Changes in the solid organ donor pool and the effect on cardiothoracic donation?

In the era of COVID-19 pandemic, organ transplantation programs were facing serious challenges. The lung transplantation donor pool was extremely limited and SARS-CoV-2 viral load assessment has become a crucial part of selecting an optimal organ donor. Since COVID-19 is a respiratory disease, the viral load is thought to be more important in lung transplantations as compared to other solid organ transplantations. We present two challenging cases of potential lung donors with a questionable COVID-19 status. Based on these cases, we suggest that the cycle threshold (Ct) value should always be requested from the laboratory and the decision whether to proceed with transplantation should be made upon complex evaluation of diverse criteria, including the nasopharyngeal swab and bronchoalveolar lavage PCR results, the Ct value, imaging findings and the medical history. However, as the presence of viral RNA does not ensure infectivity, it is still to be clarified which Ct values are associated with the viral viability. Anti-SARS-CoV-2 IgA antibodies may support the diagnosis and moreover, novel methods, such as quantifying SARS-CoV-2 nucleocapsid antigen in serum may provide important answers in organ transplantations and donor selections.

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Knowledge and Attitudes about Organ Donation among Patient Companion at a Tertiary Hopsital in Ethiopia

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v31i1.14 ◽

2021 ◽

Vol 31 (1) ◽

Author(s):

Mahteme Bekele ◽

Wubshet Jote ◽

Tigist Workneh ◽

Berhanu Worku

Keyword(s):

Organ Donation ◽

Medical Center ◽

Negative Attitude ◽

Organ Donor ◽

Tertiary Hospital ◽

Favorable Attitude ◽

Good Knowledge ◽

Donor Pool ◽

Cross Sectional ◽

Study Participants

BACKGROUND: Worldwide, the supply of organs continues to be much less than the demand. Many studies identify poor knowledge and negative attitude about organ donation for this. The purpose of this study was to assess knowledge and attitude towards organ donation and associated factors among people who accompany patient during hospital visit at tertiary hospital in Ethiopia.METHODS: A hospital-based cross-sectional study was conducted from March 1st to May 31, 2019, at a tertiary hospital and the only transplant center in Ethiopia. The patient companions were interviewed with structured questionnaires. Descriptive statistics were presented and factors associated with good knowledge and favorable attitude were assessed using Binary logistic regression.RESULTS: A total of 414 patient companion participated in the study. The mean age of the respondents was 35+13years, and 252(60.9%) were males. Forty-four (10.6%) of the study participants had good knowledge about organ donation. Male gender was significantly associated with improved knowledge (AOR=2.127 95% CI: 1.036, 4.368). A favorable attitude towards donation was found in 219(52.9%) of the study participants. Participants who had completed secondary education were more likely to have unfavorable attitude towards organ donation (AOR=0.498, 95% CI: 0.290, 0.857).CONCLUSION: Knowledge about organ donation was found to be poor, and attitudes towards organ donation were found to be unfavorable among patient companions at a major medical center in Ethiopia. Strategies focused on education of the general public and broad dissemination of information on the benefits of organ donation will be critical for improving the organ donor pool.

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Expanding renal transplantation organ donor pool in Nigeria

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.243946 ◽

2018 ◽

Vol 29 (5) ◽

pp. 1181

Author(s):

AdemolaAlabi Popoola ◽

TimothyOlusegun Olanrewaju ◽

BenjaminOlusomi Bolaji ◽

TajudeenOlalekan Ajiboye

Keyword(s):

Renal Transplantation ◽

Organ Donor ◽

Donor Pool

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Transplantation of a Heart Donated After Circulatory Death via Thoraco-Abdominal Normothermic Regional Perfusion. Results from the first Spanish case.

10.21203/rs.3.rs-57954/v2 ◽

2020 ◽

Author(s):

Marina Pérez Redondo ◽

Sara Alcántara Carmona ◽

Susana Villar García ◽

Alberto Forteza Gil ◽

Hector Villanueva Fernández ◽

...

Keyword(s):

Organ Donor ◽

Regional Perfusion ◽

Ex Situ ◽

Donor Pool ◽

Case Presentation ◽

Suitable Candidate ◽

First Case ◽

Normothermic Regional Perfusion ◽

Multiorgan Procurement ◽

Circulatory Death

Abstract BackgroundControlled donation after circulatory death (cDCD) has emerged as one of the main strategies for increasing the organ donor pool. Because of the ischemic injury that follows the withdrawal of life-sustaining therapies, hearts from cDCD donors have not been considered for transplantation until recently. The ex-situ perfusion of hearts directly procured from cDCD donors has been used to allow the continuous perfusion of the organ and the assessment of myocardial viability prior to transplantation. Based on our experience with abdominal normothermic regional perfusion in cDCD, we designed a protocol to recover and validate hearts from cDCD donors using thoraco-abdominal normothermic regional perfusion without the utilization of an ex-situ device.Case presentationWe describe the first case of a cDCD heart transplant performed with this approach in Spain. The donor was a 43-year-old asthmatic female diagnosed with severe hypoxic encephalopathy. She was considered a potential cDCD donor and a suitable candidate for multiorgan procurement including the heart via thoraco-abdominal normothermic regional perfusion. The heart recipient was a 60-year-old male diagnosed with amyloid cardiomyopathy. Cold ischemia time was 55 minutes. The surgery was uneventful.ConclusionsThis case report, the first of its kind in Spain, supports the feasibility of evaluating and successfully transplanting cDCD hearts without the need for ex-situ perfusion based on the use of thoraco-abdominal normothermic regional perfusion opening the way for multiorgan donation in cDCD.

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Abstract 16: Sex Disparities in Organ Donation: Finding an Equal Donor Pool

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.16 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Erika Yee ◽

Seyedeh Maryam Hosseini ◽

Bianca Duarte ◽

Shannon Knapp ◽

Nancy K Sweitzer ◽

...

Keyword(s):

Organ Donation ◽

Family Member ◽

Family Members ◽

Organ Donor ◽

Medical Mistrust ◽

Organ Donors ◽

Donor Pool ◽

Men And Women ◽

Willingness To Donate ◽

Amazon's Mechanical Turk

Introduction: The majority of living organ donors are women, and the majority of deceased organ donors are men. This poses a problem for transplant candidates who have worsened survival with sex mismatched organs. The objective of this study was to identify reasons for disparities in organ donation between sexes and identify strategies to increase organ donors. Methods: We conducted a fifteen question survey using a crowdsourcing marketplace, Amazon’s Mechanical Turk, in September 2019. The survey assessed how participants make decisions about becoming an organ donor. The survey was distributed to U.S. adult participants, including eight write-in questions and two Likert scale questions. Qualitative descriptive analyses were used to understand reasons for and against becoming an organ donor. Quantitative results were compared with t test. Results: Among the 667 eligible participants representing 49 states, 54.9% were women and 63.1% were in the 18-40 age group. The majority of men (64.8%) and women (63.4%) were registered organ donors. Among men and women donors, three themes guided their willingness to donate: desire to help others, personal experience with organ donors/recipients, and believing organs would have no use to the donor once dead. Among men and women non-donors, decisions were guided by three themes: no reason, medical mistrust, considering becoming a donor. Themes varied by sex when considering whether to donate organs of a deceased family member. Women were guided equally by two themes: family member’s wishes and believing the deceased family member had no further use for organs. Men had similar themes but valued the family member’s wishes more. Women’s willingness to donate their own organs to family members (p=0.03) and strangers (p=0.02) was significantly higher than men. Among non-donors, both sexes would consider becoming organ donors if more information was provided. Conclusion: In a national survey of adults, women and men had similar reasons for becoming and not becoming an organ donor. However compared to men, women were more willing to donate their organs and more altruistic in the donation of family members’ organs. Women’s deceased organ donation may increase with further communication of women’s wishes before death and by improved public education about organ donation.

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Donor organ management

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0052 ◽

2021 ◽

pp. 691-705

Author(s):

Arne P Neyrinck ◽

Patrick Ferdinande ◽

Dirk Van Raemdonck ◽

Marc Van de Velde

Keyword(s):

Brain Death ◽

Treatment Strategies ◽

Organ Donor ◽

Hormonal Changes ◽

Physiological Changes ◽

Donor Pool ◽

Potential Donor ◽

Donor Management ◽

Heart Beating ◽

Pituitary Thyroid Axis

Organ transplantation is the standard treatment modality for end-stage organ disease in selected cases. Two types of potential organ donors can be identified: the brain-dead 'heart-beating donors', referred to as DBD (donation after brain death), and the warm ischaemic 'non-heart-beating donors', referred to as DCD (donation after circulatory death). Brain death induces several physiological changes in the DBD donor. An autonomic storm is characterized by massive catecholamine release, followed by autonomic depletion during a vasoplegic phase. This is associated with several hormonal changes (suppression of vasopressin, the hypothalamic-pituitary-adrenal axis, and the hypothalamic-pituitary-thyroid axis) and an inflammatory response. These physiological changes form the basis of organ donor management, including cardiovascular stabilization and hormonal therapy (including vasopressin and analogues, thyroid hormone, and cortisol). Donor management is the continuation of critical care, with a shift towards individual organ stabilization. An aggressive approach to maximize organ yield is recommended; however, many treatment strategies need further investigation in large randomized trials. DCD donors have now evolved as a valid alternative to increase the potential donor pool and challenge the clinician with new questions. Optimal donor comfort therapy and end-of-life care are important to minimize the agonal phase. A strict approach towards the determination of death, based on cardiorespiratory criteria, is prerequisite. Novel strategies have been developed, using ex situ organ perfusion as a tool, to evaluate and recondition donor organs. They might become more important in the future to further optimize organ quality.

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