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 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.

scholarly journals Determination of HLA -A, -B, -DRB1 polymorphism in brain dead organ donors representative of the Colombian general population, 2007-2014

Biomédica ◽  
2017 ◽  
Vol 37 (2) ◽  
Author(s):  
Yazmin Rocío Arias ◽  
Karime Osorio-Arango ◽  
Brayan Bayona ◽  
Guadalupe Ercilla ◽  
Mauricio Beltrán-Durán
Keyword(s):  
General Population ◽  
Organ Donors ◽  
Hla Dr ◽  
El Sistema ◽  
Brain Dead

Introducción. Los genes que codifican para el sistema de antígenos leucocitarios humanos (HLA) son altamente polimórficos y tiene alta importancia en procedimientos de trasplante de órganos. La determinación de frecuencias alélicas en poblaciones definidas se tiene en cuenta en la designación de criterios científicos para la asignación de órganos.Objetivo. Establecer las frecuencias antigénicas y haplotípicas de HLA -A, -B, y -DRB1 en donantes de órganos en muerte encefálica, representativos de población colombiana.Materiales y métodos. Estudio descriptivo retrospectivo que incluyó 2.506 donantes cadavéricos de órganos en el que se realizó un análisis alélico y haplotípico de HLA- A, HLA-B, HLA-DRB1, así como la determinación del desequilibrio de Hardy Weinberg.Resultados. Se identificaron 21, 43 y 15 grupos alélicos para los locus A*, B* y DRB1*, respectivamente. Fue posible la identificación de 1.268 haplotipos HLA A-HLA B-HLA DR; 409 haplotipos HLA A, B; 383 haplotipos HLA B, DR y 218 haplotipos HLA A, DR. Los tres locus se encontraron en equilibrio de Hardy-Weinberg al encontrar valores de p<0,05 entre el número de heterocigóticos observados en relación al número de heterocigóticos esperados.Conclusiones. Este estudio por primera vez proporciona información sobre la distribución de los alelos HLA clase I y II en población de donantes de órganos, con representación de individuos de las seis regionales en las que está dividida estructuralmente Colombia para la prestación de servicios de trasplante.

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.

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

The Washington, D.C. Experience with Uncontrolled Donation after Circulatory Determination of Death: Promises and Pitfalls

2008 ◽  
Vol 36 (4) ◽  
pp. 735-740 ◽  
Author(s):  
Jimmy A. Light
Keyword(s):  
Organ Procurement ◽  
Organ Donor ◽  
Deceased Donor ◽  
The United States ◽  
Demand And Supply ◽  
Deceased Donor Kidney ◽  
Donor Population ◽  
History Of ◽  
Expanded Criteria

As of January 1, 2008, over 98,000 people are waiting for organ transplants in the United States of America. Of those, nearly 75,000 are waiting for a kidney. In this calendar year, fewer than 15,000 will receive a kidney transplant from a deceased donor. The average waiting time for a deceased donor kidney now exceeds five years in virtually all metropolitan areas. Sadly, nearly as many people die waiting as there are deceased donors each year, despite monumental efforts by the entire transplant community to increase both the number of organ donors and the number of organs recovered from each donor. The imbalance between demand and supply has led to considerable efforts to expand the criteria for what is considered an acceptable organ donor by the Organ Procurement and Transplant Network (OPTN), thereby hoping somewhat to assuage the shortfall of donor organs. So-called Expanded Criteria Donors (ECDs) may be older than 50, have history of hypertension, or have died from intracerebral hemorrhage and/or have impaired renal function. ECDs now make up nearly 40% of the donor population.

scholarly journals Organ Donation and Declaration of Death: Combined Neurologic and Cardiopulmonary Standards

2019 ◽  
Vol 86 (4) ◽  
pp. 285-296
Author(s):  
Stephen E. Doran ◽  
Joseph M. Vukov
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Conflict Of Interest ◽  
Life Support ◽  
Organ Procurement ◽  
Organ Donors ◽  
Neurologic Injury ◽  
Brain Dead ◽  
Moral Certainty ◽  
Death By Neurologic Criteria

Prolonged survival after the declaration of death by neurologic criteria creates ambiguity regarding the validity of this methodology. This ambiguity has perpetuated the debate among secular and nondissenting Catholic authors who question whether the neurologic standards are sufficient for the declaration of death of organ donors. Cardiopulmonary criteria are being increasingly used for organ donors who do not meet brain death standards. However, cardiopulmonary criteria are plagued by conflict of interest issues, arbitrary standards for candidacy, and the lack of standardized protocols for organ procurement. Combining the neurological and cardiopulmonary standards into a single protocol would mitigate the weaknesses of both and provide greater biologic and moral certainty that a donor of unpaired vital organs is indeed dead. Summary: Before a person’s organs can be used for transplantation, he or she must be declared “brain-dead.” However, sometimes when someone is declared brain-dead, that person can be maintained on life-support for days or even weeks. This creates some confusion about whether the person has truly died. For patients who have a severe neurologic injury but are not brain-dead, organ donation can also occur after his or her heart stops beating. However, this protocol is more ambiguous and lacks standardized protocols. We propose that before a person can donate organs, he or she must first be declared brain-dead, and then his or her heart must irreversibly stop beating before organs are taken.

Pediatric Donor Management Goals in Use by US Organ Procurement Organizations

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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