scholarly journals P098: Solid organ donation from the emergency department - a systematic review

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S91-S91
Author(s):  
J. McCallum ◽  
B. Ellis ◽  
I. G. Stiell
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Organ Donation ◽  
Cardiopulmonary Arrest ◽  
Meta Analysis ◽  
Organ Transplant ◽  
Donation After Cardiac Death ◽  
Solid Organ ◽  
Organ Donors ◽  
Human Adults

Introduction: There is a significant gap between the number of organ donors and people awaiting an organ transplant; therefore it is essential that all potential donors are identified. Given the nature of Emergency Medicine it is a potential source of organ donors. The purpose of this study is to determine what percent of successful donors come from the Emergency Department (ED) and whether there are any missed potential donors. Methods: Electronic searches of EMBASE, MEDLINE, and CINAHL were performed July 7, 2017 using PRISMA guidelines. Primary literature in human adults were included if they described identification of patients in the ED who went on to become successful solid organ donors, or described missed potential donors in the ED. Data on the total population of actual or missed donors was required to allow calculation of a percentage. Studies describing non-solid organ donation, consent, ethics, survey of attitudes, teaching curricula, procurement techniques, donation outside the ED, and recipient factors were excluded. 2 authors independently screened articles for inclusion and discrepancies were resolved through consensus. Quality was assessed using STROBE for observational studies. Heterogeneity of patient populations precluded pooling of the data to conduct a meta-analysis. Results: 1058 articles were identified, 17 duplicates were removed, 800 articles were excluded based on title and abstract, and 217 full text articles were excluded, yielding 24 articles for the systematic review. For neurologic determination of death (NDD), ED patients comprised 4 44% of successful donors. ED death reviews revealed 0 84% of patients dying in the ED are missed as potential donors and hospital-wide death reviews revealed 13 80.9% of missed donors die in the ED. For donation after cardiac death (DCD), 4 20% of successful donors came from the ED and studies investigating potential donors suggest 2 36% of patients dying the in the ED could be potential DCD donors. The most common population of successful DCD organ donors was in traumatic cardiopulmonary arrest (TCPA), with 3.6 8.9% of TCPA patients presenting to the ED becoming successful donors. Conclusion: Patients dying in the Emergency Department are a significant source of both successful organ donors and missed potential donors. Emergency physicians should be familiar with their local organ donation protocol to ensure potential organ donors are not missed.

scholarly journals Solid organ donation from the emergency department – A systematic review

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 626-637 ◽  
Author(s):  
Jessica McCallum ◽  
Brittany Ellis ◽  
Sonny Dhanani ◽  
Ian G. Stiell
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Organ Donation ◽  
Meta Analysis ◽  
Healthcare Team ◽  
Solid Organ ◽  
Organ Donors ◽  
Determination Of Death ◽  
Eligibility Criteria

ABSTRACTObjectivesA significant gap exists between people awaiting an organ transplant and organ donors. The purpose of this study was to determine what percent of successful donors come from the emergency department (ED), whether there are any missed donors, and to identify factors associated with successful and missed donation.MethodsThis systematic review used electronic searches of EMBASE, MEDLINE, and CINAHL according to PRISMA guidelines on July 7, 2017. We included primary literature in adults describing successful and missed organ donation. Two authors independently screened articles, and discrepancies were resolved through consensus. Quality was assessed using the STROBE checklist.ResultsThis systematic review identified 1,058 articles, and 25 articles were included. For neurologic determination of death, ED patients comprised 4%–50% of successful donors and 3.6%–8.9% of successful donors for donation after circulatory determination of death. ED death reviews revealed up to 84% of missed neurologic determination of death, and 46.2% of missed circulatory determination of death donors who died in the ED are missed due to a failure to refer for consideration of organ donation. Clinical heterogeneity precluded pooling of the data to conduct a meta-analysis.ConclusionsThe ED is a source of actual and missed donors. Potential donors are often missed due to incorrect assumptions regarding eligibility criteria and failure of the healthcare team to refer for consideration of donation. ED healthcare professionals should be aware of organ donation referral protocols at their institution to ensure that no organ donors are missed.

scholarly journals Does Post-Transplant Cytomegalovirus Increase the Risk of Invasive Aspergillosis in Solid Organ Transplant Recipients? A Systematic Review and Meta-Analysis

2021 ◽  
Vol 7 (5) ◽  
pp. 327
Author(s):  
Nipat Chuleerarux ◽  
Achitpol Thongkam ◽  
Kasama Manothummetha ◽  
Saman Nematollahi ◽  
Veronica Dioverti-Prono ◽  
...  
Keyword(s):  
Systematic Review ◽  
Invasive Aspergillosis ◽  
Meta Analysis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Effect Estimate ◽  
Solid Organ ◽  
Post Transplant ◽  
Cmv Disease ◽  
The Impact

Background: Cytomegalovirus (CMV) and invasive aspergillosis (IA) cause high morbidity and mortality in solid organ transplant (SOT) recipients. There are conflicting data with respect to the impact of CMV on IA development in SOT recipients. Methods: A literature search was conducted from existence through to 2 April 2021 using MEDLINE, Embase, and ISI Web of Science databases. This review contained observational studies including cross-sectional, prospective cohort, retrospective cohort, and case-control studies that reported SOT recipients with post-transplant CMV (exposure) and without post-transplant CMV (non-exposure) who developed or did not develop subsequent IA. A random-effects model was used to calculate the pooled effect estimate. Results: A total of 16 studies were included for systematic review and meta-analysis. There were 5437 SOT patients included in the study, with 449 SOT recipients developing post-transplant IA. Post-transplant CMV significantly increased the risk of subsequent IA with pORs of 3.31 (2.34, 4.69), I2 = 30%. Subgroup analyses showed that CMV increased the risk of IA development regardless of the study period (before and after 2003), types of organ transplantation (intra-thoracic and intra-abdominal transplantation), and timing after transplant (early vs. late IA development). Further analyses by CMV definitions showed CMV disease/syndrome increased the risk of IA development, but asymptomatic CMV viremia/infection did not increase the risk of IA. Conclusions: Post-transplant CMV, particularly CMV disease/syndrome, significantly increased the risks of IA, which highlights the importance of CMV prevention strategies in SOT recipients. Further studies are needed to understand the impact of programmatic fungal surveillance or antifungal prophylaxis to prevent this fungal-after-viral phenomenon.

scholarly journals LO66: Solid organ donation from the emergency department: A death review

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S31-S32
Author(s):  
J. McCallum ◽  
R. Yip ◽  
S. Dhanani ◽  
I. Stiell
Keyword(s):  
Emergency Department ◽  
Organ Donation ◽  
Primary Outcome ◽  
Organ Procurement ◽  
Care Center ◽  
Demographic Data ◽  
Tertiary Care ◽  
Solid Organ ◽  
Organ Donors ◽  
Organ Procurement Organization

Introduction: A significant gap exists between the number of people waiting for an organ and donors. There are currently 1,628 people awaiting organ donation in Ontario alone. In 2018 to date, 310 donors have donated 858 organs. The purpose of this study was to determine whether there were missed donors in the Emergency Department (ED) and by what percent those missed donors would increase organ donation overall. Methods: This was a health records and organ donation database review of all patients who died in the ED at a large academic tertiary care center with 2 campuses and 160,000 visits per year. Patients were included from November 1, 2014 – October 31, 2017. We collected data on demographics, cause of death, and suitability for organ donation. Data was cross-referenced between hospital records and the provincial organ procurement organization called Trillium Gift of Life Network (TGLN) to determine whether patients were appropriately referred for consideration of donation in a timely manner. Potential missed donors were manually screened for suitability according to TGLN criteria. We calculated simple descriptive statistics for demographic data and the primary outcome. The primary outcome was percentage of potential organ donors missed in the Emergency Department (ED). Results: There were 606 deaths in the ED from November 1, 2014 – October 31, 2017. Patients were an average of 71 years old, 353 (58%) were male, and 75 (12%) died of a traumatic cause. TGLN was not contacted in 12 (2%) of cases. During this period there were two donors from the ED and 92 from the ICU. There were ten missed potential donors. They were an average of 67 years, 7 (70%) were male, and 2 (20%) died of a traumatic cause. In all ten cases, patients had withdrawal of life sustaining measures for medical futility prior to TGLN being contacted for consideration of donation. There could have been an addition seven liver, six pancreatic islet, four small bowel, and seven kidney donors. The ten missed ED donors could have increased total donors by 11%. Conclusion: The ED is a significant source of missed organ donors. In all cases of missed organ donation, patients had withdrawal of life sustaining measures prior to TGLN being called. In the future, it is essential that all patients have an organ procurement organization such as TGLN called prior to withdrawal of life sustaining measures to ensure that no opportunity for consideration of organ donation is missed.

scholarly journals COVID-19 in solid organ transplant recipients: A systematic review and meta-analysis of current literature

2021 ◽  
Vol 35 (1) ◽  
pp. 100588
Author(s):  
Mohammed A. Raja ◽  
Maria A. Mendoza ◽  
Aasith Villavicencio ◽  
Shweta Anjan ◽  
John M. Reynolds ◽  
...  
Keyword(s):  
Systematic Review ◽  
Current Literature ◽  
Meta Analysis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

scholarly journals Quality of the reporting of exercise interventions in solid organ transplant recipients: a systematic review

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Uma Raje ◽  
Tyler M Saumur ◽  
Fernanda Pesce de Souza ◽  
Sunita Mathur ◽  
Tania Janaudis-Ferreira
Keyword(s):  
Systematic Review ◽  
Exercise Training ◽  
Meta Analysis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Solid Organ ◽  
Exercise Interventions

Background:Exercise training programs must be described in detail to facilitate replication and implementation. This study aimed to evaluate the quality of exercise training program description in randomized controlled trials (RCTs) involving solid organ transplant (SOT) recipients. Methods: We evaluated 21 RCTs reporting on exercise interventions in SOT recipients that were included in a recent systematic review/meta-analysis conducted by the research team. This previous review investigated the effects of exercise training (versus no training) in adult SOT recipients. Several databases (MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) were searched from inception to May 2019. Three reviewers independently rated the exercise programs for SOT using the Consensus on Exercise Reporting Template (CERT). Results: Mean score of the CERT was 6/19. None of the RCTs described all items of the CERT. Items of crucial importance, such as adherence, whether the exercise was done individually or in a group, whether there were home program or non-exercise components, and the type and number of adverse events, were either not mentioned or not described in detail. Conclusion: RCTs in exercise in SOT recipients did not satisfactorily report their exercise protocols, which can lead to difficulties in replication by researchers and implementation by clinicians. 

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