Histological, Laboratorial, and Clinical Benefits of an Optimized Maintenance Strategy of a Potential Organ Donor-A Rabbit Experimental Model.

INTRODUCTION: Most transplanted organs are obtained from brain-dead donors. Inflammation results in a higher rate of rejection. Objectives: The objective of this animal model of brain death (BD) was to evaluate the effect of the progressive institution of volume expansion, norepinephrine, and combined hormone therapy on clinical, laboratory, and histological aspects. Methods: Twenty rabbits were divided: A (control), B (induction of BD + infusion of crystalloid), C (BD + infusion of crystalloid and noradrenaline (NA)), and D (BD + infusion of crystalloid + vasopressin + levothyroxine + methylprednisolone + NA). The animals were monitored for four hours with consecutives analysis of vital signs and blood samples. The organs were evaluated by a pathologist. Results: In Group D, we observed fewer number and lesser volume of infusions (p = 0.032/0.014) when compared with groups B and C. Mean arterial pressure levels were higher in group D when compared with group B (p = 0.008). Group D had better glycemic control when compared with group C (p = 0.016). Sodium values were elevated in group B in relation to groups C and D (p = 0.021). In Group D, the organ perfusion was better. Conclusion: The optimized strategy of management of BD animals is associated with better hemodynamic, glycemic, and natremia control, besides reducing early signs of ischemia.

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

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 hemodynamics. 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.

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.

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).

Latex anaphylaxis in a recipient child during kidney transplant performed in a latex-free environment: case report.

Latex responds for most allergic reactions in children, and repeated exposure to the agent is the main cause of sensitization. We report the case of a child allergic to latex who developed anaphylaxis during kidney transplantation performed in a latex-free environment. After immediate treatment with epinephrine the patient gradually improved. Subsequent investigation revealed that kidney harvesting was performed without latex allergy precautions, suggesting graft contamination by the antigen. We conclude that, for preventing this type of anaphylaxis, it is essential to implement latex-free procedures during donor organ harvesting.

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.

Sex differences in the coagulation process and microvascular perfusion induced by brain death in rats.

Brain death (BD) leads to a systemic inflammation associated with the activation of coagulation, which could be related to decreased microcirculatory perfusion. Evidence shows that females exhibit higher platelet aggregability than males. Thus, we investigated sex differences in platelets, coagulation and microcirculatory compromise after BD. BD was induced in male and female (proestrus) Wistar rats. After 3 h, we evaluated: (i) intravital microscopy to evaluate mesenteric perfusion and leucocyte infiltration; (ii) platelet aggregation assay; (iii) rotational thromboelastometry; and (iv) Serum NOx- . Female rats maintained the mesenteric perfusion, whereas male reduced percentage of perfused vessels. Male BD presented higher platelet aggregation than the controls. In contrast, female BD had lower platelet aggregation than the control. Thromboelastometry indicated a reduction in clot firmness with increased clotting time in the female group compared with the male group. Serum NOx- level in female BD was higher than that in the male BD and female control. There is sex dimorphism in platelet function and clotting process, which are altered in different ways by BD. Thus, it is possible to connect the reduction in microcirculatory perfusion in males to intravascular microthrombi formation and the maintenance of perfusion in females to a higher inflammatory response and NO synthesis.

Statistical analysis plan for a cluster-randomised trial assessing the effectiveness of implementation of a bedside evidence-based checklist for clinical management of brain-dead potential organ donors in intensive care units: DONORS (Donation Network to Optimise Organ Recovery Study).

BACKGROUND: The quality of clinical care of brain-dead potential organ donors may help reduce donor losses caused by irreversible or unreversed cardiac arrest and increase the number of organs donated. We sought to determine whether an evidence-based, goal-directed checklist for donor management in intensive care units (ICUs) can reduce donor losses to cardiac arrest. METHODS/DESIGN: The DONORS study is a multicentre, cluster-randomised controlled trial with a 1:1 allocation ratio designed to compare an intervention group (goal-directed checklist for brain-dead potential organ donor management) with a control group (standard ICU care). The primary outcome is loss of potential donors due to cardiac arrest. Secondary outcomes are the number of actual organ donors and the number of solid organs recovered per actual donor. Exploratory outcomes include the achievement of relevant clinical goals during the management of brain-dead potential organ donors. The present statistical analysis plan (SAP) describes all primary statistical procedures that will be used to evaluate the results and perform exploratory and sensitivity analyses of the trial. DISCUSSION: The SAP of the DONORS study aims to describe its analytic procedures, enhancing the transparency of the study. At the moment of SAP subsmission, 63 institutions have been randomised and were enrolling study participants. Thus, the analyses reported herein have been defined before the end of the study recruitment and database locking. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03179020. Registered on 7 June 2017.

The influence of female sex hormones on lung inflammation after brain death - an experimental study.

Organ donor's age negatively influences graft survival of organs, increasing risk of complications. Aging occurs in both men and women; however, the menopause marks a decrease in sex hormones and a sudden increase in the process of vascular aging. We investigated sex hormones' influence on the lung inflammatory process induced by BD in female rats. Wistar rats were grouped as: female rats from high estradiol to heat period (non-OVx) and ovariectomized (OVx) female rats. Ovariectomy was carried out 10 days before BD. BD was induced using intracranial balloon rapid inflation. Serum hormones and inflammatory mediators were quantified, leukocytes and platelets counted and lung samples were collected for RT-PCR, immunohistochemical, and histological analysis. Female sex hormones and corticosterone were reduced 6 h after BD in non-OVx group. The infiltration of leukocytes in female non-OVx lungs was higher compared to OVx. G-CSF, VEGF, and CINC-1 were found increased in non-OVx group serum in comparison to OVx. Lung mediators were increased in non-OVx rats compared to controls. The acute reduction of sex hormones induced by BD appears to have a worse effect on lung inflammation than a reduction that has happened over a prolonged period of time, allowing a physiological adaptation prior to BD.

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.

Hypertonic Saline Modulates Heart Function and Myocardial Inflammatory Alterations in Brain-Dead Rats.

BACKGROUND: Brain death (BD) in potential organ donors is responsible for hemodynamic instability and organ hypoperfusion, leading to myocardial dysfunction. Hypertonic saline (HS) is a volume expander with positive effects on hemodynamics and immunomodulation and was tested in this study to prevent left ventricular (LV) dysfunction and myocardial injury. METHODS: BD was induced in anesthetized Wistar rats by inflating a subdural balloon catheter, except in sham-operated animals (n = 6). After BD induction, Control animals received only normal saline solution (NaCl 0.9%, 4 mL/kg; n = 6), and treated animals were divided to receive HS (NaCl, 7.5% 4 mL/kg) at 1 min (HS1, n = 6) or 60 min (HS60, n = 6) thereafter. We continuously assessed cardiac function for 6 h with LV pressure-volume analysis. Inflammatory response, markers of myocardial injury, and cellular apoptosis-related proteins were investigated. RESULTS: BD was associated with decreased LV systolic and diastolic function. In comparison with the Control group, HS treatments improved LV ejection fraction (HS1, 51% [40-66]; HS60, 71% [28-82]; Control, 46% [23-55]; P < 0.05) and other parameters of LV systolic function 6 h after BD induction. However, no ventricular relaxation advantages were observed during the same period. HS treatments increased antiapoptotic protein expression and decreased vascular adhesion molecule and tumor necrosis factor alpha expression. No significant differences in histologic or structural protein changes were observed between groups. CONCLUSIONS: The observed data suggest that HS ameliorates LV systolic dysfunction and seems to reduce myocardial tissue compromise in BD rats, even when the treatment is performed during the process triggered by this event.

Evaluation of Kidney Donors: Core Curriculum 2018.

Nearly 100,000 patients are waiting for a kidney transplant, yet each year only 11,000 undergo transplantation with a deceased donor kidney. Annual death rates among waitlist registrants range from 5% to 15%; many die before receiving a transplant. Not surprisingly, registrants turn to family and friends to become living kidney donors on their behalf. Living kidney donor selection practices aim to quantify lifetime risk for kidney failure based on a candidate's predonation demographic and health characteristics. It has been established that estimated lifetime risk for kidney failure varies considerably based on predonation comorbid conditions, and as such, it is of paramount importance that potential living donor candidates undergo proper medical, surgical, and psychosocial screening before donation. This installment of AJKD's Core Curriculum in Nephrology provides readers with the tools necessary for proper evaluation of living kidney donor candidates.

Positive impact of a clinical goal-directed protocol on reducing cardiac arrests during potential brain-dead donor maintenance.

BACKGROUND: The disproportion between the large organ demand and the low number of transplantations performed represents a serious public health problem worldwide. Reducing the loss of transplantable organs from deceased potential donors as a function of cardiac arrest (CA) may contribute to an increase in organ donations. Our purpose was to test the hypothesis that a goal-directed protocol to guide the management of deceased donors may reduce the losses of potential brain-dead donors (PBDDs) due to CA. METHODS: The quality improvement project included 27 hospitals that reported deceased donors prospectively to the Transplant Center of the State of Santa Catarina, Brazil. All deceased donors reported prospectively between May 2012 and April 2014 were analyzed. Hospitals were encouraged to use the VIP approach checklist during the management of PBDDs. The checklist was composed of the following goals: protocol duration 12-24 hours, temperature > 35 °C, mean arterial pressure ≥ 65 mmHg, diuresis 1-4 ml/kg/h, corticosteroids, vasopressin, tidal volume 6-8 ml/kg, positive end-expiratory pressure 8-10 cmH2O, sodium < 150 mEq/L, and glycemia < 180 mg/dl. A logistic regression model was used to identify predictors of CA. RESULTS: There were 726 PBDD notifications, of which 324 (44.6) were actual donors, 141 (19.4 %) CAs, 226 (31.1 %) family refusals, and 35 (4.8 %) contraindications. Factors associated with CA reduction included use of the checklist (odds ratio (OR) 0.43, p < 0.001), maintenance performed inside the ICU (OR 0.49, p = 0.013), and vasopressin administration (OR 0.56, p = 0.04). More than three interventions had association with less CAs (OR 0.19, p < 0.001). After 24 months, CAs decreased from 27.3 % to 14.6 % (p = 0.002), reaching 12.1 % in the following two 4-month periods (p < 0.001). Simultaneous increases in organ recovered per donor and in actual donors were observed. CONCLUSIONS: A quality improvement program based on education and the use of a goal checklist for the management of potential donors inside the ICU is strongly associated with a decrease in donor losses and an increase in organs recovered per donor.

The effect of brain death protocol duration on potential donor losses due to cardiac arrest.

BACKGROUND: The severe inflammatory reaction that occurs after brain death (BD) tends to amplify over time, contributing to cardiovascular deterioration and occurrence of cardiac arrest (CA). Our purpose is to evaluate the effect of BD protocol duration (BDPD) on potential donor losses due to CA. METHODS: This retrospective analysis included potential donors reported during the period from May 2012 to April 2014. The risk of losses due to CA was analyzed to identify the chronological threshold at which the probability of loss due to CA increases. RESULTS: Three hundred and eighty-four potential donors were analyzed. There was a greater chance of CA after a 30-hour threshold (OR 1.67, 95% CI: 1.38-1.83), and the lowest risk of was identified for the range from 12 to 30 hours (OR 0.32, 95% CI: 0.19-0.52). Multivariate analysis identified the following variables as being associated with lower occurrence of CA: BDPD between 12 and 30 hours, management of a potential donor inside the intensive care unit, and the adherence to a goal-directed protocol. CONCLUSION: A long duration between the first clinical test for BD diagnosis and the procurement of organs may be an important risk factor for the occurrence of cardiac arrest in deceased potential donors.

Transplantation of "high-risk" donor hearts: Implications for infection.

BACKGROUND: Heart transplantation is the gold-standard treatment for end-stage heart failure. Short- and long-term outcomes have been excellent, but the shortage of organs persists. The number of potential recipients who die while awaiting orthotopic heart transplantation increases yearly. In 2004, the label "high-risk donor" (HRD) was applied, by the United Network for Organ Sharing (UNOS), to any organ donor who met the Centers for Disease Control (CDC) criteria for behavior that put them at high risk of infection. Despite organ shortages, grafts from HRD CDCs are often declined, because of concerns regarding infection. We undertook this study to analyze our extensive experience with orthotopic heart transplantation of grafts from HRD CDCs, and to determine the short- and long-term outcomes associated with recipients of hearts from HRD CDCs, particularly transmission of infection. METHODS: We performed 367 heart transplantations at our center from September 2008 to September 2014, a timeframe during which the HRD CDC labeling had been implemented. Of the total number of orthotopic heart transplantations performed, 55 patients (15%) received organs from HRD CDCs that had known negative serology for human immunodeficiency virus (HIV), hepatitis B, and hepatitis C. We reviewed demographic, perioperative, and short- and long-term outcomes. The recipients of grafts from HRD CDCs were followed closely, with 3- and 12-month surveillance laboratory testing of viral load for HIV, for hepatitis B, and for hepatitis C core- and surface-antigen serology. RESULTS: All 55 patients (72.7% were men) underwent a successful transplantation procedure. One patient was excluded from follow-up analysis because he was re-transplanted within 4 days owing to the posttransplant finding of metastatic lung adenocarcinoma within the donor. Primary etiology of heart failure was ischemic in 18 of the patients. The most common blood type was O positive, in 20 patients (37.1%), followed by A positive, in 19 patients (35.2%). A total of 19 (35.2%) patients were supported with a mechanical assist device before the transplantation. The average allograft ischemic time was 173 ± 96 minutes. The median length of hospital stay was 19.5 days. A low incidence was observed of the postoperative complications of stroke (1.9%), dialysis (3.9%), and complete heart block (3.9%). Kaplan-Meier analysis demonstrated excellent survival, both short-term (1 year; 94%) and long-term (3 years; 80%). Allograft function was excellent at time of discharge with a left ejection fraction of 67.8% ± 7.3%. Only one patient (1.9%) was noted to have hepatitis C seroconversion at 105 days after receiving the transplant. After antiviral treatment, the patient has had undetectable viral loads to date. All other patients had undetectable plasma viral loads of HIV, hepatitis C, and hepatitis B, determined using rigorous testing. CONCLUSIONS: We present the only single-center series on recipients of heart transplants from HRD CDCs. This potential source of suitable donor organs is shown to lead to excellent survival, without an increased incidence of perioperative or postoperative complications. Furthermore, the risk of transmission of infection from donors in this subgroup seems to be minimal.

A simple bedside approach to therapeutic goals achievement during the management of deceased organ donors--An adapted version of the "VIP" approach.

The disproportion between the supply and demand of transplant organs could be alleviated by improving the quality of clinical management of deceased potential donors. As a large number of donor losses by cardiac arrest occur due to hemodynamic instability, without instituting all essential maintenance measures, it is likely that the application of simplified potential donor maintenance protocols will help to decrease potential donor losses and increase the supply of organs for transplantation. The Ventilation, Infusion and Pumping (VIP) strategy is a mnemonic method that brings together key aspects of the restoration of oxygen delivery to tissues during hemodynamic instability: adequate mechanical Ventilation, volume Infusion and evaluation of heart Pump effectiveness. The inclusion of the additional initials, "P" and "S," refers to Pharmacological treatment and Specificities involved in the etiology of shock. The use of simplified care standards can assist in adhering to essential potential donor management measures. Therefore, using a simplified method as the adapted VIP approach can contribute to improving management standards of potential organ donors and increasing the supply of organs for transplantation.

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.

[Transplant coordinator: organ donation process]. / Coordinador de trasplantes: proceso de donación de órganos.

BACKGROUND: Spain is a leader in organ donations although it seems that this number does not increase in the same proportion that the waiting list and it is necessary to decrease the refusal situations, which are ~16%. METHOD: Analytic study. We review the reports prepared by the coordinators of transplants archived at the hospital La Fe during the period between May 1, 2004 and December 31, 2007, resulting in conceptualization and categorization. RESULTS: Sixty-nine topics were obtained from the point of view of the family and 11 from the point of view of the interviewer. After its conceptualization, codification and classification, we proceeded to create an appropriate text. CONCLUSIONS: Certain guidelines may be offered that allow us to standardize the action of transplant coordinators during the interview and to be more effective.

Antecedentes: España se mantiene a la cabeza del mundo en donaciones, aunque parece que su número no aumenta en la misma proporción que las listas de espera, lo que hace necesario disminuir las situaciones de negativa cifradas en torno al 16%. Objetivo: analizar los informes de los coordinadores de trasplantes, conceptualizarlos y categorizarlos. Material y métodos: estudio retrospectivo y descriptivo de los informes elaborados por los coordinadores de trasplantes archivados en el Hospital La Fe, entre el 1 de mayo de 2004 y el 31 de diciembre de 2007. Resultados: se extrajeron 69 temas desde el punto de vista de la familia y 11 del de los entrevistadores, que se conceptualizaron, codificaron y clasificaron para textualizarlos de manera ordenada. Conclusiones: con el fin de lograr mayor efectividad podrían plantearse determinadas pautas para homogeneizar la acción de los coordinadores de trasplante en la entrevista.