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donation after circulatory death

Louise E See Hoe, David McGiffin, John F Fraser
No abstract text is available yet for this article.
April 2, 2018: Medical Journal of Australia
J Hunter Mehaffey, Eric J Charles, Adishesh K Narahari, Sarah Schubert, Victor E Laubach, Nicholas R Teman, Kevin R Lynch, Irving L Kron, Ashish K Sharma
BACKGROUND: Sphingosine-1-phosphate regulates endothelial barrier integrity and promotes cell survival and proliferation. We hypothesized that upregulation of sphingosine-1-phosphate during ex vivo lung perfusion would attenuate acute lung injury and improve graft function. METHODS: C57BL/6 mice (n = 4-8/group) were euthanized, followed by 1 hour of warm ischemia and 1 hour of cold preservation in a model of donation after cardiac death. Subsequently, mice underwent 1 hour of ex vivo lung perfusion with 1 of 4 different perfusion solutions: Steen solution (Steen, control arm), Steen with added sphingosine-1-phosphate (Steen + sphingosine-1-phosphate), Steen plus a selective sphingosine kinase 2 inhibitor (Steen + sphingosine kinase inhibitor), or Steen plus both additives (Steen + sphingosine-1-phosphate + sphingosine kinase inhibitor)...
March 11, 2018: Journal of Thoracic and Cardiovascular Surgery
Dagmar Kollmann, Gonzalo Sapisochin, Nicolas Goldaracena, Bettina E Hansen, Ramraj Rajakumar, Nazia Selzner, Mamatha Bhat, Stuart McCluskey, Mark S Cattral, Paul D Greig, Les Lilly, Ian D McGilvray, Anand Ghanekar, David R Grant, Markus Selzner
By cause of the shortfall between the number of patients listed for liver transplantation (LT) and available grafts, strategies to expand the donor pool have been developed. Donation after Circulatory Death (DCD) and Living donor (LD) grafts are not universally used due to the concerns of graft failure, biliary complications and donor risks. In order to overcome the barriers for the implementation of using all three types of grafts, we compared outcomes after LT of DCD, LD and donation after brain death (DBD) grafts...
March 31, 2018: Liver Transplantation
P Ramirez, D Ferreras, B Febrero, M Royo, P Cascales, J M Rodriguez, A Rios, J A Fernandez, M R González, F Sanchez-Bueno, R Robles, P Parrilla
INTRODUCTION: Donation after circulatory death (DCD) has increased in the last decade, although a slight increase in surgical complications has been reported in liver transplantation (LT). Therefore, DCD is not recommended with donors aged 60 years or more because it entails an added risk. However, donation after brain death (DBD)-LT with donors aged 70 years or more shows acceptable results. OBJECTIVE: The objective was to analyze the characteristics and complications of DCD-LT with donors aged 70 years or more (DCD-70)...
March 2018: Transplantation Proceedings
N Palomo-López, L Martín-Villén, Á J Roldán-Reina, Z Ruiz de Azúa-López, D X Cuenca-Apolo, M Adriaensens-Pérez, Y Corcia-Palomo, J J Egea-Guerrero
OBJECTIVE: To investigate the characteristics and evolution of controlled donation after circulatory death (DCD) type III. MATERIALS AND METHODS: Observational and retrospective study of controlled DCD type III of donors conducted from 2014 to 2016. Clinical data, intensive care unit (ICU) stay, cause of death, warm ischemia time, and total time were collected. Delayed graft function (DGF) and survival of renal transplant were also registered. Qualitative variables are described as frequencies and absolute values and quantitative variables as medians and interquartile ranges...
March 2018: Transplantation Proceedings
Á J Roldán-Reina, J J Egea-Guerrero, N Palomo-López, D X Cuenca-Apolo, M Adriaensens-Pérez, M Porras-López, Z Ruiz de Azúa-López, Y Corcia-Palomo, L Martín-Villén
Recent research in kidney transplantation has revealed differences in the evolution of renal function among patients transplanted from 2 alternative programs for donation after circulatory death (DCD). A retrospective, observational, single-center study was carried out from 2013 to 2016 at a level III hospital intensive care unit (ICU) to assess the progression of kidney recipients after transplants from uncontrolled DCD (uDCD) or controlled DCD (cDCD). The following variables were collected for data analysis: demographics, comorbidities, type of donation, lactate, hemoglobin and glucose levels at ICU admission, creatinine concentration at ICU admission, at-hospital ward transfer, at-hospital discharge, radioisotope imaging results, ICU and in-hospital length of stay, and mortality...
March 2018: Transplantation Proceedings
J J Egea-Guerrero, L Martín-Villén, Z Ruiz de Azúa-López Zaida, F Bonilla-Quintero Francisco, E Pérez-López Enrique, R Marín-Andrés, E Correa-Chamorro, Á Vilches-Arenas
BACKGROUND: In all organ transplantation programs, election of the proper protocol relies primarily on the professionals involved in the detection of potential donors. The objective of our study was to assess the impact of a series of prehospital training sessions, as well as to develop several positive feedback strategies within the uncontrolled organ donation after circulatory death (uDCD) program in our city. METHODS: A before-after intervention study was carried out in 3 steps...
March 2018: Transplantation Proceedings
Gregory I Snell, Bronwyn J Levvey, Kovi Levin, Miranda Paraskeva, Glen Westall
Lung transplantation (LTx) has traditionally been limited by a lack of suitable donor lungs. With the recognition that lungs are more robust than initially thought, the size of the donor pool of available lungs has increased dramatically in the past decade. Donation after brain death (DBD) and donation after circulatory death (DCD) lungs, both ideal and extended are now routinely utilized. DBD lungs can be damaged. There are important differences in the public's understanding, legal and consent processes, intensive care unit strategies, lung pathophysiology, logistics, and potential-to-actual donor conversion rates between DBD and DCD...
April 2018: Seminars in Respiratory and Critical Care Medicine
Andrea Schlegel, Xavier Muller, Philipp Dutkowski
Purpose of Review: In this review, we highlight which livers may benefit from additional treatment before implantation and describe the concept of hypothermic machine liver perfusion. Furthermore, we explain why cold oxygenated perfusion concepts could potentially lead to a breakthrough in this challenging field of transplantation. Accordingly, we summarize recent clinical applications of different hypothermic perfusion approaches. Recent Findings: The impact of end-ischemic, hypothermic liver perfusion in liver transplantation is currently assessed by two multicenter, randomized controlled trials...
2018: Current Transplantation Reports
James R Rodrigue, Richard Luskin, Helen Nelson, Alexandra Glazier, Galen V Henderson, Francis L Delmonico
INTRODUCTION: Unfavorable attitudes and insufficient knowledge about donation after cardiac death among critical care providers can have important consequences for the appropriate identification of potential donors, consistent implementation of donation after cardiac death policies, and relative strength of support for this type of donation. The lack of reliable and valid assessment measures has hampered research to capture providers' attitudes. Design and Research Aims: Using stakeholder engagement and an iterative process, we developed a questionnaire to measure attitudes of donation after cardiac death in critical care providers (n = 112) and examined its psychometric properties...
January 1, 2018: Progress in Transplantation
Andrew McGee, Dale Gardiner
This article defends the criterion of permanence as a valid criterion for declaring death against some well-known recent objections. We argue that it is reasonable to adopt the criterion of permanence for declaring death, given how difficult it is to know when the point of irreversibility is actually reached. We claim that this point applies in all contexts, including the donation after circulatory determination of death context. We also examine some of the potentially unpalatable ramifications, for current death declaration practices, of adopting the irreversibility criterion...
March 13, 2018: Journal of Medicine and Philosophy
James M West
Anesthesiologists have clearly established their place in the history of medical ethics. Our involvement goes back to 1966 when Henri Beecher published his landmark paper on research and informed consent. Participation in the ethics of transplantation is no less important than our previous work. Organ transplant has been life saving for many but also has given rise to many misunderstandings not just from the public but also among our own colleagues. These include methods of allocation and donation, the role that affluence may play in receiving an organ, the definition of death and donation after circulatory death...
March 1, 2018: Seminars in Cardiothoracic and Vascular Anesthesia
Janske Reiling, Elizabeth Forrest, Kim R Bridle, Laurence J Britton, Nishreen Santrampurwala, Darrell H G Crawford, Cornelis H C Dejong, Jonathan Fawcett
Background: In recent years, an increasing number of donor livers are being declined for transplantation in Australia. The aim of this study was to evaluate the impact of donation after cardiac death and other factors associated with organ quality on liver utilization rates in Australia. Methods: Data on organ donors who donated at least 1 organ between 2005 and 2014 were obtained from the Australia and New Zealand organ donation registry. Temporal changes in donor characteristics were assessed and a logistical regression analysis was performed to evaluate their association with liver nonuse...
December 2017: Transplantation Direct
Erwin J O Kompanje, Jelle L Epker
No abstract text is available yet for this article.
April 2018: Journal of Intensive Care Medicine
Hassiba Smail, Pankaj Saxena, Andreas Wallinder, Enjarn Lin, Gregory I Snell, Jamie Hobson, Adam D Zimmet, Silvana F Marasco, David C McGiffin
There is an ever increasing demand for donor lungs in patients waiting for transplantation. Lungs of many potential donors will be rejected if the standard criteria for donor assessment are followed. We have expanded our donor lung pool by accepting marginal donors and establishing a donation after circulatory death program. We have achieved comparable results using marginal donors and accepting donor lungs following donation after circulatory death. We present our assessment and technical guidelines on lung procurement taking into consideration an increasingly complex cohort of lung donors...
December 22, 2017: Heart, Lung & Circulation
Gonzalo Sirgo, Federico Esteban, Josep Gómez, Gerard Moreno, Alejandro Rodríguez, Lluis Blanch, Juan José Guardiola, Rafael Gracia, Lluis De Haro, María Bodí
BACKGROUND: Big data analytics promise insights into healthcare processes and management, improving outcomes while reducing costs. However, data quality is a major challenge for reliable results. Business process discovery techniques and an associated data model were used to develop data management tool, ICU-DaMa, for extracting variables essential for overseeing the quality of care in the intensive care unit (ICU). OBJECTIVE: To determine the feasibility of using ICU-DaMa to automatically extract variables for the minimum dataset and ICU quality indicators from the clinical information system (CIS)...
April 2018: International Journal of Medical Informatics
Kevin Koomalsingh, Jon A Kobashigawa
The first human-to-human heart transplant was performed 50 years ago in 1967. Heart transplantation has now entered an era of tremendous growth and innovation. The future of heart transplantation is bright with the advent of newer immunosuppressive medications and strategies that may even result in tolerance. Much of this progress in heart transplant medicine is predicated on a better understanding of acute and chronic rejection pathways through basic science studies. The future will also include personalized medicine where genomics and molecular science will dictate customized treatment for optimal outcomes...
January 2018: Annals of Cardiothoracic Surgery
Mohan John, Leonard L Bailey
Neonatal heart transplantation was developed and established in the 1980's as a durable modality of therapy for complex-uncorrectable heart disease. Patients transplanted in the neonatal period have experienced unparalleled long-term survival, better than for any other form of solid-organ transplantation. However, the limited availability of neonatal and young infant donors has restricted the indications and applicability of heart transplantation among newborns in the current era. Indications for heart transplantation include congenital heart disease not amenable to other forms of surgical palliation, and cardiomyopathy, including some primary tumors...
January 2018: Annals of Cardiothoracic Surgery
Aravinda Page, Simon Messer, Stephen R Large
Fifty years since the first successful human heart transplant from a non-heart beating donor, this concept of heart transplantation from donation after circulatory determined death (DCD) promises to be one of the most exciting developments in heart transplantation. Heart transplantation has established itself as the best therapeutic option for patients with end-stage heart failure, with the opportunity to provide these patients with a near-normal quality of life. However, this treatment is severely limited by the availability of suitable donor hearts...
January 2018: Annals of Cardiothoracic Surgery
Christopher W White, Simon J Messer, Stephen R Large, Jennifer Conway, Daniel H Kim, Demetrios J Kutsogiannis, Jayan Nagendran, Darren H Freed
Cardiac transplantation has become limited by a critical shortage of suitable organs from brain-dead donors. Reports describing the successful clinical transplantation of hearts donated after circulatory death (DCD) have recently emerged. Hearts from DCD donors suffer significant ischemic injury prior to organ procurement; therefore, the traditional approach to the transplantation of hearts from brain-dead donors is not applicable to the DCD context. Advances in our understanding of ischemic post-conditioning have facilitated the development of DCD heart resuscitation strategies that can be used to minimize ischemia-reperfusion injury at the time of organ procurement...
2018: Frontiers in Cardiovascular Medicine
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