Never Declared Brain Dead Potential Organ Donors—An Additional Source of Donor Organs?

2017 ◽  
Vol 28 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Patricia A. Webster ◽  
Lori E. Markham
Keyword(s):  
Outcome Measures ◽  
Organ Procurement ◽  
Retrospective Chart Review ◽  
Donation After Cardiac Death ◽  
Organ Donors ◽  
Additional Source ◽  
Imminent Death ◽  
Brain Dead ◽  
Injured Patients ◽  
Donor Organs

Context: Patients never declared brain dead may represent an additional source of donor organs. Objective: To determine the number of likely brain dead potential donors who are never declared brain dead and to compare them with brain dead and donation after cardiac death potential organ donors. Design, Setting, and Participants: This study was a retrospective chart review of all catastrophically brain-injured patients referred to a single-organ procurement organization (OPO) over a 4-year period. This study identified 159 likely brain dead potential organ donors, 902 brain dead potential organ donors, and 357 potential donation after circulatory death donors over a 4-year period. Interventions: None. Main Outcome Measures: This study did not predetermine outcome measures before data collection because the study group, likely brain dead potential organ donors, had not previously been described. Results: Likely brain dead potential donors were significantly older than brain dead potential donors ( P < .0001) but were otherwise not different demographically. They were more likely to be a late referral to the OPO ( P < .0001) and less likely to be in the donor registry ( P < .0001). The most commonly identified factors associated with a failure to declare brain death were an unwillingness to continue supportive care by the family, premention of donation, a nontimely imminent death referral, known prior objection to donation, terminal instability, and a lack of cooperation with the OPO.

Imminent Death Donation: Ethical and Practical Policy Considerations

2018 ◽  
Vol 46 (2) ◽  
pp. 524-537 ◽  
Author(s):  
Jordan Potter
Keyword(s):  
Organ Donation ◽  
Cardiac Death ◽  
Organ Procurement ◽  
Donation After Cardiac Death ◽  
Live Organ Donation ◽  
Life Sustaining Treatment ◽  
Imminent Death

While the practice of organ donation after cardiac death has long been trending upwards in acceptance and use, it is still a highly controversial and practically inefficient method of organ procurement. One policy that has recently been proposed to try and alleviate some of the ethical and practical concerns with organ donation after cardiac death is the practice of imminent death organ donation. This type of live organ donation comes in patients at the end of their life who have decided to withdraw life-sustaining treatment, but still want to ensure that their organs are donated and not wasted, which isn't always the case with organ donation after cardiac death. This paper then gives some ethical and practical reflections and recommendations regarding the potential implementation of this controversial practice into regular transplant practice and policy.

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

Trials ◽  
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

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

2001 ◽  
Vol 10 (5) ◽  
pp. 306-312 ◽  
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.

Whole Blood Thiamine in Organ Donors After the Neurologic Determination of Death

2021 ◽  
pp. 152692482110246
Author(s):  
Robert S. Ream ◽  
Michelle Piole ◽  
Eric S. Armbrecht ◽  
Gary F. Marklin ◽  
Jeremy S. Garrett
Keyword(s):  
Lactic Acidosis ◽  
Whole Blood ◽  
Thiamine Deficiency ◽  
Organ Procurement ◽  
Vitamin B1 ◽  
Organ Donors ◽  
Donor Population ◽  
Hospital Stays ◽  
Brain Dead

Introduction: Metabolic resuscitation of organ donors and the attenuation of oxidative stress incurred by organs following brain death and transplantation have the potential to improve organ yield and allograft function. Thiamine (vitamin B1) is a vital coenzyme in both energy metabolism and the production of antioxidants that has not been studied in the donor population. Research Aim: To determine the frequency of subclinical thiamine deficiency in brain-dead organ donors and its correlation with demographics, length of hospitalization, donor management, lactic acidosis, and the requirement for vasoactive support. Design: Prospective cohort study of brain-dead donors managed at a single organ procurement organization’s organ recovery facility. Results: A total 64 donors were enrolled; 24 donors had thiamine levels drawn upon arrival and 40 donors had levels drawn at the time of organ procurement. Whole blood thiamine levels were inversely correlated with the time from death (P = .007) and 20% (8/40) of donors had levels below the normal range at the time of organ procurement. Demographic features of the donor were not associated with thiamine levels although longer hospital stays prior to death were associated with lower levels ( P < .05). The presence and resolution of lactic acidosis was not associated with whole blood thiamine level. Higher thiamine levels were associated with earlier discontinuation of vasoactive support ( P = .04). Discussion: Whole blood thiamine deficiency was not uncommon at the time of organ procurement. Thiamine may be associated with the requirement for hemodynamic support.

scholarly journals Effects of Terlipressin on Management of Hypotensive Brain-Dead Patients Who are Potential Organ Donors: A Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Donghua Zheng ◽  
Genglong Liu ◽  
Li Chen ◽  
Wenfeng Xie ◽  
Jiaqi Sun ◽  
...  
Keyword(s):  
Renal Function ◽  
Retrospective Study ◽  
Liver Function ◽  
Estimated Glomerular Filtration Rate ◽  
Organ Procurement ◽  
Venous Pressure ◽  
Organ Donors ◽  
Hemodynamic Stability ◽  
Norepinephrine Dose ◽  
Brain Dead

Background: Administration of terlipressin can reverse hypotension in potential organ donors with norepinephrine-resistance. The aim of this study was to determine the effects of terlipressin on the hemodynamics, liver function, and renal function of hypotensive brain-dead patients who were potential organ donors.Methods: A retrospective study was conducted by using the ICU database of one hospital. 18 patients in a total of 294 brain-dead cases were enrolled and administered terlipressin intravenously. All physiological parameters of recruited patients were obtained at baseline, 24 and 72 h after administration, and immediately before organ procurement.Results: Terlipressin induced significant increases in mean arterial pressure (MAP) from 69.56 ± 10.68 mm Hg (baseline) to 101.82 ± 19.27 mm Hg (immediately before organ procurement) and systolic blood pressure (SBP) from 89.78 ± 8.53 mm Hg (baseline) to 133.42 ± 26.11 mm Hg (immediately before organ procurement) in all patients. The increases in MAP were accompanied by significant decreases in heart rate (HR) from 113.56 ± 28.43 bpm (baseline) to 83.89 ± 11.70 bpm (immediately before organ procurement), which resulted in the decrease of norepinephrine dose over time from 0.8 ± 0.2 μg/kg/min (baseline) to 0.09 ± 0.02 μg/kg/min (immediately before organ procurement). There were no changes in central venous pressure, liver function including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin. Renal function, assessed by serum creatinine (SCr), urine output (UOP), creatinine clearance rate (CCr), and estimated glomerular filtration rate (eGFR), improved significantly.Conclusion: Our analysis of brain-dead patients with hypotension indicates that administration of terlipressin can significantly increases MAP, SBP, UOP, CCr, and eGFR, while decreases HR and Scr. Terlipressin appears to help maintain hemodynamic stability, reduce vasoactive support, and improve renal function.

scholarly journals Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: results from a French survey

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Benoit Champigneulle ◽  
◽  
Arthur Neuschwander ◽  
Régis Bronchard ◽  
Gersende Favé ◽  
...  
Keyword(s):  
Organ Procurement ◽  
Organ Donors ◽  
Intraoperative Management ◽  
Brain Dead ◽  
Procurement Procedure

scholarly journals 4139 Risk Aversion in Lung Transplantation: Organ Procurement Organizations Differ in Willingness to Pursue Non-ideal Donor Organs

2020 ◽  
Vol 4 (s1) ◽  
pp. 144-144
Author(s):  
Samantha Ellen Halpern ◽  
Alec McConnell ◽  
Sarah Peskoe ◽  
Vignesh Raman ◽  
Oliver K Jawitz ◽  
...  
Keyword(s):  
Risk Aversion ◽  
Performance Metrics ◽  
Organ Procurement ◽  
Significant Risk ◽  
Smoking History ◽  
Donation After Cardiac Death ◽  
Strongly Correlated ◽  
Increased Risk ◽  
Organ Procurement Organizations ◽  
Donor Organs

OBJECTIVES/GOALS: Lung transplant (LTx) candidates benefit from use of non-ideal donor organs. Each organ procurement organization (OPO) defines “acceptable” donor organs introducing unmeasured variation in donor pursuit. We characterized non-ideal donor pursuit among OPOs to identify drivers of risk aversion in LTx. METHODS/STUDY POPULATION: We queried the UNOS registry for adult donors who donated ≥1 organ for transplantation from 12/2007-12/2018. Non-ideal donors were those with any of age>50, smoking history ≥20 pack-years, PaO2/FiO2 (P/F) ratio<350, donation after cardiac death (DCD) status, or CDC increased risk (IRD) status. Non-ideal donor pursuit rate was defined as the proportion of non-ideal donors at each OPO from whom consent for lung donation was requested with lower numbers indicating increased risk aversion. We estimated the correlation between non-ideal and overall donor pursuit using a Spearman correlation coefficient. Adjusted non-ideal donor pursuit rates were estimated using multivariable logistic regression. RESULTS/ANTICIPATED RESULTS: Overall, 18,333 deceased donors were included and classified as ideal or non-ideal. Among 58 OPOs, rates of non-ideal donor pursuit ranged from 0.24-1.00 Figure). Of 5 non-ideal characteristics, DCD and IRD status were associated with the most and least risk aversion, respectively. Non-ideal donor pursuit was strongly correlated with overall donor pursuit (r = 0.99). On adjusted analysis, older age (OR 0.15, 95% CI 0.13-0.16), smoking history (OR 0.38, 95% CI 0.34-0.44), low P/F ratio (OR 0.12, 95% CI 0.11-0.14), and DCD status (OR 0.04, 95% CI 0.03-0.04) were all independently associated with significant risk aversion, corresponding to decreased rates of donor pursuit. DISCUSSION/SIGNIFICANCE OF IMPACT: OPOs differ in their levels of risk aversion in LTx and risk aversion is not uniform across selected categories of non-ideal lung donor. Consideration of new OPO performance metrics that encourage the pursuit of non-ideal lung donors is warranted.

Perioperative nurses’ experiences of caring for donation after cardiac death organ donors and their family within the operating room

2019 ◽  
Vol 30 (3) ◽  
pp. 69-78
Author(s):  
Zaneta Smith
Keyword(s):  
Grounded Theory ◽  
Operating Room ◽  
Cardiac Death ◽  
Organ Procurement ◽  
Donation After Cardiac Death ◽  
Organ Donors ◽  
Limited Information ◽  
Perioperative Nurses ◽  
Grounded Theory Method ◽  
Study Participants

Background Worldwide, operating rooms have seen the re-emergence of donation after cardiac death organ donors to increase the number of available organs. There is limited information on the issues perioperative nurses encounter when caring for donor patients after cardiac death who proceed to organ procurement surgery. Objectives The purpose of this paper is to report a subset of findings derived from a larger study highlighting the difficulties experienced by perioperative nurses when encountering donation after cardiac death organ donors and their family within the operating room during organ procurement surgery from an Australian perspective. Methods A qualitative grounded theory method was used to explore perioperative nurses’ (n = 35) experiences of participating in multi-organ procurement surgery. Results This paper reports a subset of findings of the perioperative nurses’ experiences directly related to donation after cardiac death procedures drawn from a larger grounded theory study. Participants revealed four aspects conceptualised as: ‘witnessing the death of the donation after cardiac death donor’; ‘exposure to family’; ‘witnessing family grief’ and ‘stepping into the family’s role by default’. Conclusion Perioperative nurses’ experiences with donation after cardiac death procedures are complex, challenging and demanding. Targeted support, education and training will enhance the perioperative nurses’ capabilities and experiences of caring for the donation after cardiac death donor and their family with the operating room context.

scholarly journals Ethical issues of organ donation after cardiac death

2018 ◽  
Vol 20 (3) ◽  
pp. 116-125 ◽  
Author(s):  
O. N. Reznik ◽  
A. E. Skvortcov ◽  
O. V. Popova
Keyword(s):  
Cardiac Arrest ◽  
Ethical Issues ◽  
Organ Procurement ◽  
Organ Transplant ◽  
Point Of View ◽  
Donation After Cardiac Death ◽  
Organ Donors ◽  
Artificial Blood ◽  
Transplant Program ◽  
Opposite Position

There is renewal of interests to the organs that could be obtained from asystolic donors. Our goal was to identify ethical issues raised by attempts of classification  and terms such kind of organ donors depended on time and place of cardiac arrest.  Based only on the reasoning of medical experts group these principles going to be  routine State policy. That followed by erased roles of physicians and misleading the  meaning or organ transplant program. From our point of view there should be clear  opposite position between death and life in order to initiate organ procurement  activity. That is possible only in case of artificial blood supply for preserving  transplant-to-be-organs after relevant time between cardiac arrest and start of such kind of perfusion procedure.

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