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Donor management of brain stem dead donors

Shuijun Zhang, Shengli Cao, Tao Wang, Bing Yan, Yantao Lu, Yongfu Zhao
OBJECTIVES: Experimental animal models of brain death that mimic human conditions may be useful for investigating novel strategies that increase quality and quantity of organs for transplant. MATERIALS AND METHODS: Brain death was induced by increasing intracranial pressure by inflating an intracranial placed balloon catheter. Brain death was confirmed by flatline electroencephalogram, physical signs of apnea, and absence of brain stem reflexes. Donor management was done after brain death...
October 2014: Experimental and Clinical Transplantation
S Dixon, C R Tapping, J N Walker, M Bratby, S Anthony, P Boardman, J Phillips-Hughes, R Uberoi
Pancreatic islet cell transplantation (PICT) is a novel treatment for patients with insulin-dependent diabetes who have inadequate glycaemic control or hypoglycaemic unawareness, and who suffer from the microvascular/macrovascular complications of diabetes despite aggressive medical management. Islet transplantation primarily aims to improve the quality of life for type 1 diabetic patients by achieving insulin independence, preventing hypoglycaemic episodes, and reversing hypoglycaemic unawareness. The islet cells for transplantation are extracted and purified from the pancreas of brain-stem dead, heart-beating donors...
September 2012: Clinical Radiology
Aaron M Ranasinghe, Robert S Bonser
Following brain death (BD) many hormonal changes occur. These include an increase and then a fall in the levels of circulating catecholamines, reduced levels of anti-diuretic hormone and cortisol as well as alterations in the hypothalamic-pituitary thyroid axis consistent with the non-thyroidal illness syndrome. In an era when the numbers of potential recipients listed for transplantation are greater than the number of donors, with an increasing donor age, a detailed knowledge of the endocrine changes and pathophysiological consequences of these is essential to optimise the management of the brain-stem dead organ donor...
October 2011: Best Practice & Research. Clinical Endocrinology & Metabolism
Dominic M Summers, Claire Counter, Rachel J Johnson, Paul G Murphy, James M Neuberger, J Andrew Bradley
INTRODUCTION: Organ donation after brain death (DBD) has declined in the United Kingdom, whereas donation after cardiac death (DCD) has increased markedly. We sought to understand the reasons for the decline in DBD and determine whether the increase in DCD was a major factor. METHODS: The UK Transplant Registry was analyzed to determine trends in organ donation. Data from the "Potential Donor Audit," an audit of all patients younger than 76 years who died in noncardiothoracic UK intensive care units, was analyzed to identify trends in clinical demographics and management and to determine whether potential donors (DBD and DCD) were identified and appropriate steps were taken to enable organ donation...
December 27, 2010: Transplantation
Yorick J de Groot, Nichon E Jansen, Jan Bakker, Michael A Kuiper, Stan Aerdts, Andrew I R Maas, Eelco F M Wijdicks, Hendrik A van Leiden, Andries J Hoitsma, Berry H P H Kremer, Erwin J O Kompanje
PURPOSE: There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria for determination of imminent brain death, which can be seen as a precursor for organ donation. METHODS: We organized meetings with representatives from the field of clinical neurology, neurotraumatology, intensive care medicine, transplantation medicine, clinical intensive care ethics, and organ procurement management...
September 2010: Intensive Care Medicine
Sally R James, Aaron M Ranasinghe, Rajamiyer Venkateswaran, Christopher J McCabe, Jayne A Franklyn, Robert S Bonser
CONTEXT: After brain stem death (BSD), a low T(3) state is common, and T(3) supplementation has been advocated to improve heart function and yield for transplantation. OBJECTIVES: The aim of the study was to assess the effects of T(3) on expression of mRNAs encoding T(3)-responsive genes in the post-BSD human heart. DESIGN: Within a prospective double-blind trial, potential BSD cardiac donors undergoing hemodynamic optimization were randomized to T(3) (0...
March 2010: Journal of Clinical Endocrinology and Metabolism
Richard Arbour
There is a critical mismatch between available organs for transplant and acutely or critically ill patients with end-stage organ disease. Patients who may benefit from organ transplantation far outnumber available organs. The causes for this imbalance are multiple. One cause is family refusal to donate. A second cause is nonrecognition or delay in determination of brain death. A third cause is donor loss due to profound cardiopulmonary and metabolic instability consequent to brain-stem herniation and brain death...
October 2005: AACN Clinical Issues
S T Fan, C M Lo, R J Lo, K Y Fung, W Wei, Y B Chen, C L Lai, I O Ng, K Y Yuen, J Chan, J Wong
OBJECTIVE: To evaluate the strategy of the management of patients with fulminant hepatic failure at Queen Mary Hospital. METHODS: In the period 1994 through 1996, 30 patients with fulminant hepatic failure were managed by active supportive treatment in the Intensive Care Unit in preparation for liver transplantation. Liver transplantation was performed in 14 patients (aged 17-47), 3 of whom received liver grafts from brain-stem dead donors and 11 received live-related grafts from family members...
June 1997: Chinese Medical Journal
T A Howlett, A M Keogh, L Perry, R Touzel, L H Rees
Blood samples were obtained, at the time of organ donation, from 31 consecutive brain-stem-dead (BSD) donors referred to one transplant coordinator during a 9-month period. Twenty-four cases (77%) had clinical diabetes insipidus (DI), which was poorly controlled with marked dehydration in a majority of cases (serum osmolality range 268-357; median 302 mOSM/kg). Serum triiodothyronine (T3) was subnormal in 25 (81%); all had normal or high serum reverse T3; and the serum free thyroxine (T4) index was subnormal in 9 (29%), and TSH was subnormal in 7 (23%)...
May 1989: Transplantation
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