The Impact of Meeting Donor Management Goals on the Number of Organs Transplanted per Expanded Criteria Donor

Patel, Madhukar S.; Zatarain, John R.; Cruz, Salvador De La; Sally, Mitchell B.; Ewing, Tyler; Crutchfield, Megan; Enestvedt, C. Kristian; Malinoski, Darren

doi:10.1001/jamasurg.2014.967

Cited by 72 publications

(52 citation statements)

References 11 publications

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“…[42][43][44] Based on our observations, consistent achievement of donor management goals may be less realistic for donors with anoxic brain injury, especially those sustaining prolonged cardiac arrest. For example, despite routine adherence to Canadian guidelines, 18 significantly fewer donors with anoxic brain injury achieved the donor management goals of P a O 2 /F I O 2 greater than 300 mm Hg or urine output greater than 0.5 mL/kg per hour.…”

Section: Discussionmentioning

confidence: 99%

“…For example, despite routine adherence to Canadian guidelines, 18 significantly fewer donors with anoxic brain injury achieved the donor management goals of P a O 2 /F I O 2 greater than 300 mm Hg or urine output greater than 0.5 mL/kg per hour. 42,43 Nevertheless, adoption of Canadian recommendations for organ donor management may be one reason why the number of organs transplanted per donor has increased nationally for each individual cause of neurologic death.…”

Section: Discussionmentioning

confidence: 99%

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Time trends in organ donation after neurologic determination of death: a cohort study

2017

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Background:The cause of brain injury may influence the number of organs that can be procured and transplanted with donation following neurologic determination of death. We investigated whether the distribution of causes responsible for neurologic death has changed over time and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes. Methods:We performed a cohort study involving consecutive brain-dead organ donors in southern Alberta between 2003 and 2014. For each donor, we determined last available measures of organ injury and number of organs transplanted, and compared these variables for various causes of neurologic death. We compared trends to national Canadian data for 2000-2013 (2000-2011 for Quebec).Results: There were 226 brain-dead organ donors over the study period, of whom 100 (44.2%) had anoxic brain injury, 63 (27.9%) had stroke, and 51 (22.6%) had traumatic brain injury. The relative proportion of donors with traumatic brain injury decreased over time (> 30% in 2003-2005 v. 6%-23% in 2012-2014) (p = 0.004), whereas that with anoxic brain injury increased (14%-37% v. 46%-80%, respectively) (p < 0.001). Nationally, the annual number of brain-dead donors with traumatic brain injury decreased from 4.4 to less than 3 per million population between 2000 and 2013, and that with anoxic brain injury increased from 1.1 to 3.1 per million. Donors with anoxic brain injury had higher concentrations of creatinine, alanine aminotransferase and troponin T, and lower P a O 2 /F I O 2 and urine output than donors with other diagnoses. The average number of organs transplanted per donor was 3.6 with anoxic brain injury versus 4.5 with traumatic brain injury or stroke (p = 0.002).Interpretation: Anoxic brain injury has become a leading cause of organ donation after neurologic determination of death in Canada. Organs from donors with anoxic brain injury have a greater degree of injury, and fewer are transplanted. These findings have implications for availability of organs for transplantation in patients with end-stage organ failure. AbstractResearch Research CMAJ OPEN E20CMAJ OPEN, 5(1)We performed a cohort study among consecutive braindead donors in southern Alberta to determine whether the distribution of causes responsible for neurologic death has changed (primary outcome) and, if so, whether this has had an impact on organ quality, transplantation rates and recipient outcomes (secondary outcomes). Using data from the Canadian Institute of Health Information (CIHI), we also assessed trends in the cause of neurologic death and number of organs transplanted per donor across Canada. Methods SettingA comprehensive clinical information system (ALTRABase) is used to manage all organ donation referrals in southern Alberta and enables linkage of donor and recipient data. Donor management is in accordance with national guidelines, which are incorporated directly into a region-wide electronic order set. 18 In every case, solid organs are routinely offered to transplantation ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Time trends in organ donation after neurologic determination of death: a cohort study

2017

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“…2 On the basis of these recommendations, and other prospective studies validating critical care endpoints as DMGs, 6,17 seven DMGs were chosen (vasopressor use ≤ 1, mean arterial blood pressure > 60, ejection fraction > 45%, sodium < 155 mEq/L, glucose < 150 mg/dL, PaO2:FiO2 ratio > 300, and average urine output (UOP) of 0.05–3 mL/kg/h), in addition to the use of hormonal therapy at any time point (T4, steroids, and insulin), serum creatinine, and ventilator settings at time of procurement, as a measure of donor optimization during their time in intensive care. Additional variables obtained from the GOL database included demographics, treatment facilities, and comorbidities of each potential donor.…”

Section: Methodsmentioning

confidence: 99%

Early declaration of death by neurologic criteria results in greater organ donor potential

Resnick

Seamon

Holena

et al. 2017

Journal of Surgical Research

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Background Aggressive management of patients prior to and after determination of death by neurologic criteria (DNC) is necessary to optimize organ recovery, transplantation, and increase the number of organs transplanted per donor (OTPD). The effects of time management are understudied but potentially pivotal component. The objective of this study was to analyze specific time points (time to DNC, time to procurement) and the time intervals between them to better characterize the optimal timeline of organ donation. Methods Using data over a 5-year time period (2011–2015) from the largest US OPO, all patients with catastrophic brain injury and donated transplantable organs were retrospectively reviewed. Active smokers were excluded. Maximum donor potential was seven organs (heart, lungs [2], kidneys [2], liver, and pancreas). Time from admission to declaration of DNC and donation was calculated. Mean time points stratified by specific organ procurement rates and overall OTPD were compared using unpaired t-test. Results Of 1719 Declaration of Death by Neurologic Criteria organ donors, 381 were secondary to head trauma. Smokers and organs recovered but not transplanted were excluded leaving 297 patients. Males comprised 78.8%, the mean age was 36.0 (±16.8) years, and 87.6% were treated at a trauma center. Higher donor potential (>4 OTPD) was associated with shorter average times from admission to brain death; 66.6 versus 82.2 hours, P = 0.04. Lung donors were also associated with shorter average times from admission to brain death; 61.6 versus 83.6 hours, P = 0.004. The time interval from DNC to donation varied minimally among groups and did not affect donation rates. Conclusions A shorter time interval between admission and declaration of DNC was associated with increased OTPD, especially lungs. Further research to identify what role timing plays in the management of the potential organ donor and how that relates to donor management goals is needed.

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“…Elle reposait sur l'identification et l'admission précoce des potentiels donneurs en unité de réanimation et sur une gestion par une équipe dédiée, associées à une réanimation hémodynamique agressive. Une prise en charge spécifique visant à atteindre des objectifs prédéfinis (dont des objectifs hémodynamiques et métaboliques) a montré un impact positif sur le nombre d'organes prélevés par donneur [68,69]. Des travaux ont également montré que la mise à profit du temps incompressible nécessaire à l'organisation du PMO permettait une optimisation de la fonction des organes, voire une augmentation du nombre d'organes prélevés [70][71][72].…”

Section: Contrôle Glycémiqueunclassified

Conséquences cardiovasculaires de la mort cérébrale et prise en charge pour prélèvement d’organe(s)

Champigneulle

Charpentier

2015

Réanimation

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La mort encéphalique (ME) est susceptible d'entraîner une dysfonction cardiocirculatoire, par l'intermé-diaire de différents mécanismes résultant de l'ischémie céré-brale : orage catécholaminergique, dysfonction neurohormonale et inflammation systémique. Cette dysfonction cardiovasculaire est potentiellement exacerbée par les anté-cédents du potentiel donneur décédé en mort encéphalique (DDME) et le contexte clinique dans lequel survient la ME. La détection et la prise en charge d'une défaillance hémo-dynamique survenant dans ce contexte sont cruciales dans le but de préserver la viabilité des greffons potentiels, mais aussi de tenter d'en améliorer la qualité et d'en augmenter le nombre. Cette prise en charge hémodynamique nécessite de connaître la physiopathologie de la ME et d'utiliser un monitorage. Elle repose sur l'administration d'agents inotropes en cas de dysfonction myocardique, la correction d'une hypovolémie et l'administration d'amines vasopressives. En l'état actuel, une opothérapie substitutive (hormones thyroï-diennes, glucocorticoïdes) ne peut être recommandée. Les principales mesures associées indispensables sont : la correction des désordres électrolytiques et métaboliques, la lutte contre l'hypothermie et le traitement d'un diabète insipide. Une réanimation « agressive » du potentiel DDME doit être poursuivie jusqu'au clampage aortique au bloc opératoire. Le sujet en ME, potentiel donneur d'organe(s), doit être considéré comme un « patient » de réanimation à part entière. Mots clés Mort encéphalique · Prélèvement d'organe · Réanimation · Gestion hémodynamiqueAbstract During brain death (BD) process, several mechanisms may induce cardio-circulatory failure. These mechanisms are secondary to brain ischemia and involve a catecholamine storm, a systemic inflammatory state and a hormonal dysfunction. Donor past history and associated medical context may worsen the hemodynamic failure. Objectives of early recognition and treatment of cardiocirculatory failure in potentials BD donors are: to preserve the viability of the potential grafts, to improve organ's function and to increase the number of recovered organs. Hemodynamic resuscitation is principally based on the use of inotropic agents in case of myocardial dysfunction, the correction of hypovolemia and the use of vasopressors (norepinephrine) adapted using a cardiovascular monitorage. Systematic hormone therapy is still debated. Associated supportive treatment includes correction of metabolic and electrolytic disorders, avoidance of hypothermia and management of diabetes insipidus. Aggressive management must be conducted until aortic clamping during organ recovery in operating room. Potential BD donor must be managed like any other intensive care unit patient.

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The Impact of Meeting Donor Management Goals on the Number of Organs Transplanted per Expanded Criteria Donor

Cited by 72 publications

References 11 publications

Time trends in organ donation after neurologic determination of death: a cohort study

Time trends in organ donation after neurologic determination of death: a cohort study

Early declaration of death by neurologic criteria results in greater organ donor potential

Conséquences cardiovasculaires de la mort cérébrale et prise en charge pour prélèvement d’organe(s)

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