES: Cardiac involvement is frequently observed in HIV-infected patients, especially in those in the late stage of the disease. This study was designed to evaluate the impact of highly active antiretroviral therapy (HAART) in patients with cardiac involvement. METHODS: A retrospective study of 1042 patients admitted to a Division of Infectious Diseases between 1989 and 1998. During the period 1989-1995, 544 patients were treated with nucleoside reverse transcriptase inhibitors (NRTI), whereas 498 patients were treated with HAART during the period 1996-1998. RESULTS: Cardiac involvement, including arrhythmias, pericarditis, ischaemia, dilated cardiomyopathy, endocarditis, pulmonary hypertension, and myocarditis were observed in 282 of 544 (51.8%) patients treated with NRTI, compared with 93 of 498 (18.6%) patients with HAART (P < 0.0001). CONCLUSIONS: HAART has significantly decreased the incidence of cardiac involvement, especially pericarditis, arrhythmias, and dilated cardiomyopathy.