Machine Learning Prediction of Liver Allograft Utilization From Deceased Organ Donors Using the National Donor Management Goals Registry

This study was a retrospective review of 252 brain-dead potential donors from 1990 to 1996, including 5 organ donors in the peripartum period. The purpose of the study was to determine the effects of pregnancy on organ donor management and recipient outcome. Case analysis of 5 pregnant donors identified problems with hemodynamic stability and electrolyte abnormalities, including hypernatremia, hyperchloremia, and hypocalcemia. In addition, blood glucose was frequently elevated. Two donors were treated for diabetes insipidus. All 5 donors produced organs for 20 transplant recipients. Five heart recipients (including 1 heart-lung), 4 liver recipients, 4 kidney recipients, and 4 pancreas-kidney recipients have reported excellent outcomes. The use of organs from brain-dead organ donors in the peripartum period has minimal impact on donor management and recipient outcome.

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A multicenter randomized placebo-controlled trial of intravenous thyroxine for heart-eligible brain-dead organ donors

Trials ◽

10.1186/s13063-021-05797-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Rajat Dhar ◽

Dean Klinkenberg ◽

Gary Marklin

Keyword(s):

Thyroid Hormone ◽

Organ Procurement ◽

Hemodynamic Instability ◽

Controlled Study ◽

Primary Study ◽

Organ Donors ◽

Donor Management ◽

Link Type ◽

Thyroxine Treatment ◽

Brain Dead

Abstract Background Brain death frequently induces hemodynamic instability and cardiac stunning. Impairments in cardiac performance are major contributors to hearts from otherwise eligible organ donors not being transplanted. Deficiencies in pituitary hormones (including thyroid-stimulating hormone) may contribute to hemodynamic instability, and replacement of thyroid hormone has been proposed as a means of improving stability and increasing hearts available for transplantation. Intravenous thyroxine is commonly used in donor management. However, small controlled trials have not been able to demonstrate efficacy. Methods This multicenter study will involve organ procurement organizations (OPOs) across the country. A total of 800 heart-eligible brain-dead organ donors who require vasopressor support will be randomly assigned to intravenous thyroxine for at least 12 h or saline placebo. The primary study hypotheses are that thyroxine treatment will result in a higher proportion of hearts transplanted and that these hearts will have non-inferior function to hearts not treated with thyroxine. Additional outcome measures are the time to achieve hemodynamic stability (weaning off vasopressors) and improvement in cardiac ejection fraction on echocardiography. Discussion This will be the largest randomized controlled study to evaluate the efficacy of thyroid hormone treatment in organ donor management. By collaborating across multiple OPOs, it will be able to enroll an adequate number of donors and be powered to definitively answer the critical question of whether intravenous thyroxine treatment increases hearts transplanted and/or provides hemodynamic benefits for donor management. Trial registration ClinicalTrials.govNCT04415658. Registered on June 4, 2020

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The Reward is Worth the Wait: A Prospective Analysis of 100 Consecutive Organ Donors

The American Surgeon ◽

10.1177/000313481207800336 ◽

2012 ◽

Vol 78 (3) ◽

pp. 296-299 ◽

Cited By ~ 2

Author(s):

A. Britton Christmas ◽

Tyson A. Bogart ◽

Kristina E. Etson ◽

Brett A. Fair ◽

Harold R. Howe ◽

...

Keyword(s):

Patient Management ◽

Organ Procurement ◽

Prospective Analysis ◽

Organ Donors ◽

Donor Management ◽

Organ Procurement Organization ◽

Patient Demographics ◽

Included Patient ◽

Initial Hypothesis

Aggressive donor management protocols have evolved to maximize the number of procured organs. Our study assessed donor management time and the number and types of organs procured with the hypothesis that shorter management time yields increased organ procurement and transplant rates. We prospectively analyzed 100 donors managed by a regional organ procurement organization (OPO) during 2007 to 2008. Data included patient demographics, number and types of organs procured and transplanted, patient management time by the OPO, and achievement of donor pre-procurement goals. One hundred consecutive organ donors were managed with a mean age 41 ± 18 years and mean management time 23 ± 9 hours; 376 organs were procured and 327 successfully transplanted. Donors managed greater than 20 hours yielded significantly more heart (5 vs 26, P < 0.01) and lung (6 vs 40, P < 0.01) procurements, more organs procured per donor (3.2 ± 1.4 vs 4.2 ± 1.6, P < 0.01), and more organs transplanted per donor (2.6 ± 1.5 vs 3.7 ± 1.8, P < 0.01) than those managed 20 hours or less. No difference in the attainment of donor management goals was observed between these populations. Contrary to our initial hypothesis, donor management times greater than 20 hours yielded increased organ procurement and transplant rates, particularly for hearts and lungs, despite no differences in the achievement of donor preprocurement management goals.

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The effect of steroid pretreatment of deceased organ donors on liver allograft function: A blinded randomized placebo-controlled trial

Journal of Hepatology ◽

10.1016/j.jhep.2012.01.020 ◽

2012 ◽

Vol 56 (6) ◽

pp. 1305-1309 ◽

Cited By ~ 20

Author(s):

Stefan Amatschek ◽

Julia Wilflingseder ◽

Mario Pones ◽

Alexander Kainz ◽

Martin Bodingbauer ◽

...

Keyword(s):

Controlled Trial ◽

Organ Donors ◽

Liver Allograft ◽

Allograft Function

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An In-House Coordinator Program to Increase Organ Donation in Public Trauma Hospitals

Journal of Transplant Coordination ◽

10.1177/090591999800800205 ◽

1998 ◽

Vol 8 (2) ◽

pp. 82-87 ◽

Cited By ~ 6

Author(s):

Teresa Shafer ◽

R. Patrick Wood ◽

Charles Van Buren ◽

William Guerriero ◽

Kimberly Davis ◽

...

Keyword(s):

Retrospective Study ◽

Organ Donation ◽

Organ Procurement ◽

Consent Process ◽

Organ Donors ◽

Consent Rate ◽

Donor Management ◽

Organ Procurement Organization ◽

Conversion Rates ◽

Organ Recovery

A 4-year retrospective study was conducted regarding the donor potential, consent rates, and organ recovery at a large 500-bed public trauma hospital. An independent organ procurement organization hired two in-house coordinators, one white and one black, to work exclusively in the hospital. The duties of the in-house coordinators included the following: working with nurses, physicians, and residents to identify donors; closely managing and coordinating the consent process; and assisting organ procurement coordinators in donor management. Following the program's implementation and the use of race-specific requesters, a 64% increase in consent rate resulted along with an overall increase of 94% in the number of organ donors. The consent rate of blacks increased 115%, whereas the number of black organ donors increased 154%. The Hispanic consent rate increased 48% with a corresponding increase of 83% in the number of Hispanic organ donors. In addition, the white consent rate increased from 55% (the 3-year average from 1993 to 1995) to 75% in 1996, resulting in a 36% increase following the implementation of the program. The investment of dedicated race-sensitive personnel in large urban county trauma facilities can result in a significant increase in donor conversion rates.

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Canada-DONATE study protocol: a prospective national observational study of the medical management of deceased organ donors

BMJ Open ◽

10.1136/bmjopen-2017-018858 ◽

2017 ◽

Vol 7 (9) ◽

pp. e018858 ◽

Cited By ~ 5

Author(s):

Frederick D’Aragon ◽

Sonny Dhanani ◽

Francois Lamontagne ◽

Deborah J Cook ◽

Karen Burns ◽

...

Keyword(s):

Clinical Trials ◽

Observational Study ◽

Medical Management ◽

Organ Donors ◽

Multilevel Regression ◽

Donor Management ◽

Management Objectives ◽

Registration Number ◽

Recipient Age ◽

Current Practices

IntroductionResearch on the management of deceased organ donors aims to improve the number and quality of transplants and recipient outcomes. In Canada, this research is challenged by regionalisation of donation services within provinces and the geographical, clinical and administrative separation of donation from transplantation services. This study aims to build a national platform for future clinical trials in donor management. Objectives are to engage collaborators at donation hospitals and organ donation organisations (ODOs) across Canada, describe current practices, evaluate the effectiveness of donation-specific interventions and assess the feasibility of future clinical trials.Methods and analysisThis ongoing prospective observational study of the medical management of deceased organ donors will enrol more than 650 consented potential donors from adult intensive care units at 33 hospital sites across Canada, each participating for 12 months. ODOs ensure enrolment of consecutive eligible participants. Research staff record detailed data about participants, therapies, organ assessments, death declaration procedures and adverse clinical exposures from the time of donation consent to organ recovery. ODOs provide reasons that organs are declined, dates and places of transplantation, and recipient age and sex.Descriptive analyses will summarise current practices. Effectiveness analyses will examine donation-specific interventions with respect to the number of transplants, using multilevel regression models to account for clustering by donor, hospitals and ODOs. Feasibility analyses will focus on acceptance of the research consent model; participation of academic and community hospitals as well as ODOs; and accessibility of recipient data.Ethics and disseminationThis study uses a waiver of research consent. Hospitals will receive reports on local practices benchmarked to (1) national practices and (2) national donor management guidelines. We will report findings to donation and transplant collaborators (ie, clinicians, researchers, ODOs) and publish in peer-reviewed journals.Trial registration numberNCT03114436.

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Pediatric Donor Management Goals in Use by US Organ Procurement Organizations

Progress in Transplantation ◽

10.1177/1526924819835835 ◽

2019 ◽

Vol 29 (2) ◽

pp. 150-156

Author(s):

Robert S. Ream ◽

Matthew G. Clark ◽

Eric S. Armbrecht

Keyword(s):

Serum Creatinine ◽

Organ Procurement ◽

Venous Pressure ◽

Serum Glucose ◽

Arterial Oxygen ◽

Organ Donors ◽

Donor Management ◽

Organ Procurement Organizations ◽

Pediatric Donors

Introduction: A recent study of pediatric organ donation after the neurologic determination of death (DNDD) demonstrated an association between the use of donor management goals (DMGs) by organ procurement organizations (OPOs) and organ yield. Objective: To describe the pediatric DMGs used by OPOs and any association between specific DMGs and organ yield. Design: Query of US OPOs who utilized DMGs in the care of pediatric DNDD organ donors from 2010 to 2013. Results: All 23 OPOs using DMGs for pediatric DNDD organ donors during the study period participated (100%). The OPOs pursued an average 9.6 goals (standard deviation: 3.9; range: 5-22) with 113 unique definitions that targeted 33 aspects of donor hemodynamics, gas exchange/mechanical ventilation, electrolytes/renal function, blood products, thermoregulation, and infection control. The DMGs used by >50% of OPOs included blood pressure, oxygenation (partial pressure of arterial oxygen (PaO2), oxygen saturation of hemoglobin by pulse oximetry, or PaO2/fractional concentration of inspired oxygen [FiO2] ratio), pH, central venous pressure, serum sodium, urine output, limitations on inotropic support, and serum glucose. There was no significant correlation between the number of DMGs pursued by OPOs and organ yield. There was a difference in the observed/expected organs transplanted in the 0- to 10-year age-group for OPOs that included serum creatinine among their DMGs ( P = .046). Conclusions: The pediatric DMGs used by OPOs were generally measurable but diverse in definition and the number of goals pursued. There was no benefit in organ yield from larger DMG bundles. There may be a benefit in organ yield through the use of serum creatinine as a DMG in pediatric donors aged 0 to 10 years.

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Mind wandering as data augmentation: How mental travel supports abstraction

Behavioral and Brain Sciences ◽

10.1017/s0140525x1900311x ◽

2020 ◽

Vol 43 ◽

Author(s):

Myrthe Faber

Keyword(s):

Machine Learning ◽

Data Augmentation ◽

Mental Content ◽

Mind Wandering ◽

Theoretical Framework ◽

Important Addition

Abstract Gilead et al. state that abstraction supports mental travel, and that mental travel critically relies on abstraction. I propose an important addition to this theoretical framework, namely that mental travel might also support abstraction. Specifically, I argue that spontaneous mental travel (mind wandering), much like data augmentation in machine learning, provides variability in mental content and context necessary for abstraction.

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Machine Learning for Speaker Recognition

10.1017/9781108552332 ◽

2020 ◽

Cited By ~ 2

Author(s):

Man-Wai Mak ◽

Jen-Tzung Chien

Keyword(s):

Machine Learning ◽

Speaker Recognition

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