Human Split-Thickness Skin Allograft from Brain-Dead Donors.

BACKGROUND: Looking for an appropriate skin substitute for temporary and permanent coverage of wounds remains one of the main obstacles of medical researchers. OBJECTIVE: To investigate the rate of inflammation, symbiosis, and survival of grafted allograft skin from brain-dead donors (BDDs) in rabbits. METHODS: After receiving negative serologic tests of BDDs, we prepared partial thickness skin grafts. They were then used in treating wounds of 5 rabbits in comparison with split-thickness skins taken from cardiac dead donors. RESULTS: On histopathological examinations, we found no difference between the skins. All samples were separated from the baseline in 15-20 days. CONCLUSION: Gamma-irradiated freeze-dried human split-thickness skin taken from BDDs is safe and can be used for the treatment of deep skin burns.

Knowledge and Attitude of Iranian Physicians towards Organ and Tissue Donation.

BACKGROUND: Nowadays, organ transplantation is the treatment of choice for end-stage organ failure, which increases the importance of organ procurement. It seems that the attitude towards organ donation and transplantation affects people's satisfaction. Moreover, health care personnel, especially physicians, should be familiar with transplantation rules and standards. It seems that understanding the knowledge and attitude of this group can affect the transplantation center policies. OBJECTIVE: To assess knowledge and attitude of a group of Iranian physicians towards organ and tissue donation. METHODS: In a cross-sectional study, 560 Iranian physicians including nephrologists, urologists and internists were asked to fill out a validated questionnaire containing their demographics, knowledge and attitude towards organ and tissue donation and transplantation. RESULTS: Of 560 participants, 435 (78%) agreed with organ donation after death and 285 (51%) agreed with living kidney donation. The most common reason provided by those who agreed with donation was "helping people" whereas the most common cause of disagreement was "to honor the body." Only 32 (6%) physicians had no knowledge about transplantation rules. Complete awareness about theoretical basis and financial issues of transplantation was observed in 265 (47%) and 221 (40%) participants, respectively. CONCLUSION: Physicians had a good attitude towards organ and tissue transplantation although less than half of them had knowledge of transplantation rules and its theoretical basis and financial issues; therefore, additional awareness and education of physicians is needed in all areas of the organ donation process in Iran.

Comparison of various scoring methods for the diagnosis of protein-energy wasting in hemodialysis patients.

PURPOSE: The present study was designed to determine the cutoff points for the diagnosis of mild-to-moderate and severe protein-energy wasting (PEW) based on dialysis malnutrition score (DMS) and malnutrition inflammation score (MIS), and the sensitivity, specificity, accuracy, area under receiver operating characteristic (ROC) curve, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR(+)) and negative likelihood ratio (LR(-)) of DMS and MIS in comparison with subjective global assessment (SGA) in hemodialysis (HD) patients. METHODS: In this study, 291 HD patients were randomly selected from among 2,302 adult HD patients in Tehran hemodialysis centers. The PEW in these patients was determined by SGA, DMS and MIS. RESULTS: According to the cutoff points derived from the area under ROC curves, scores of 7-13 for DMS represented normal status or without PEW; 14-23, mild-to-moderate PEW; and 24-35, severe PEW. For MIS, scores of 0-7 represented normal status or without PEW; 8-18, mild-to-moderate PEW; and 19-30, severe PEW. In comparison with SGA, the sensitivity, specificity, accuracy, area under ROC curve, PPV, NPV, LR(+) and LR(-) of DMS were 94 %, 88 %, 92 %, 97 %, 93 %, 92 %, 7.8 and 0.07, respectively. Those of MIS were 87 %, 96 %, 91 %, 97 %, 97 %, 83 %, 22.0 and 0.13 in comparison with SGA, respectively. CONCLUSION: The results of the present study indicate that the DMS and MIS are almost similar to SGA for identifying PEW in HD patients, but it seems that the DMS is a more appropriate alternative tool for SGA in hospital routine assessments.

Human split-thickness skin allograft: skin substitute in the treatment of burn.

BACKGROUND: Human skin allograft has been used as wound coverage for a long time; it is one of the most successful and widely used dressings for burn wounds in the world. OBJECTIVE: To prepare a freeze-dried human split-thickness skin allograft and evaluate its cytotoxicity, the structure and physical properties after processing methods and clinical efficacy in burn patients. METHODS: After ensuring tissue safety, we lyophilized human cadaveric partial thickness skin and exposed it to gamma radiation. Histopathological and immunohistochemical properties, tensile strength and in vitro cytotoxicity were assayed for the skin samples. Then, we tested the samples in 11 patients with deep skin burn. RESULTS: On histological and histopathological examinations, we found a normal skin structure. The tensile strength of the rehydrated freeze-dried human skin allograft was not lesser than the fresh human skin. Cell viability in MTT testing was more than 95%. None of our patients showed any signs of immunological reactions or complications. CONCLUSION: Gamma-irradiated freeze-dried human split-thickness skin is safe and non-toxic and can be used for the treatment of patients with deep skin burn.

Hemodynamic factors affecting the suitability of the donated heart and kidney for transplantation.

BACKGROUND: Due to the loss of autonomic nervous system, precise control of the hemodynamic status in dead brain potential donors presents a clinical dilemma. In these patients, due to head trauma and cerebral edema, fluids administration is restricted. Moreover, the decreased central venous pressure may put the viability of the organs at risk. OBJECTIVE: To investigate hemodynamic factors affecting the suitability of the donated heart and kidney for transplantation. METHODS: Data were retrospectively collected from the maintained databases of all dead-brain donors (DBDs) admitted to our organ procurement unit (OPU) ICU between 1999 and 2008. In this study, laboratory variables in addition to demographic data were collected. The time between donor entrance to the DBD ICU and organ procurement, vital signs, hourly urine output, amount of IV fluid administered, and the dosage of vasopressor and desmopressin were recorded. The end-point of the study was organ suitability for organ retrieval. RESULTS: A total of 132 dead brain donors were studied. The mean±SD age of the donors was 26.3±12.2 years. The main cause of brain death was multiple trauma (53%). The organ retrieval rate was 82.6% for the kidney, 59.8% for the liver, and 53% for the heart. 83 (63%) and 106 (80.3%) donors had suitable hearts and kidneys, respectively. 66 cases did not receive desmopressin (50.4%) at all. The mean±SD dose of desmopressin the donors received was 7±1 µg. There was a significant association between the suitability of these two organs for transplantation and the dosage of the administered desmopressin and volume of IV solution the donors received. CONCLUSION: Fluid therapy and administration of desmopressin can improve the number and quality of retrieved organs from dead brain donors.

Comparative study of depression and consent among brain death families in donor and nondonor groups from March 2001 to December 2002 in Tehran.

OBJECTIVE: The aim of this research was to study the relationship between depression and organ donation among families of brain death cases. MATERIALS AND METHODS: This descriptive, cross-sectional study included a sample of first-degree relatives of brain death cases: 54 relatives among 27 organ donor families and 104 relatives among 58 nonorgan donor families participated in the research by the counting method. All families were questioned about their willingness for organ donation and at least 3 months had passed from their relative's death to the time we performed the research. Data were collected via a demographic questionnaire and Beck depression inventory (BDI) with a cutoff point of 16; persons with scores over 16 were considered depressed. Data were analyzed using descriptive statistics, Student t test, and chi-square test. RESULTS: Depression was observed in 20.4% of donor families and 17.3% of nondonor families; there was no significant difference between them. There were no significant differences in the frequency of depression between parents, spouses, and children of the 2 groups. The organ donors' relatives reported the effectiveness of organ donation to alleviate their grief: 66% completely and 32% partially. CONCLUSION: Organ donation does not have a significant effect on the course of grief and later depression among relatives of brain death cases.