Contribution by Departments of Forensic Medicine to Tissue Donation for Transplant Purposes

2016 ◽  
Vol 26 (4) ◽  
pp. 378-380
Author(s):  
Torsten Malm ◽  
Åsa Sandgren Åkerman ◽  
Jesper Greby ◽  
Björn Odö ◽  
Bengt-Åke Henriksson
Keyword(s):  
Forensic Medicine ◽  
Tissue Donation ◽  
Positive Interactions ◽  
Contributing Factors ◽  
Positive Serology ◽  
Tissue Quality ◽  
National Board ◽  
Cardiovascular Tissue ◽  
Technical Errors ◽  
Tissue Procurement

Background: A department of forensic medicine (DFM) can be a valuable source for tissue donation, but logistics can prove difficult to overcome as it pertains to obtaining tissues for donation. This article describes the potential of tissues that can be procured for transplantation. Materials and Methods: Sweden has 9.7 million inhabitants, with an annual mortality rate of 90 000 and 5500 medicolegal autopsies per year. Cooperation between tissue banking and 2 DFMs began in the mid-1980s. Recently, cooperation has expanded to include all six DFMs. All tissue establishments (TEs) were asked to complete a questionnaire concerning their cooperation with DFMs from 2011 through 2013. Results: A total of 298 actual donors were identified; 1090 tissues were procured including cardiovascular tissue, cornea, sclera, ear bones, and skin for transplantation. Of the tissues distributed, 553 were for transplantation and 72 for other medical purposes. Twenty-three percent of the tissues were discarded. Reasons for tissue rejection included deficient tissue quality (65%), positive serology tests (9%), positive bacteriology tests after decontamination procedures (7%), technical errors (<1%), and other reasons (18%). Conclusion: Nineteen percent of all tissues distributed for transplantation came from donors in DFMs. The cooperation between DFMs and TEs was described as well functioning and excellent. Education and national courses in tissue procurement for employees in DFMs are contributing factors to such positive interactions. The support from the National Board of Forensic Medicine is an important factor for sustainable progress.

scholarly journals Human Failure: An Analysis of 2000 Incident Reports

1993 ◽  
Vol 21 (5) ◽  
pp. 678-683 ◽  
Author(s):  
J. A. Williamson ◽  
R. K. Webb ◽  
A. Sellen ◽  
W. B. Runciman ◽  
J. H. Van Der Walt
Keyword(s):  
Crisis Management ◽  
Human Error ◽  
Best Practice ◽  
Contributing Factors ◽  
Rule Based ◽  
Relative Contribution ◽  
Technical Errors ◽  
Human Failure ◽  
Traditional Patterns ◽  
The Individual

Information of relevance to human failure was extracted from the first 2,000 incidents reported to the Australian Incident Monitoring Study (AIMS). All reports were searched for human factors amongst the “factors contributing”, “factors minimising”, and “suggested corrective strategies” categories, and these were classified according to the type of human error with which they were associated. In 83% of the reports elements of human error were scored by reporters. “Knowledge-based errors” contributed directly to about one-quarter of incidents; the outcome of one third of incidents was thought to have been minimised by prior experience or awareness of the potential problems, and in one fifth some strategy to improve knowledge was suggested. Correction of “rule-based errors” or provision of protocols or algorithms were thought, together, to have a potential impact on nearly half of all incidents. Failure to check equipment or the patient contributed to nearly one-quarter of all incidents, and inadequate crisis management contributed to a further I in 8. “Skill-based errors” (slips and lapses) were directly responsible for I in 10 of all incidents, and were thought to make an indirect contribution in up to one quarter. “Technical errors” were responsible for about 1 in 8 incidents. Analysing the relative contribution of each type of error for each type of problem allows the development of rational preventative strategies. Continued efforts must be made to improve the knowledge-base of anaesthetists, but AIMS has shown that there may also be much to gain from directing attention towards eliminating rule-based errors, for promoting the use of protocols, check-lists and crisis management algorithms, and improving anaesthetists’ insight into the factors contributing and circumstances in which slips and lapses may occur. Traditional patterns of behaviour in doctors may also make them more liable to certain types of human error; removing the onus for adhering to standards and approved work practices from the individual to the “system” may lead to more consistent application of the “best practice”.

scholarly journals Explosion fatalities in Sweden, 2000–2018

2021 ◽  
pp. 002580242110252
Author(s):  
Mensura Junuzovic
Keyword(s):  
Incidence Rate ◽  
Forensic Medicine ◽  
National Study ◽  
Adult Males ◽  
Manner Of Death ◽  
National Board ◽  
Swedish Study ◽  
Study Material ◽  
Child Deaths ◽  
Comprehensive Knowledge

Epidemiological aspects of explosion-related deaths in a civilian setting may bring comprehensive knowledge that is important for prevention efforts. This Swedish national study aimed to describe the extent of such deaths, circumstances and fatal injuries. Data, including all explosion-related deaths in Sweden from 2000 through 2018, were retrieved from the register of the National Board of Forensic Medicine. Among all 87 cases found, accidental deaths accounted for 62%, suicides for 21%, homicides for 7% and undetermined manner of death for the remaining 10% of cases. Most victims died on site. Adult males dominated in the study material, but explosions also killed four children. Explosives were most commonly involved in occupational blast deaths, suicides and homicides, followed by flammable gases and fluids. The incidence showed a significant decrease since the 1980s, based on the incidence rate from this study and a previous Swedish study (1979–1984). As already rare occurrences, blast-related deaths are challenging to prevent. Prevention efforts are needed to restrict the availability of explosives and focus on lowering the occupational risk for injury. In addition, child deaths must not be neglected. A vision of no fatalities is an appropriate goal for acting against explosion-related deaths in a civilian setting.

scholarly journals Experimental procedures for decontamination and microbiological testing in cardiovascular tissue banks

2018 ◽  
Vol 243 (17-18) ◽  
pp. 1286-1301 ◽  
Author(s):  
Paula Hansen Suss ◽  
Victoria Stadler Tasca Ribeiro ◽  
Juliette Cieslinski ◽  
Letícia Kraft ◽  
Felipe Francisco Tuon
Keyword(s):  
Tissue Banking ◽  
Critical Issue ◽  
Tissue Banks ◽  
Quality And Safety ◽  
Tissue Quality ◽  
Cardiovascular Tissue ◽  
Sterility Testing ◽  
Microbiological Methods ◽  
Microbiological Testing ◽  
Microbiological Procedures

Several methods for sampling, culturing, and decontaminating donor grafts are available for cardiovascular tissue banks. Most of these protocols are not standardized, leaving tissue banks to adapt their microbiological procedures to their tissue processing routines. Effective microbiological testing and decontamination procedures are essential to ensure tissue quality and safety for human application. This review presents the different procedures currently available for microbiological testing in cardiovascular tissue banks. Impact statement Sterility testing is a critical issue in the recovery, processing, and release of tissue allografts. Contaminated allografts are often discarded, increasing costs, and reducing tissue stocks. Given these concerns, it is important to determine the most effective methodology for sterility testing. This work provides an overview of microbiological methods for sampling and culturing donor grafts for cardiovascular tissue banking.

scholarly journals Regional Experiences of Tissue Donation and Forensic Medicine in Hamburg – Results of a 5-Year Period

2012 ◽  
Vol 39 (6) ◽  
pp. 405-408 ◽  
Author(s):  
Birgit Wulff ◽  
Katja Müller ◽  
Axel Heinemann ◽  
Klaus Püschel
Keyword(s):  
Forensic Medicine ◽  
Tissue Donation

scholarly journals Errors, Incidents and Accidents in Anaesthetic Practice

1993 ◽  
Vol 21 (5) ◽  
pp. 506-519 ◽  
Author(s):  
W. B. Runciman ◽  
A. Sellen ◽  
R. K. Webb ◽  
J. A. Williamson ◽  
M. Currie ◽  
...  
Keyword(s):  
Human Error ◽  
Contextual Information ◽  
Physiological State ◽  
Contributing Factors ◽  
Anaesthetic Practice ◽  
Knowledge Based ◽  
Technical Errors ◽  
Outcome Bias ◽  
Social And Cultural Factors

Human error is a pervasive and normal part of everyday life and is of interest to the anaesthetist because errors may lead to accidents. Definitions of, and the relationships between, errors, incidents and accidents are provided as the basis to this introduction to the psychology of human error in the context of the work of the anaesthetist. Examples are drawn from the Australian Incident Monitoring Study (AIMS). An argument is put forward for the use of contemporaneous incident reporting (eliciting relevant contextual information as well as details of use to cognitive psychologists), rather than the use of accident investigation after the event (with the inherent problems of scant information, altered perception and outcome bias). A classification of errors is provided. “Active” errors may be classified into knowledge-based, rule-based, skill-based and technical errors. Different strategies are required for the prevention of each type and it may now be useful to place more emphasis in anaesthetic practice on categories to which little attention has been directed in the past. “Latent” errors make an enormous contribution to problems in anaesthesia and several categories are discussed (e.g. environment, physiological state, equipment, work practices, personnel training, social and cultural factors). An approach is provided for the prevention and management of errors, incidents and accidents which allows clinical problems to be categorized, the relative importance of various contributing factors to be established, and appropriate preventative strategies to be devised and implemented on the basis of priorities determined from the AIMS data. Accidents cannot be abolished; however, an understanding of the factors underlying them can lead to the rational direction of resources and effort to prevent them and minimise their effects.

scholarly journals In-house coordination project for organ and tissue procurement: social responsibility and promising results

2016 ◽  
Vol 24 (0) ◽  
Author(s):  
Vanessa Silva e Silva ◽  
Luciana Carvalho Moura ◽  
Luciana Ribeiro Martins ◽  
Roberta Cristina Cardoso dos Santos ◽  
Janine Schirmer ◽  
...  
Keyword(s):  
Organ Donation ◽  
Tissue Donation ◽  
Potential Donor ◽  
Significance Level ◽  
Conversion Rates ◽  
Before And After ◽  
Tissue Procurement ◽  
Student’S T ◽  
Nonparametric Statistical ◽  
Student’S T Test

Abstract Objectives: to report the results of evaluation regarding changes in the number of potential donor referrals, actual donors, and conversion rates after the implementation of an in-house organ and tissue donation for transplantation coordination project. Methods: epidemiological study, both retrospective and transversal, was performed with organ donation data from the Secretariat of Health for the State and the in-house organ donation coordination project of a beneficent hospital. The data was compared using nonparametric statistical Mann-Whitney test, and the Student's t-test, considering a significance level of 5% (p <0.05). Results: there were statistically significant differences (p < 0.05), before and after the implementation of the project on the number of potential donor notification/month (3.05 - 4.7 ), number of actual donor/month (0.78 to 1.60) and rate of conversion ( 24.7 to 34.8 %). The hospitals 1, 2, 7 and 8 had significant results in potential donor, actual donor or conversion rate. Conclusion: the presence of an in-house coordinator is promising and beneficial, the specialist is important to change the indicators of efficiency, which consequently reduces the waiting lists for organ transplants.

scholarly journals The Importance of BHB Testing on the Post-Mortem Diagnosis of Ketoacidosis

Biomolecules ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Stina Ahlström ◽  
Johan Ahlner ◽  
Anna K. Jönsson ◽  
Henrik Green
Keyword(s):  
Cause Of Death ◽  
Forensic Medicine ◽  
Forensic Pathology ◽  
Scientific Basis ◽  
Post Mortem ◽  
National Board ◽  
Specific Diagnosis ◽  
Not Otherwise Specified ◽  
Alcoholic Ketoacidosis ◽  
Beta Hydroxybutyrate

Although beta-hydroxybutyrate (BHB) analysis has proved its importance in forensic pathology, its effects on cause-of-death diagnostics are unaddressed. Therefore, this study aims at evaluating the effects of BHB analysis on the number of deaths by DKA (diabetes ketoacidosis), AKA (alcoholic ketoacidosis), HHS (hyperosmolar hyperglycaemic state), hypothermia, diabetes, alcoholism, and acidosis NOS (not otherwise specified). All 2900 deaths from 2013 through 2019 in which BHB was analysed at the National Board of Forensic Medicine, and 1069 DKA, AKA, HHS, hypothermia, diabetes, alcoholism, and acidosis cases without BHB analysis were included. The prevalence of BHB-positive cases for each cause of death, and trends and proportions of different BHB concentrations, were investigated. The number of BHB analyses/year increased from 13 to 1417. AKA increased from three to 66 and acidosis from one to 20. The deaths from alcoholism, DKA, and hypothermia remained stable. It is unclear why death from alcoholism remained stable while AKA increased. The increase in unspecific acidosis deaths raises the question why a more specific diagnosis had not been used. In conclusion, BHB analysis is instrumental in detecting AKA and acidosis. The scientific basis for the diagnosis of DKA and hypothermia improved, but the number of cases did not change.

Enhancing the Tissue Donor Pool through Donation after Death in the Field

2013 ◽  
Vol 28 (2) ◽  
pp. 187-190 ◽  
Author(s):  
Adam M. Shiroff ◽  
Stephen C. Gale ◽  
Mark A. Merlin ◽  
Jessica S. Crystal ◽  
Matt Linger ◽  
...  
Keyword(s):  
Medical History ◽  
Heart Valves ◽  
Tissue Donation ◽  
Time Of Death ◽  
Publication Type ◽  
Eligibility Criteria ◽  
Donor Pool ◽  
Tissue Donor ◽  
Ethical Implications ◽  
Tissue Procurement

AbstractIntroductionTissue transplantation is an important adjunct to modern medical care and is used daily to save or improve patient lives. Tissue allografts include bone, tendon, corneas, heart valves and others. Increasing utilization may lead to tissue shortages, and tissue procurement organizations continue to explore ways to expand the cadaveric donor pool. Currently more than half of all deaths occur outside the acute care setting.HypothesisMany who suffer prehospital deaths might be eligible for non-organ tissue donation.MethodsA retrospective review of electronic prehospital medical records was conducted from May 1, 2008 through December 31, 2009. All prehospital deaths were included irrespective of cause. Once identified, additional medical history was obtained from prehospital, inpatient, and emergency department records. Age, medical history, and time of death were compared to exclusion criteria for four tissue procurement organizations (MTF, LifeNet, LifeCell, EyeBank). After analysis, percentages of eligible donors were calculated.ResultsOver 50,000 prehospital records were reviewed; 432 subjects died in the field and were eligible for analysis. Ages ranged from four to 103 years of age; the average was 68.3 (SD = 20.1) years. After exclusion for age, medical conditions, and time of death, 185 unique patients (42.8%) were eligible for donation to at least one of the four tissue procurement organizations (range 11.6%-34.3%).ConclusionsAfter prehospital death, many individuals may be eligible for tissue donation. These findings suggest that future prospective studies exploring tissue donation after prehospital death are indicated. These studies should aim to clarify eligibility criteria, create protocols and infrastructure, and explore the ethical implications of expanding tissue donation to include this population.ShiroffAM, GaleSC, MerlinMA, CrystalJS, LingerM, ShahAD, BeaumontE, LustigerE, TabakinE, GraciasVH. Enhancing the tissue donor pool through donation after death in the field. Prehosp Disaster Med. 2013;28(2):1-4.

Impact of Regulations on Tissue Donation: Mandatory Referral of Hospital Deaths

2002 ◽  
Vol 12 (3) ◽  
pp. 221-222
Author(s):  
Carlos Soratti ◽  
Myrtha Ball Lima ◽  
Daniel Flores ◽  
Ricardo Ibar
Keyword(s):  
Cardiac Arrest ◽  
Buenos Aires ◽  
Organ Procurement ◽  
Tissue Donation ◽  
Buenos Aires Province ◽  
Tissue Procurement ◽  
Hospital Deaths ◽  
The Impact ◽  
Death Cases ◽  
La Plata City

In Buenos Aires province, there has been surprisingly less tissue procurement activity following cardiac arrest than after brain-death cases. The purpose of this study was to analyse the impact of a regulation that made referral of all irreversible cardiac arrests mandatory to our organ procurement organisation. Data were collected from 7 hospitals in La Plata city during 7 months (from June 2000 to December 2000). The results showed that the regulation was effective because there was a striking increment of tissue procured following cardiac arrest during the analysed period, despite the low efficacy of the regulation (the referrals were 48% of the dead patients).

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