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donation after circulatory death

Ahmer M Hameed, Henry C Pleass, Germaine Wong, Wayne J Hawthorne
BACKGROUND: The two main options for renal allograft preservation are static cold storage (CS) and machine perfusion (MP). There has been considerably increased interest in MP preservation of kidneys, however conflicting evidence regarding its efficacy and associated costs have impacted its scale of clinical uptake. Additionally, there is no clear consensus regarding oxygenation, and hypo- or normothermia, in conjunction with MP, and its mechanisms of action are also debated. The primary aims of this article were to elucidate the benefits of MP preservation with and without oxygenation, and/or under normothermic conditions, when compared with CS prior to deceased donor kidney transplantation...
October 2016: Medicine (Baltimore)
X Yuan, C Chen, J Zhou, M Han, X Wang, C Wang, X He
OBJECTIVES: Donors with bacteremia and sepsis are often considered to be controversial for organ retrieval due to potential transmission of an infectious agent to the recipient. Herein we report our initial experience of organ donation and transplantation results from donors with systemic infection. MATERIALS AND METHODS: From January 2013 to December 2014, 125 cases of donation were completed in our organ procurement organization including 90 cases of donation after brain death (DBD) and 35 cases of donation after circulatory death (DCD)...
September 2016: Transplantation Proceedings
R O'Meeghan, L Pedral
A detailed study of a hospital workplace led to process improvement and efficiency for organ, eye, and tissue donation. Work-flow diagrams were developed as an onsite reference for both the brain-dead donor and donation after circulatory death. The work flows have been circulated for use in other local hospitals and are key to the efficiency of the organ donation process.
September 2016: Transplantation Proceedings
R O'Meeghan, L Pedral
In the setting of an ever-increasing transplantation need, and a relatively static number of brain dead donors, donation after circulatory death (DCD) has heightened importance as a process to increase the number of organs available for transplantation. This article describes the barriers to the DCD process at a community hospital, what occurred to change the situation, and how data were used to overcome administrative and cultural barriers to create a successful DCD program. The program has become a role model in the local community...
September 2016: Transplantation Proceedings
J Hunter Mehaffey, Eric J Charles, Ashish K Sharma, Dustin T Money, Yunge Zhao, Mark H Stoler, Christine L Lau, Curtis G Tribble, Victor E Laubach, Mark E Roeser, Irving L Kron
OBJECTIVE: Critical organ shortages have resulted in ex vivo lung perfusion gaining clinical acceptance for lung evaluation and rehabilitation to expand the use of donation after circulatory death organs for lung transplantation. We hypothesized that an innovative use of airway pressure release ventilation during ex vivo lung perfusion improves lung function after transplantation. METHODS: Two groups (n = 4 animals/group) of porcine donation after circulatory death donor lungs were procured after hypoxic cardiac arrest and a 2-hour period of warm ischemia, followed by a 4-hour period of ex vivo lung perfusion rehabilitation with standard conventional volume-based ventilation or pressure-based airway pressure release ventilation...
September 22, 2016: Journal of Thoracic and Cardiovascular Surgery
Emre A Eren, Nicholas Latchana, Eliza Beal, Don Hayes, Bryan Whitson, Sylvester M Black
The supply of liver grafts for treatment of end-stage liver disease continues to fall short of ongoing demands. Currently, most liver transplants originate from donations after brain death. Enhanced utilization of the present resources is prudent to address the needs of the population. Donation after circulatory or cardiac death is a mechanism whereby the availability of organs can be expanded. Donations after circulatory death pose unique challenges given their exposure to warm ischemia. Technical principles of donations after circulatory death procurement and pertinent studies investigating patient outcomes, graft outcomes, and complications are highlighted in this review...
October 2016: Experimental and Clinical Transplantation
Congwen Bian, Yiqi Du, Rui Ding, Jun Huang, Yan Dai, Sujin Bao, Lijuan Zhao, Hefang Shen, Jing Dong, Jianjian Xu, Qiru Xiong, Lili Xu
Biliary complications remain a major source of morbidity in liver transplant patients. Among these complications, nonanastomotic biliary strictures (NAS) are especially common and they are frequently therapy resistant in part because biliary epithelial cells are more sensitive to warm ischemic injury than hepatocytes. It has been a challenge to maintain the physiological function of biliary epithelial cells during liver transplantation. In this work, we have examined the effect of oxygen on proliferation of biliary epithelial cells in the rat livers obtained from donation after circulatory death (DCD)...
2016: American Journal of Translational Research
J Moritz Kaths, Jun Yu Cen, Yi Min Chun, Juan Echeverri, Ivan Linares, Sujani Ganesh, Paul Yip, Rohan John, Darius Bagli, Istvan Mucsi, Anand Ghanekar, David Grant, Lisa A Robinson, Markus Selzner
Hypothermic preservation is known to cause renal graft injury, especially in donation after circulatory death (DCD) kidney transplantation. We investigated the impact of cold storage (SCS) vs. short periods of normothermic ex vivo kidney perfusion (NEVKP) after SCS vs. prolonged, continuous NEVKP with near avoidance of SCS on kidney function after transplantation. Following 30 minutes of warm ischemia, kidneys were removed from 30kg Yorkshire pigs and preserved for 16h with: A) 16h SCS, B) 15h SCS + 1h NEVKP, C) 8h SCS + 8h NEVKP, D) 16h NEVKP...
September 20, 2016: American Journal of Transplantation
Mariusz Bral, Boris Gala-Lopez, David Bigam, Norman Kneteman, Andrew Malcolm, Scott Livingstone, Axel Andres, Juliet Emamaullee, Leslie Russell, Constantin Coussios, Lori J West, Peter J Friend, A M James Shapiro
After extensive experimentation, outcomes of a first clinical normothermic machine perfusion (NMP) liver UK trial demonstrated feasibility and clear safety, with improved liver function when compared to standard static cold storage (SCS). We herein present a preliminary single centre North-American experience using identical NMP technology. Ten donor liver grafts were procured, 4 (40%) from donation after circulatory death (DCD) donors, of which 9 were transplanted. One liver did not proceed due to a technical failure with portal cannulation, and discarded...
September 17, 2016: American Journal of Transplantation
Krzysztof Pabisiak, Arkadiusz Krejczy, Grażyna Dutkiewicz, Krzysztof Safranow, Jerzy Sienko, Romuald Bohatyrewicz, Kazimierz Ciechanowski
BACKGROUND Donation after cardiac death offers the possibility of increasing the pool of organs for transplantation by up to 30%. Maastricht category type 3 (M3) dominates in most countries with active DCD programs. During preparations to introduce a permanent program for uncontrolled donation after circulatory death in Szczecin, Poland, the donor pool has been estimated. In Poland, Maastricht category type 2 (M2) is considered a basic source for organ recovery. MATERIAL AND METHODS This was a retrospective cohort study of out-of-hospital cardiac arrests (OHCA) reported to local Emergency Medical Services (EMS) between 1 December 2014 and 30 November 2015...
2016: Annals of Transplantation: Quarterly of the Polish Transplantation Society
Eric J Charles, Mary E Huerter, Cynthia E Wagner, Ashish K Sharma, Yunge Zhao, Mark H Stoler, J Hunter Mehaffey, James M Isbell, Christine L Lau, Curtis G Tribble, Victor E Laubach, Irving L Kron
BACKGROUND: Despite the critical need for donor lungs, logistic and geographic barriers hinder lung utilization. We hypothesized that lungs donated after circulatory death subjected to 6 hours of cold preservation after ex vivo lung perfusion (EVLP) would have similar outcomes after transplantation as lungs transplanted immediately after EVLP, and that both would perform superiorly compared with lungs transplanted immediately after procurement. METHODS: Donor porcine lungs were procured after circulatory death and 15 minutes of warm ischemia...
September 7, 2016: Annals of Thoracic Surgery
Alexander R Manara, Beatriz Dominguez-Gil, Jose Miguel Pérez-Villares, Jasmeet Soar
No abstract text is available yet for this article.
November 2016: Resuscitation
S A Yong, S D'Souza, S Philpot, D V Pilcher
With the advent of donation after circulatory death programs in Australia and New Zealand, greater knowledge is needed about physiologic variation in haemodynamic activity following withdrawal of cardiorespiratory support. The ANZICS Statement on Death and Organ Donation allows provision for variation in the observation times between two and five minutes after cessation of the circulation prior to declaration of death. We report our experience of two cases, the first where electrical activity and pulse returned after a 102 second pause and the second where electrical activity returned after a three minute pause; both longer than previously reported cases...
September 2016: Anaesthesia and Intensive Care
Daniel J Firl, Koji Hashimoto, Colin O'Rourke, Teresa Diago-Uso, Masato Fujiki, Federico N Aucejo, Cristiano Quintini, Dympna M Kelly, Charles M Miller, John J Fung, Bijan Eghtesad
Donation after circulatory death (DCD)donors show heterogeneous hemodynamic trajectories following withdrawal of life support. Impact of hemodynamics in DCD liver transplant isunclear and objective measures of graft viability would ease transplant surgeon decision making and inform safe expansion of the donor organ pool. This retrospective study tested whether hemodynamic trajectories associated withtransplant outcomes in DCD liver transplantation (n = 87). Using longitudinal clustering statistical techniques we phenotyped DCD donors based on hemodynamic trajectory for both mean arterial pressure (MAP) and peripheral oxygen saturation (SpO2 ) following withdrawal of life support...
September 6, 2016: Liver Transplantation
France Roussin
A practice authorised in France for some years, organ and tissue donation from a circulatory death donor must follow a specific medical process. It is an extreme emergency to be managed within a few minutes, and in which the organ donation nurse coordinator plays a key role in the hospital.
September 2016: Soins; la Revue de Référence Infirmière
Didier Dorez
The cessation of treatment in intensive care leads to death through circulatory arrest. In these circumstances there is an opportunity to remove organs, if that was the wish of the patient. This raises legitimate ethical questions. A French national protocol defines the conditions of this donation and ensures a harmonisation of practices as well as an overall improvement in end-of-life support in intensive care. These donors represent an opportunity to increase the number of organs available for transplant.
September 2016: Soins; la Revue de Référence Infirmière
Corinne Antoine, Daniel Maroudy
The procurement of organs from donors after circulatory death is a reliable technique which gives satisfactory posttransplant results and also represents a potential source of additional organs. In order to meet the growing need for organ donations, the 'anticipated organ donation approach' procedure is currently receiving renewed interest with new conditions for its implementation in France.
September 2016: Soins; la Revue de Référence Infirmière
Pieter Hoste, Patrick Ferdinande, Eric Hoste, Kris Vanhaecht, Xavier Rogiers, Kristof Eeckloo, Dominique Van Deynse, Didier Ledoux, Koenraad Vandewoude, Dirk Vogelaers
Belgium has achieved high deceased organ donation rates but according to the medical record data in the Donor Action database, deceased potential donors are still missed along the pathway. Between 2010 and 2014, 12.9 ± 3.3% of the potential donors after brain death (DBD) and 24.6 ± 1.8% of the potential donors after circulatory (DCD) death were not identified. Conversion rates of 41.7 ± 2.1% for DBD and 7.9 ± 0.9% for DCD indicate room for further improvement. We identify and discuss different issues in the monitoring of donation activities, practices and outcomes; donor pool; legislation on deceased organ donation; registration; financial reimbursement; educational and training programs; donor detection and practice clinical guidance...
October 2016: Acta Clinica Belgica
H Leiden, B Haase-Kromwijk, A Hoitsma, N Jansen
BACKGROUND: The Netherlands was one of the first countries in Europe to stimulate controlled donation after circulatory death (cDCD) at a national level in addition to donation after brain death (DBD). With this program the number of organ transplants increased, but it also proved to have challenges as will be shown in this 15-year review. METHODS: Data about deceased organ donation in the Netherlands, from 2000 until 2014, were analysed taking into account the whole donation process from donor referral to the number of organs transplanted...
August 2016: Netherlands Journal of Medicine
J R Scalea, A M D'Alessandro, L A Fernandez
BACKGROUND: We have previously shown that approximately 27% of patients do not progress to death in time to donate organs after attempted donation after circulatory death (DCD). As such, nearly 1000 transplants per year are not possible. One way to convert unsuccessful donations to successful donations is to increase procurement team "stand-down" times; however, increased stand-down times may predispose transplantable organs to increased ischemic damage. METHODS: Hemodynamics for successful and unsuccessful donations, occurring between 2011 and 2014, were characterized to determine if some unsuccessful DCDs could have donated successfully, had procurement teams waited longer...
July 2016: Transplantation Proceedings
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