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4.
J Card Surg ; 36(3): 1148-1149, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33448478

RESUMO

Coronavirus disease-2019 has created unprecedented challenges for society, and specifically the medical community. While the pandemic continues to unfold, the transplant community has had to pivot to keep recipients, donors, and institutional transplant teams safe given the unique circumstances inherent to solid organ transplantation.


Assuntos
/epidemiologia , Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Pandemias , Obtenção de Tecidos e Órgãos/métodos , Transplantados , Comorbidade , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doadores de Tecidos
5.
Clin Med (Lond) ; 21(1): e92-e93, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33479084

RESUMO

In May 2020, the new 'opt-out' organ donation law was passed in England. This law is a crucial step to help battle the long waiting lists of patients awaiting a transplant. This article aims to explore some of the challenges that the transplant teams may face with the new law, as well as raising awareness among the junior doctors, especially with the new COVID-19 transplant guidelines. Successful transplantations require immense training of healthcare professionals, fast retrieval services, pre- and postoperative care of patients, intensive care management, life-long follow-up and management of patients. Organ transplant surgery is a life-changing moment for a patient. Ultimately, commissioning groups, clinicians and managers need to work together, evaluate the changes required and enact thorough business plans to ensure the NHS is not overwhelmed. Together with increasing the awareness of organ donation within the public, the government needs to support the NHS to fund, train and manage transplant centres to welcome this much-awaited 'opt-out' organ donation law in England successfully.


Assuntos
/epidemiologia , Pesquisa Qualitativa , Medicina Estatal , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Comorbidade , Inglaterra , Humanos , Pandemias
6.
Emerg Med Clin North Am ; 39(1): 217-225, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218659

RESUMO

The emergency department is where the patient and potential ethical challenges are first encountered. Patients with acute neurologic illness introduce a unique set of dilemmas related to the pressure for ultra-early prognosis in the wake of rapidly advancing treatments. Many with neurologic injury are unable to provide autonomous consent, further complicating the picture, potentially asking uncertain surrogates to make quick decisions that may result in significant disability. The emergency department physician must take these ethical quandaries into account to provide standard of care treatment.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Assistência Terminal/ética , Manuseio das Vias Aéreas/ética , Manuseio das Vias Aéreas/métodos , Beneficência , Morte Encefálica/diagnóstico , Lesões Encefálicas Traumáticas/diagnóstico , Serviço Hospitalar de Emergência/ética , Procedimentos Endovasculares/ética , Ética Médica , Humanos , Consentimento Livre e Esclarecido/ética , Prognóstico , Acidente Vascular Cerebral/terapia , Obtenção de Tecidos e Órgãos/ética
7.
J Surg Res ; 257: 468-476, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32896815

RESUMO

BACKGROUND: Donation after circulatory death donors (DCD) can expand the donor pool for heart transplantation, which primarily depends on brain death donors. Ischemia and reperfusion injury are inherent to the DCD process. We hypothesize that pharmacologic inhibition of interleukin-1 (IL-1) and/or IL-18 is protective to DCD hearts. MATERIALS AND METHODS: Following clinical protocol, in-situ ischemia time in control beating-heart donor (CBD) and DCD groups was less than 5 and 40 min, respectively. Wild type (WT) C57Bl6/j, IL-1 receptor type I knockout (IL-1RI-KO), and IL-18 KO mice were used. Hearts were reanimated for 90 min on a Langendorff system with Krebs-Henseleit buffer at 37°C, to assess physiologic parameters. Recombinant IL-1 receptor antagonist (IL-1Ra) and/or IL-18 binding protein (IL-18BP) were added to the Krebs-Henseleit buffer to inhibit IL-1 and/or the IL-18 signaling, respectively. RESULTS: Developed pressure and ± dP/dt were significantly impaired in the DCD-WT group compared to CBD-WT (P ≤ 0.05). Troponin release was higher in DCD-WT groups. Functional parameters were preserved, and troponin release was significantly less in the DCD knockout groups. Heart function was improved in DCD groups treated with IL-1Ra or IL-18BP compared to the DCD-WT group. CONCLUSIONS: Heart function was significantly impaired in the DCD-WT group compared to CBD-WT. Genetic deletion or pharmacologic blockade of IL-1 or IL-18 was protective to DCD hearts.


Assuntos
Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Interleucina-18/metabolismo , Interleucina-1beta/metabolismo , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Obtenção de Tecidos e Órgãos , Animais , Morte , Avaliação Pré-Clínica de Medicamentos , Coração/efeitos dos fármacos , Peptídeos e Proteínas de Sinalização Intercelular/farmacologia , Proteína Antagonista do Receptor de Interleucina 1/farmacologia , Interleucina-18/antagonistas & inibidores , Interleucina-18/genética , Interleucina-1beta/antagonistas & inibidores , Interleucina-1beta/genética , Masculino , Camundongos Knockout , Traumatismo por Reperfusão Miocárdica/metabolismo , Distribuição Aleatória
10.
Medicine (Baltimore) ; 99(50): e23438, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327273

RESUMO

BACKGROUND: The organ donation in China has developed rapidly since fully launched donations after citizens death in 2015. This study was conducted to evaluate how the Chinese general public views changed on deceased organ donation, and to improve the donation process. METHODS: A total of 110 eligible studies, including 103, 410 individuals, were selected to analyze through searching PubMed, CBMdisc, CQVIP, CNKI, and Wanfang Data from Jan 1, 1990 to May 31, 2019. The pooled proportions (and 95% CIs) of cognition, attitudes and willingness related to organ donation were calculated using the Freeman-Tukey double arcsine transformation. RESULTS: The pooled proportions of knowing about organ donation and willing to donate increased from 84.6% (73.0-93.4) and 32.4% (23.9-41.6) before 2015, to 86.4% (74.5-95.1) and 39.9% (32.8-47.2) after 2015, respectively. The willingness to posthumous organ donation for cornea, heart, kidney, and liver had a significant improvement. Especially, the proportion of willingness to donate cornea increased to 56.0% (43.3-68.3) after 2015, from 39.2% (31.2-47.4) before 2015. However, although 69.7% (62.7-76.4) of participants approved the deceased organ donation, only 35.6% (29.7-41.8) and 43.9% (37.2-50.8) were willing to donate their own and relatives organs postmortem, respectively. The leading reasons for refraining from donating organs postmortem were distrusting the medical professionals (49.8%, 35.2-64.4) and traditional Chinese values (40.6%, 32.4-49.0). Popularizing knowledge about organ donation (61.5%, 45.7-76.1), humanitarian aid (57.1%, 48.8-65.3), and priority of using donated organs for relatives (53.1%, 30.8-74.7) were the applauded strategies to improve the willingness to posthumous organ donation. CONCLUSIONS: The willingness toward posthumous organ donation has a significant improvement among Chinese general public since 2015, however, several important measures still need to be taken to promote the favorable attitudes and willingness toward organ donation.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Transplante de Órgãos/psicologia , Obtenção de Tecidos e Órgãos/provisão & distribução , Adulto , China , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Inquéritos e Questionários
11.
Swiss Med Wkly ; 150: w20447, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33382904

RESUMO

The Swiss stepwise shutdown approach in organ donation and transplantation helped to maintain a limited national organ procurement and vital organ transplant activity, avoiding a complete nationwide shutdown of organ donation and transplant activity. .


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis/organização & administração , Transplante de Órgãos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Humanos , Pandemias , Estudos Retrospectivos , Suíça
12.
Epidemiol Serv Saude ; 30(1): e2020754, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331601

RESUMO

OBJECTIVE: To describe organ donations and transplants in Ceará state, Brazil, following the declaration of the COVID-19 pandemic. METHODS: This was a descriptive study using data from the Brazilian Organ Transplantation Association. The number of donors and transplants from April to June 2020 was compared to the same period in 2019 and to the first quarter of 2020. RESULTS: In the first half of 2020, the state registered 72 effective donors, just 17 (23.6%) of whom related to the second quarter. Of the 352 transplants in the first half of 2020, 37 (10.7%) were performed in the second quarter. Compared with the period from April to June 2019, there was a reduction of 67.9% and 89.3% in the number of donors and transplants, respectively, in the same period of 2020. CONCLUSION: The number of donors and transplants in Ceará showed an important fall in the three months following the declaration of the COVID-19 pandemic, especially for kidney, heart and cornea transplants.


Assuntos
Transplante de Órgãos/estatística & dados numéricos , Doadores de Tecidos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Brasil , Humanos
13.
Zhonghua Nan Ke Xue ; 26(7): 616-619, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-33377717

RESUMO

Objective: To analyze the efficiency of sperm donation by qualified donors and provide some experience for improving the success rate of sperm donation in human sperm banks. METHODS: This study included 440 qualified sperm donors in Chongqing Human Sperm Bank from April 2015 to June 2019. We analyzed the general information about the donors, the causes of failed sperm donation and the results of semen bacterial culture. RESULTS: Among the 440 qualified donors, 11 (2.50%) did not donate sperm, 28 (6.36%) were excluded because of frequent failures to donate, 397 (90.2%) completed all the procedures of sperm donation, and 4 (0.91%) failed to undergo HIV test six months after the last donation. The 397 donors that fulfilled the procedures donated sperm for 2 965 person-times, of which 2 159 (72.8%) were qualified and 806 (27.2%) unqualified for substandard semen quality (n = 684 ï¼»23.1%ï¼½), semen volume <2 ml (n = 33 ï¼»1.11%ï¼½), abnormal seminal liquefaction (n = 14 ï¼»0.47%ï¼½), or positive semen bacterial culture (n = 75 ï¼»2.53%ï¼½). CONCLUSIONS: Substandard semen quality is the main factor affecting the efficiency of sperm donation. The staff of the human sperm bank should pay adequate attention to the first reception of and communication with the donors, dispel their worries, enhance health care guidance, prevent pollution and improve the success rate of sperm donation.


Assuntos
Bancos de Esperma/estatística & dados numéricos , Obtenção de Tecidos e Órgãos , Humanos , Masculino , Análise do Sêmen , Espermatozoides , Doadores de Tecidos
14.
PLoS One ; 15(12): e0243504, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370296

RESUMO

The ultimate treatment for patients with end-stage heart failure is heart transplantation. The number of donor hearts which are primarily procured from donation after brain death (DBD) donors is limited, but donation after circulatory death (DCD) donor hearts can increase the heart donor pool. However, ischemia and reperfusion injuries associated with the DCD process causes myocardial damage, limiting the use of DCD hearts in transplantation. Addressing this problem is critical in the exploration of DCD hearts as suitable donor hearts for transplantation. In this study, rat hearts were procured following the control beating-heart donor (CBD) or DCD donation process. Changes in mitochondria and cardiac function from DCD hearts subjected to 25 or 35 minutes of ischemia followed by 60 minutes of reperfusion were compared to CBD hearts. Following ischemia, rates of oxidative phosphorylation and calcium retention capacity were progressively impaired in DCD hearts compared to CBD hearts. Reperfusion caused additional mitochondrial dysfunction in DCD hearts. Developed pressure, inotropy and lusitropy, were significantly reduced in DCD hearts compared to CBD hearts. We, therefore, suggest that interventional strategies targeted before the onset of ischemia and at reperfusion could protect mitochondria, thus potentially making DCD hearts suitable for heart transplantation.


Assuntos
Coração/fisiologia , Mitocôndrias/metabolismo , Traumatismo por Reperfusão/etiologia , Obtenção de Tecidos e Órgãos/métodos , Animais , Morte Encefálica , Cálcio/metabolismo , Frequência Cardíaca , Transplante de Coração , Peróxido de Hidrogênio/metabolismo , Masculino , Contração Miocárdica , Fosforilação Oxidativa , Ratos , Ratos Sprague-Dawley , Fatores de Tempo , Doadores de Tecidos , Função Ventricular Esquerda/fisiologia , Isquemia Quente
16.
Artigo em Alemão | MEDLINE | ID: mdl-33180159

RESUMO

In academic and public debate, the meaning of irreversible loss of brain function as a reliable sign of death (brain death criterion) is repeatedly challenged. In the present article, six prototypical theses against the brain death criterion are discussed: 1) the nonsuperiority of brain versus other organs, 2) the unreliability of brain death diagnostics, 3) the preserved perception of pain in brain death, 4) the (spontaneous) sexual maturation and preserved reproductive function in brain death, 5) the symmetry of brain death and embryonic stage, and 6) the equalization of an artificially respired brain-dead body and a living human being.None of these theses withstand critical analysis. In Germany, the whole-brain death criterion is applied. Brain death involves the complete loss of all sensation, consciousness, as well as facial, ocular, lingual and pharyngeal motor, voluntary motor, and sexual function (functional "decapitation"). Other organs or their basic control can be replaced artificially, but not the brain. The brain, not the remaining body, is determinant of the human individual. The equalization of an artificially respired brain-dead organism, that may be considered as a living system from a natural philosophy point of view, and the organism of the same living human being leads, through reducibility of constituting organs, to an obvious absurdity. The irreversible loss of brain function results inevitably in cardiac arrest, spontaneously within minutes, with intensive care usually within days. In the embryo/fetus, malformation of the complete brain also results in (prenatal) death. The statutory guideline of the German Medical Association for the determination of brain death has, by comparison, high diagnostic reliability; no confirmed misdiagnoses have occurred.


Assuntos
Morte Encefálica , Obtenção de Tecidos e Órgãos , Morte Encefálica/diagnóstico , Cuidados Críticos , Morte , Alemanha , Humanos , Reprodutibilidade dos Testes
20.
Rozhl Chir ; 99(9): 391-396, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33242967

RESUMO

INTRODUCTION: Liver transplantation is established as a lifesaving procedure for patients with acute and chronic liver failure, as well as certain selected malignancies. Due to a continuing organ shortage and ever-growing patient waiting lists, donation after cardiac death (DCD) is becoming more frequently utilized in order to close the gap between “supply and demand”. METHODS: A retrospective analysis of DCD and subsequent liver transplantations was performed. RESULTS: From May 2016 to September 2019, a total of 9 DCD liver transplantations were performed in our institution. All cases except one were primary liver transplantations. The recipients comprised 5 (56%) males and 4 (44%) females. The mean DCD donor age was 41±12 (22-57) years, with ventilation duration of 7±1 days and warm ischemia time 19±3 minutes. The average recipient age was 51±22 (4-73) years, with an average cold ischemia 3h:59m±27m and manipulation time of 23±5 minutes. Periprocedural mortality was 1 (11%). Hepatitis C recurrence was documented in 1 (11%) patient. The mean follow-up time was 19±13 (7-37) months. Until now, we have not observed any signs of ischemic cholangiopathy. CONCLUSION: DCD liver transplantation allows us to enlarge the pool of potential liver grafts, thus decreasing the time spent on the liver recipient waiting list. This paper documents the first series of DCD liver transplantations in the Czech Republic.


Assuntos
Transplante de Fígado , Obtenção de Tecidos e Órgãos , República Tcheca , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Estudos Retrospectivos , Doadores de Tecidos
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