Analysis of Organ Donors in the Peripartum Period

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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DONORS (Donation Network to Optimise Organ Recovery Study): Study protocol to evaluate the implementation of an evidence-based checklist for brain-dead potential organ donor management in intensive care units, a cluster randomised trial

BMJ Open ◽

10.1136/bmjopen-2018-028570 ◽

2019 ◽

Vol 9 (6) ◽

pp. e028570 ◽

Cited By ~ 2

Author(s):

Glauco Adrieno Westphal ◽

Caroline Cabral Robinson ◽

Alexandre Biasi ◽

Flávia Ribeiro Machado ◽

Regis Goulart Rosa ◽

...

Keyword(s):

Cardiac Arrest ◽

Organ Donor ◽

Evidence Based ◽

Organ Donors ◽

Potential Organ Donor ◽

Cluster Randomised ◽

Recovery Study ◽

Organ Recovery ◽

Brain Dead ◽

Organ Donor Management

IntroductionThere is an increasing demand for multi-organ donors for organ transplantation programmes. This study protocol describes the Donation Network to Optimise Organ Recovery Study, a planned cluster randomised controlled trial that aims to evaluate the effectiveness of the implementation of an evidence-based, goal-directed checklist for brain-dead potential organ donor management in intensive care units (ICUs) in reducing the loss of potential donors due to cardiac arrest.Methods and analysisThe study will include ICUs of at least 60 Brazilian sites with an average of ≥10 annual notifications of valid potential organ donors. Hospitals will be randomly assigned (with a 1:1 allocation ratio) to the intervention group, which will involve the implementation of an evidence-based, goal-directed checklist for potential organ donor maintenance, or the control group, which will maintain the usual care practices of the ICU. Team members from all participating ICUs will receive training on how to conduct family interviews for organ donation. The primary outcome will be loss of potential donors due to cardiac arrest. Secondary outcomes will include the number of actual organ donors and the number of organs recovered per actual donor.Ethics and disseminationThe institutional review board (IRB) of the coordinating centre and of each participating site individually approved the study. We requested a waiver of informed consent for the IRB of each site. Study results will be disseminated to the general medical community through publications in peer-reviewed medical journals.Trial registration numberNCT03179020; Pre-results.

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Organ donor management: Common recommendations that deserve evidence

Medicina Intensiva (English Edition) ◽

10.1016/j.medine.2018.02.002 ◽

2018 ◽

Vol 42 (8) ◽

pp. 513

Author(s):

T. Gil-Salazar ◽

J.J. Egea-Guerrero ◽

L. Martin-Villen ◽

Z. Ruiz de Azua-López

Keyword(s):

Organ Donor ◽

Donor Management ◽

Organ Donor Management

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Organ Donor Management

Journal of the Korean Medical Association ◽

10.5124/jkma.2006.49.6.502 ◽

2006 ◽

Vol 49 (6) ◽

pp. 502 ◽

Cited By ~ 2

Author(s):

Sung Joo Kim

Keyword(s):

Organ Donor ◽

Donor Management ◽

Organ Donor Management

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State of the Science in Deceased Organ Donor Management

Current Transplantation Reports ◽

10.1007/s40472-018-0207-8 ◽

2018 ◽

Vol 5 (4) ◽

pp. 273-281

Author(s):

Madhukar S. Patel ◽

Mitchell Sally ◽

Claus U. Niemann ◽

Darren J. Malinoski

Keyword(s):

Organ Donor ◽

Donor Management ◽

State Of The Science ◽

Organ Donor Management

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The Continued Need for Clinical Trials in Deceased Organ Donor Management

Transplantation Journal ◽

10.1097/tp.0000000000002512 ◽

2019 ◽

Vol 103 (7) ◽

pp. 1298-1299 ◽

Cited By ~ 3

Author(s):

Claus U. Niemann ◽

Michael A. Matthay ◽

Lorraine B. Ware

Keyword(s):

Clinical Trials ◽

Organ Donor ◽

Donor Management ◽

Organ Donor Management

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Organ donor management and procurement

Organ Transplantation ◽

10.1017/cbo9780511994876.010 ◽

2011 ◽

pp. 53-62 ◽

Cited By ~ 3

Author(s):

Edward Cantu III ◽

David W. Zaas

Keyword(s):

Organ Donor ◽

Donor Management ◽

Organ Donor Management

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Organ Donor Management and Organ Outcome

Journal of Trauma and Acute Care Surgery ◽

10.1097/00005373-199006000-00013 ◽

1990 ◽

Vol 30 (6) ◽

pp. 728-732 ◽

Cited By ~ 81

Author(s):

CHRISTINE E. NYGAARD ◽

RICARD N. TOWNSEND ◽

DANIEL L. DIAMOND

Keyword(s):

Organ Donor ◽

Donor Management ◽

Organ Donor Management

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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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How nurses shift from care of a brain-injured patient to maintenance of a brain-dead organ donor

American Journal of Critical Care ◽

10.4037/ajcc2001.10.5.306 ◽

2001 ◽

Vol 10 (5) ◽

pp. 306-312 ◽

Cited By ~ 21

Author(s):

L Day

Keyword(s):

Critical Care ◽

Organ Procurement ◽

Injured Patient ◽

Organ Donor ◽

Critical Care Nurses ◽

Organ Donors ◽

Early Referral ◽

Brain Injured Patient ◽

Brain Injured ◽

Brain Dead

BACKGROUND: The responsibility of obtaining organs for transplantation rests partly on critical care nurses. How nurses balance care of critically ill, brain-injured patients with the professional responsibility to procure organs is a question of ethical and clinical importance. OBJECTIVES: To describe the experiences of critical care nurses in making the shift from caring for a brain-injured patient identified as a potential organ donor to maintaining a brain-dead body. METHODS: An interpretive, phenomenological design was used. In 2 trauma centers, 9 critical care nurses were interviewed, and 2 of the 9 nurses were observed. RESULTS: Identification of potential organ donors is made under conditions of prognostic ambiguity. The transition from brain injury to brain death is a period of instability in which the critical care team must decide quickly whether to resuscitate a patient in order to procure organs. After a patient is brain dead, critical care nurses' relationship with and responsibility toward the patient change. CONCLUSIONS: The process of identifying potential organ donors and holding open the tentative possibility of organ procurement illustrates the practical difficulties of early referral of potential donors to organ procurement organizations. Early referral to an organ procurement organization implies a commitment to organ procurement that some nurses may hesitate to make because such a commitment changes their relationship with a brain-injured patient.

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