[How many potential organ donors are there really? : Retrospective analysis of why determination of irreversible loss of brain function was not performed in deceased patients with relevant brain damage]. / Wie viele potenzielle Organspender gibt es wirklich? : Retrospektive Analyse zu nichterfolgter Diagnostik des irreversiblen Hirnfunktionsausfalls bei verstorbenen Patienten mit relevanter Hirnschädigung.

BACKGROUND: No systematic study has previously been undertaken in Germany to ascertain why irreversible brain death determination (BDD) has not been carried out. OBJECTIVE: A comprehensive analysis of reasons for unperformed BDD in deceased patients with acute, severe brain damage could improve the identification of potential organ donors. METHOD: Using the Transplantcheck program of the German Organ Transplantation Foundation (DSO) an analysis of the data from 2016 was undertaken in participating hospitals in Saxony, Saxony-Anhalt and Thuringia (Region East of the DSO), regarding why a BDD was not initiated in deceased patients with primary or secondary brain damage. RESULTS: In 128 of the 144 Region East hospitals, 7889 deceased patients with primary or secondary brain damage were detected. In 7389 patients a BDD was out of the question for a variety of reasons. In 232 patients organ donation was not considered due to an advance directive. In 195 cases treatment was limited based on the patient's infaust neurological prognosis without the possibility of organ donation being discussed with relatives. In 73 cases initiation of BDD was indicated but not performed. CONCLUSION: The number of potential organ donors in Region East of the DSO could be significantly increased by identifying patients where BDD is indicated. By consistent evaluation of patients' wills in terms of organ donation before treatment is withdrawn in patients with poor neurological prognosis, additional potential organ donors could be identified. Furthermore, involving neurointensive care physicians in the care of all patients with brain damage could improve the prognostic assessment.

Postnatal development of sex differences in renal tubular transport of p-aminohippurate (PAH) in rats.

Compared with female rats a distinctly higher rate of accumulation of p-aminohippurate (PAH) in renal cortical slices from mature male rats can be proved; there are no sex differences in young rats with immature kidney function. Postnatal development of sex differences in kidney weight shows the same pattern. The lack of sex differences in the renal excretion of PAH in all age groups could be caused by a higher fraction of glomerularly filtered PAH in female rats. In mature male rats the high rate of tubular transport of PAH can be diminished by castration or by blockade of testosterone receptor sites (treatment with cyproterone). Stimulation of PAH transport by repeated treatment with testosterone is more expressed in male than in female rats. Furthermore, estrogens seem not to be responsible for sex differences in renal tubular transport of PAH (no influence of ovarectomy, low effects of treatment with estradiol in male rats).