Extended criteria donor organ use for heart-lung transplantation in the modern era

Abstract Background: Demand for donor hearts and lungs exceeds their supply. Extended Criteria Donor (ECD) organs are used to help meet this demand, but their impact on heart-lung transplantation outcomes is poorly characterized. Methods and results: The United Network for Organ Sharing was queried for data on adult heart-lung transplantation recipients (n = 447) from 2005‒2021. Recipients were stratified based on whether they received ECD hearts and/or lungs. Morbidity was analyzed using Kruskal-Wallis, chi-square, and Fisher's exact tests. Mortality was analyzed using Kaplan-Meier estimation, log-rank tests and Cox regression. Sixty-five (14.5%) patients received two ECD organs, 134 (30.0%) received only an ECD lung, and 65 (14.5%) only an ECD heart. Recipients of two ECD organs were older, more likely to have diabetes, and more likely transplanted from 2015‒2021 (p < 0.05). Groups did not differ by pre-transplant diagnosis, intensive care unit disposition, life support use, or hemodynam-ics. Group five-year survival rates ranged from 54.5% to 63.2% (p = 0.428). Groups did not differ by 30-day mortality, strokes, graft rejection, or hospital length of stay. Conclusions: Using ECD hearts and/or lungs for heart-lung transplantation is not associated with increased mortality and is a safe strategy for increasing donor organ supply in this complex patient population.

Analysis of conversion rate, organ procurement rate and influencing factors of organ donation: a single-center study in Fujian province / 器官移植

Objective To investigate the conversion rate, organ procurement rate and influencing factors of organ donation in a single center from Fujian province. Methods Baseline data of 182 potential organ donors of Fujian Medical University Union Hospital from November 2018 to June 2021 were retrospectively analyzed. The conversion rate of organ donation, baseline data of successful organ donors and the causes of failure of organ donors were identified. The organ procurement rate and the influencing factors of the number of organ donations were analyzed. Results Among 182 potential organ donors, 46 cases were successful organ donors with a conversion rate of 25.3%. In addition, 136 cases failed to donate organ. The main causes included disagreement from family members (58.1%), insufficient evaluation time (24.3%) and ineligible for donation criteria (17.6%). A total of 212 large organs and tissues were donated by 46 organ donors, including 88 kidneys, 42 livers, 15 lungs, 19 hearts and 48 corneas, with 4.6 large organs and tissues, and 3.6 large organs for each donor. Age, sex, native place, organ donation area and blood type were the influencing factors of the number of large organ donations. Organ donation area was the influencing factor of the number of tissue donations. Conclusions The conversion rate of organ donation is relatively low in a single center from Fujian province. Disagreement from family members is the main cause. Suitable potential organ donors should be selected for organ donation to improve the conversion rate and organ procurement rate of organ donation.

Seroprevalence of HTLV-1 and 2 in organ donors and kidney transplant recipients. Colombia 2010-2017

Abstract Since 2004, in Colombia, the detection of human T-cell lymphotropic virus type 1 and 2 (HTLV-1-2) has been recommended for organ donors and recipients. The prevention of HTLV-1 and 2 infection in recipients is important due to its relationship with lymphoproliferative and inflammatory diseases and opportunistic infections. The objective of this study was to describe the seroprevalence of HTLV-1 and 2 among organ donors and kidney transplant recipients between 2010 and 2017 in Colombia. Methods: this was a descriptive study which included 1979 organ donors and 3,311 kidney transplant recipients from the donation and transplant network from 2010 to 2017. The seroprevalence of HTLV-1 and 2 was calculated, and serological and demographic variables were described. Results: out of 1979 donors, detection of antibodies against HTLV-1 was performed in 92% (1820), with a seroprevalence of 0.2%; 50% of the cases were from the Pacific region (an endemic zone in Colombia). Ninety percent of the donors were examined for HTLV-2, with a seroprevalence of 0.2%. Of the 3311 kidney recipients between 2010 and 2017, only 44% were evaluated for HTLV-1 and 43% for HTLV-2. The seroprevalence for both viruses was 0.3%. Two of the HTLV-1 cases were positive for HLADRB1*01. Conclusions: the seroprevalence found in organ donors and kidney transplant recipients was similar to that previously reported in Colombia. Screening of all potential donors must be adhered to prevent transmission of this virus. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2001).

Long-term lung inflammation is reduced by estradiol treatment in brain dead female rats

OBJECTIVES: Lung transplantation is limited by the systemic repercussions of brain death (BD). Studies have shown the potential protective role of 17β-estradiol on the lungs. Here, we aimed to investigate the effect of estradiol on the long-lasting lung inflammatory state to understand a possible therapeutic application in lung donors with BD. METHODS: Female Wistar rats were separated into 3 groups: BD, subjected to brain death (6h); E2-T0, treated with 17β-estradiol (50 μg/mL, 2 mL/h) immediately after brain death; and E2-T3, treated with 17β-estradiol (50 μg/ml, 2 ml/h) after 3h of BD. Complement system activity and macrophage presence were analyzed. TNF-α, IL-1β, IL-10, and IL-6 gene expression (RT-PCR) and levels in 24h lung culture medium were quantified. Finally, analysis of caspase-3 gene and protein expression in the lung was performed. RESULTS: Estradiol reduced complement C3 protein and gene expression. The presence of lung macrophages was not modified by estradiol, but the release of inflammatory mediators was reduced and TNF-α and IL-1β gene expression were reduced in the E2-T3 group. In addition, caspase-3 protein expression was reduced by estradiol in the same group. CONCLUSIONS: Brain death-induced lung inflammation in females is modulated by estradiol treatment. Study data suggest that estradiol can control the inflammatory response by modulating the release of mediators after brain death in the long term. These results strengthen the idea of estradiol as a therapy for donor lungs and improving transplant outcomes.

Impacto del éxito en trasplantes debido al mantenimiento de órganos en terapia intensiva, a propósito de la primera donación multiorgánica en Chiapas, reporte de caso / Impact of success in transplants due to maintenance of organs in intensive therapy, apropos of the first multiorgan donation in Chiapas, case report / Impacto do êxito em transplantes devido a manutenção de órgãos na Unidade de Terapia Intensiva, a respeito da primeira doação multiorgânica em Chiapas, relato de caso

Resumen: Existe alta necesidad de órganos para trasplante en Chiapas y no hay registro previo de donación multiorgánica con fines de trasplante en el estado. Caso clínico: Hombre de 19 años con probable muerte encefálica debido a traumatismo craneoencefálico atendido en el IMSS y con imposibilidad de traslado a hospitales de tercer nivel, se coordinó la red chiapaneca de apoyo interinstitucional y en «Ciudad Salud¼ se diagnosticó muerte cerebral, se activó la red nacional de trasplantes y los equipos tardarían en llegar para procuración. El donador se mantuvo en terapia intensiva donde sus condiciones generales se mantuvieron de manera óptima, la donación fue exitosa gracias al apoyo multidisciplinario. Conclusión: En Chiapas la red de coordinación interinstitucional y el apoyo multidisciplinario fueron clave para la primera donación multiorgánica con fines de trasplante. El manejo en terapia intensiva fue crucial para el éxito de la donación.

Abstract: There is a high need of organs for transplantation in Chiapas and there is no previous registration of multiorgan donation for transplant purposes in the state. Case report: A 19 year old man with probably brain death due to traumatic brain injury treated at IMSS and unable to transfer to third level hospitals, the Chiapanecan interinstitutional support network was coordinated and in «Ciudad Salud¼, brain death was diagnosed, the national network of transplants was activated and the teams would arrive late for procurement, the donor stayed in Intensive Care Unit where their general conditions were maintained in optimal conditions, the donation was successful thanks to the multidisciplinary support. Conclusion: In Chiapas, the interinstitutional coordination network and multidisciplinary support were key for the first multiorgan donation for transplant purposes, the management in intensive care was crucial for the success of the donation.

Resumo: Há uma grande necessidade de órgãos para transplante em Chiapas e não há registro prévio de doação de múltiplos órgãos para fins de transplante no estado. Caso clínico: Homem de 19 anos com provável morte encefálica por traumatismo cranioencefálico tratado no IMSS e com inviabilidade de transferência para hospitais de terceiro nível, coordenou-se a rede Chiapaneca de apoio interinstitucional, na «Ciudad Salud¼ foi diagnosticada morte encefálica. Ativou-se a rede nacional de transplantes e as equipes chegariam atrasadas para a aquisição, o doador permaneceu em Terapia Intensiva onde suas condições gerais foram mantidas em condições ótimas, a doação foi bem sucedida graças ao apoio multidisciplinar. Conclusão: Em Chiapas a rede de coordenação interinstitucional e o apoio multidisciplinar foram fundamentais para a primeira doação de múltiplos órgãos para fins de transplante, o manejo em Terapia Intensiva foi fundamental para o sucesso da doação.

Status of Organ Donation and Solution of Organ Shortage in Korea / 대한이식학회지

Deceased organ donation in Korea has increased steadily after legislation of transplantation law. Since last year, however, several obstacles resulting in a decrease in organ donation have been experienced. Among them, the reduced reporting of potential brain death from large size hospitals and reduced consent rate of medically available deceased donors are two main hurdles. The consent rate of organ donation was 41.9% in 2017 but has dropped to approximately 10% than 2016. Other strong family members overrode approximately 10% of donations initially consented by their next of kin. In addition to the medical points, difficulties in labor shortage are being experienced during donor management, testing and organ recovery in the hospital. Some end stage patients who are candidates as organ donor give up further management and decide to withdrawing life sustaining treatment, which deprive the chance of donation. Moreover, the national mortality rate of cerebrovascular and traffic accidents, which occupy a major part of brain death, have decreased over the recent 10 years. All of these events can cause a decrease in brain death development so it is important to find solutions to overcome all of them. Revising transplant law and donation system should be led by government. Efforts to increase the consent rate, procurement rate, and transplant rate and decrease the organ discard rate are all the responsibility of the medical team. Public awareness and a positive attitude towards organ donation are the most important basic requirements for increasing organ donation. A comprehensive task force team to overcome all of these problems is requested.

A Preliminary Study to Revise the Marginal Donor Criteria of KONOS in Deceased Donor Kidney Transplantation / 대한이식학회지

BACKGROUND: The Korean Network for Organ Sharing (KONOS), which was established in December 31st, 1999, is a nationwide system of deceased donor detection and distribution. From its inception, KONOS has defined marginal donors and used this definition for over 15 years. However, this definition should be reevaluated to determine if it requires revision. This study was conducted to confirm the feasibility of the main study for revision of the marginal donor definition in deceased donor kidney transplantation. METHODS: This study is a retrospective meta-analysis of 786 patients who had deceased donor kidney transplant from six centers. After the data validation process, multivariable analysis was conducted to evaluate whether the marginal donor criteria of KONOS or UNOS expected adequately in terms of graft survival and delayed graft function (DGF). RESULTS: Neither the KONOS or UNOS criteria affected graft survival. Expanded criteria for donors of UNOS was a risk factor for DGF. However, KONOS criteria did not affect DGF. CONCLUSIONS: Based on this preliminary study, there is a need to conduct a study to revise the marginal donor criteria of KONOS in deceased donor kidney transplantation. Such a study should have large scale and long-term follow-up data.

La donación de órganos y tejidos: una realidad en el Hospital Carlos Andrade Marín. Actividad y registro de procesos de procuración durante el período de enero a diciembre de 2014 / Organ and tissue donation: a reality in the Carlos Andrade Marin Hospital. Activity and registering of the procurement process during the January 2014 to December 2014 period

Introducción: a nivel mundial nos enfrentamos al rápido incremento en la prevalencia de enfermedades crónicas que causan disfunción de órganos vitales por lo que se estima que existe un gran número de pacientes esperando recibir un trasplante. La probabilidad de fallecer en la lista de espera es alta, por lo que la procuración de órganos es un proceso indispensable en los hospitales. Objetivos: reportar los procesos y los resultados de la procuración de órganos y tejidos en el Hospital Carlos Andrade Marín, durante el período comprendido entre enero a diciembre de 2014, con el fin de fomentar y promover dicho proceso. Materiales y métodos: se trata de un estudio descriptivo y de reporte de proceso, en el cual se incluyeron a todos los pacientes neurocríticos que cumplían criterios de muerte encefálica como donantes multiorgánicos y pacientes en parada cardíaca como donantes de tejidos, durante el período de 1 de enero al 31 de diciembre de 2014. Resultados: durante el 2014 en el Hospital Carlos Andrade Marín, se realizaron 11 procesos de procuración de órganos y tejidos; nueve de ellos siendo considerados efectivos, se trató de pacientes ingresados en los servicios de críticos de emergencias y terapia intensiva, a causa de Traumatismo Craneoencefálico Severo en el 66,6% y el 33,3% a causa de Hemorragia Intraencefálica, diagnosticados con criterios de Muerte Encefálica. Entre octubre a diciembre de 2014 se llevaron a cabo el 77,7% de las procuraciones, reflejando la puesta en práctica de estrategias y el trabajo de la procuración intrahospitalaria. Conclusiones: la promoción de estrategias para promover el aumento de número de donantes efectivos es el pilar del proceso de trasplante de órganos en el Hospital Carlos Andrade Marín. La negativa de donación por parte de familiares es baja (un caso), a partir del correcto desarrollo de las actividades planteadas en cada parte del proceso de procuración descrito en el presente artículo.

Introduction: globally we face the rapid increase in the prevalence of chronic diseases, which often cause dysfunction of vital organs so it is estimated that there are a large number of patients waiting for a transplant. The probability of dying on the waiting list is high, so the organ procurement is an essential process in hospitals. Objectives: report the processes and results of the procurement of organs and tissues in the Carlos Andrade Marin Hospital during the period from january to december 2014, in order to encourage and promote this process. Materials and methods: this descriptive study reports the procurement process in which all neurocritical patients who met criteria for Brain Death as multiorgan donors and patients in cardiac arrest as tissue donors during the period included 1 january to 31 december 2014. Results: 11 organ procurement processes and tissues were performed during 2014 at the Carlos Andrade Marin Hospital; nine of them were considered effective. Organs came from patients admitted to the Critical Care Services in Emergency Room and Critical Care Medicine, causes of admission were: Severe Traumatic Brain Injury (66.6%) and intracerebral hemorrhage (33.3%), all diagnosed with criteria of death brain. Between october and december 2014 were held 77.7% of the activity, refecting the implementation of strategies and the work of the hospital procurement. Conclusions: the promotion of strategies to promote increased effective donors is the mainstay of the process of organ transplantation in the Carlos Andrade Marin Hospital. The refusal of donation from relatives is low (one case), thanks to the proper implementation of the proposed activities in every part of the procurement process described in this article.

Cuidado ao potencial doador: percepções de uma equipe de enfermagem / Care to potential donor: perceptions of a nurse team / Cuidado al donante potencial: percepciones del personal de enfermería

Pesquisa qualitativa, com o objetivo de conhecer as percepções de uma equipe de enfermagem acerca do cuidado ao potencial doador. Os dados foram obtidos por meio de entrevista semiestruturada, aplicada entre janeiro e março de 2011. Os resultados apontam que a equipe de enfermagem percebe o cuidado ao potencial doador como um cuidado que objetiva a preservação de órgãos e é favorecido por disponibilidade da tecnologia e de uma equipe multiprofissional na UTI, mas é complexo por envolver aspectos psicoemocionais e psicossociais sobre a morte.Concluiu-se que cuidar do potencial doador de órgão evoca, na equipe de enfermagem, sentimentos e crenças sobre morte e morrer que resultam em conflitos, negação e distanciamento que podem comprometer a qualidade do cuidado.

A qualitative research, aimed at understanding the perceptions of a nursing team in relation to the care to a potentialdonor. Data was collected through semi-structured interviews, performed between January and March 2011. The results demonstrated that the nursing staff perceives the care to the potential donor as a caution that aims to preserve organs, favored by availability of technology and a multidisciplinary ICU team, but it is complex because it involves psycho-emotional and psychosocial aspects of death. It is concluded that care to potential organ donor evokes feelings and beliefs about death and dying, resulting in conflicts, denial and detachment that can compromise the care quality.

Una investigación cualitativa con el fin de conocer las percepciones de un equipo de enfermería sobre el cuidadoal potencial donante. Los datos fueron recolectados a través de entrevista semiestructurada, aplicada entre enero ymarzo de 2011. Los resultados mostraron que el personal de enfermería percibe el cuidado del potencial donantecomo un cuidado que objetiva preservar órganos favorecidos por la disponibilidad de la tecnología y un equipomultidisciplinario en la UCI, pero es complejo porque involucra aspectos psico-emocionales y psicosociales de lamuerte. Se concluye que la atención a los donantes potenciales de órganos evoca, en el equipo de enfermería,sentimientos y creencias sobre la muerte y el morir que resultan en conflictos, la negación y el desapego que puedecomprometer la calidad de la atención.

Optimal Management of Brain Death Donor / 대한이식학회지

Since the Harvard criteria for brain death was proposed in 1968, deceased donor, mainly brain death donor (BD), organ transplantation has been performed worldwide and given the chance for a new life to patients suffering from end-stage organ disease. In Korea by the eager efforts promoting brain-dead organ donation, fortunately, the number of organ donations from the brain-dead has increased successfully in the last decade. However, the disparity between the number of patients awaiting organ transplantation on the list and the number of actual organ donations has become wider and the organ shortage remains a limitation for new lives by transplantation. Because of donor organ restriction, optimal management of brain-dead donors is increasingly important. In addition, the favorable clinical outcomes of recipients is directly associated with the well-preserved organ function of brain-dead donors, which can be accomplished by the maintenance of optimal perfusion. However the brain-dead condition leads to various and profound pathophysiological changes in the neuroendocrine and cardiovascular systems, and management of brain-dead organ donors usually includes active intensive care for maintaining organ function. Therefore, to enhance the potential organ graft function and increase the organ supply, physicians must have knowledge of the pathophysiology of brain death and must deal with rapid hemodynamic changes, endocrine and metabolic abnormalities, and respiratory complications. This article reviews the pathophysiologic changes resulting from brain death and the adequate management for maximizing use of organs recovered from brain death donors.

Liver Procurement / 대한이식학회지

With increasing demand for liver transplantation, liver grafts are used from marginal donors who were not considered suitable. This trend toward the use of marginal donors reinforces the need to balance the recipient's condition and graft quality and to perform a liver retrieval process with a proper method for preservation of liver function. Although the issues in organ procurement are debatable, rapid and high pressure perfusion for the aorta only with a cold dissection method can be an optimal method for the successful recipient outcome in liver transplantation using a marginal graft.

Activation Policy for Brain-dead Organ Donation / 이화의대지

Organ transplantation has become the standard of care for treatment of end stage organ failure patients medically suitable for transplantation. Unfortunately, the availability of transplantable organs has not been able to meet the high demand. The organ shortage of transplantation has become worldwide and a national crisis. Despite various attempts to expand the donor pool, the difference between organ supply and organ demand continues. This article reviews methods to increase the number of potential deceased organ donor and the number of organs per donor by aggressive donor management protocol.

Successful Brain Dead Donor Management with CRRT: A Case Report / 대한구급학회지

Brain death results in adverse pathophysiologic effects in many brain-dead donors with cardiovascular instability. We experienced a brain-dead donor with continuous renal replacement therapy (CRRT) who was in a severe metabolic, electrolyte derangement and poor pulmonary function. The thirty-nine-year-old male patient with subarachnoid hemorrhage and intraventricular hemorrhage was admitted into the intensive care unit (ICU). After sudden cardiac arrest, he went into a coma state and was referred to as a potential organ donor. When he was transferred, his vital sign was unstable even under the high dose of inotropics and vasopressors. Even with aggressive treatment, the level of blood sugar was 454 mg/dl, serum K+ 7.1 mEq/L, lactate 5.33 mmol/L and PaO2/FiO2 60.3. We decided to start CRRT with the mode of continuous venovenous hemodiafiltration (CVVHDF). After 12 hours of CRRT, vital sign was maintained well without vasopressors, and blood sugar, serum potassium and lactate levels returned to 195 of PaO2/FiO2. Therefore, he was able to donate his two kidneys and his liver.

Manuseio do potencial doador de múltiplos órgãos / Care of the potential organ donor

JUSTIFICATIVA E OBJETIVOS: O transplante de órgãos sólidos vem sendo considerado o tratamento de eleição para várias doenças terminais que afetam rim, pâncreas, fígado, coração e pulmão. Atualmente, o maior limitante às cirurgias dos transplantes é a escassez de órgãos. O objetivo deste estudo foi revisar aspectos fisiopatológicos da morte encefálica e resumir estratégias terapêuticas atuais, para o cuidado otimizado do doador, do que depende o sucesso dos transplantes. CONTEÚDO: A morte encefálica é uma síndrome inflamatória que pode rapidamente produzir alterações deletérias nos órgãos dos potenciais doadores. Esse contexto de instabilidade hemodinâmica, metabólica e eletrolítica, exige do intensivista cuidados especiais com o doador de múltiplos órgãos. CONCLUSÔES: O adequado conhecimento da complexa fisiopatologia envolvendo a morte encefálica é de fundamental importância para que se implemente de forma racional um protocolo de manuseio agressivo do potencial doador, o que certamente resultará num aumento de órgãos captados e do número de órgãos captados por doador, além da redução das taxas de disfunção primária dos enxertos transplantados.

BACKGROUND AND OBJECTIVES: Organ transplantation has long been considered the treatment of choice for many end-stage organ diseases. As soon as transplantation turned to be a viable therapy, organ shortage became the major limitation for the procedures. Nowadays, there is an increasing imbalance between organ supply and demand. Apparently, the most promising way to increase organ supply is optimizing the care for the brain death organ donor. The objective of this manuscript was to review the pathophysiological aspects and therapeutic strategies for the optimized care of the potential organ donor. CONTENTS: Brain death causes a massive catecholamine release, inducing a variety of deleterious effects that can threat organ perfusion. Studies have documented a sudden decrease in cortisol, insulin, thyroid and pituitary hormones. In this scenario of hemodynamic and metabolic instability, a special attention to the multiple organ donor support is required. CONCLUSIONS: An extensive knowledge of the complex brain death pathophysiology is extremely important for the implementation of rational aggressive management protocols of the potential organ donor, aiming to increase the number of harvested organs and the number of organs harvested per donor.

Potential Organ Donor Pool for Renal Transplantation in Intensive Care Unit and Emergency Room : Single center study for donor action program / 대한이식학회지

Organ shortage remains a main obstacle to the development of organ transplantation for end stage organ disease. Identification of potential donors is a key point of donation/transplantation process. We evaluated the entire potential organ donor developed in intensive care unit and emergency room to find out the way to improve the real donation program .Pro-and retrospective analysis were performed in death patient occurred in intensive care unit and emergency room between May. 1997 and Oct. 1997. There are 394 death patients in ICU and 324 in ER during study period. 293 patients (74.3%) were eliminated by age under 1 year or over 70 years, and medical disease unsuitable for organ transplantation. After a series of elimination due to no possibility of brain death or organ unsutability, 35 patients (8.9%) finally were found to be a acceptable potential donors for organ transplantation in ICU, and 3 (0.9%) in ER. 28 of the 35 potential donors (80.0%) were found in neurology or neurosurgery ICU. Causes of brain death in 35 potential donors were traumatic intracerebral injury in 10 (29.4%), and non traumatic intracranial cerebral catastrophe in 21 (61.8%). Actual multiorgan harvest was performed in 2 (5.7%) among 35 medically acceptable potential donors in ICU. Three (8.6%) among 35 potential donors refused organ donation by donor families, 29 (82.9%) could not be actual donors due to absence of any information on organ donation to families of donors. Conclusively organ donation rate and efficacy from the potential donor are very poor in this series. Comprehensive donor action programs including practical donor detection program with donor linker, education program to medical staff and public are mandatory to increase the cadaveric organ donation effectively.