Variability in Pediatric Brain Death Determination Protocols in the United States

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012225
Author(s):  
Conall Francoeur ◽  
Matthew J Weiss ◽  
Jennifer M Macdonald ◽  
Craig Press ◽  
David Matthew Greer ◽  
...  
Keyword(s):  
United States ◽  
Brain Injury ◽  
Organ Procurement ◽  
The United States ◽  
Cross Sectional Study ◽  
Neurologic Examination ◽  
National Guidelines ◽  
Cross Sectional ◽  
Organ Procurement Organizations ◽  
Death By Neurologic Criteria

Objective:To determine the variability in pediatric death by neurologic criteria (DNC) protocols between US pediatric institutions and compared to the 2011 DNC guidelines.Methods:Cross-sectional study of DNC protocols obtained from pediatric institutions in the United States (US) via regional organ procurement organizations. Protocols were evaluated across five domains: general DNC procedures, prerequisites, neurologic examination, apnea testing and ancillary testing. Descriptive statistics compared protocols to each other and the 2011 guidelines.Results:One hundred and thirty protocols were analyzed with 118 dated after publication of the 2011 guidelines. Of those 118 protocols, identification of a mechanism of irreversible brain injury was required in 97%, while 67% required an observation period after acute brain injury before DNC evaluation. Most protocols required guideline-based prerequisites such as exclusion of hypotension (94%), hypothermia (97%), and metabolic derangements (92%). On neurologic examination, 91% required a lack of responsiveness, 93% no response to noxious stimuli, and 99% loss of brainstem reflexes. 84% of protocols required the guideline-recommened two apnea tests. CO2 targets were consistent with guidelines in 64%. Contrary to guidelines, fifteen percent required ancillary testing for all patients and 15% permitted ancillary studies that are not validated in pediatrics.Conclusionsand Relevance: Variability exists between pediatric institutional DNC protocols in all domains of DNC determination, especially with respect to apnea and ancillary testing. Better alignment of DNC protocols with national guidelines may improve the consistency and accuracy of DNC determination.

scholarly journals MO932POPULATION DENSITY AND U.S. KIDNEY TRANSPLANTATION DURING THE FIRST YEAR COVID-19 PANDEMIC

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ekamol Tantisattamo ◽  
Natnicha Leelaviwat ◽  
Natchaya Polpichai ◽  
Natsuki Eguchi ◽  
Natsumon Udomkittivorakul ◽  
...  
Keyword(s):  
United States ◽  
Population Density ◽  
Organ Procurement ◽  
The United States ◽  
Cross Sectional Study ◽  
High Rate ◽  
High Population ◽  
High Population Density ◽  
Cross Sectional ◽  
Healthcare Resources

Abstract Background and Aims Coronavirus disease 19 (COVID-19) pandemic leads to poorer health outcomes and more utilizing of healthcare resources. Kidney transplant (KT) can lead to worsening transplant outcomes with COVID-19 and trend of KT in the United States decreases. Given a highly contagious disease, high population density may contribute to not only higher rate of the disease, but also lower rate of KT. We aim to examine the association of the number of COVID-19 cases and change in the number of KT with the interaction of population density in the United States. Method A cross-sectional study was conducted by using publicly available data of COVID-19 cases and KT in the United States were retrieved from the Centers of Disease Control and Prevention (CDC) and the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR), respectively. The association of the cumulative COVID-19 cases of 47 states in the United States where KT occurred between January 1, 20202 and January 6, 2021 with difference in the number of KT between year 2019 and 2020 (ΔKT) was examined by using multiple linear regression. Results During the study period, a total of 20,136,895 COVID-19 cases were detected in the United States and 326,535 patients died. From all 47 states, 23,002 and 20,554 adult KT were performed in 2019 and 2020, respectively. Mean COVID-19 cases and deaths were 428,445±457,344 and 6,948± 6,911, respectively among the 47 states. Mean ΔKT2019 - 2020 were 52± 81. Every 10,000 COVID-19 cases was associated with a decrease in 1.06 KT in year 2020 compared to year 2019 (βcoeff 0.00011, p <0.0001, 95% CI 0.00006, 0.00015). However, after adjusted for the number of KT in 2019, COVID-19 cases (< or ≥ median cases of 317,545), population density (< or ≥ median density of 114 people/mile2), and the interaction term between COVID-19 cases and population density, the states with high rate of COVID-19 (≥317,545 cases/year) and high population density (≥114 people/mile2) had a decrease in 12.4 KT; whereas, there was 4.5 KT decrease in states with low COVID-19 rate and low population density (βcoeff 0.1024705, p 0.000, 95%CI 0.066272, 0.1386691, p interaction -0.686). Conclusion The number of KT in 2020 has decreased independent to the number of 2019 KT and population density. However, a decrease in the number of KT was lower in the states with low COVID-19 rate and low population density compared to those with high COVID-19 rate and high population density. Distribution of healthcare resources and utilization including KT in the states with low COVID-19 cases and low population density may be one of the strategies to continue KT, which is life-saving therapy and better survival benefit compared to being on dialysis in end-stage kidney disease population with a high mortality risk.

An Adapted Process and Organ Procurement Perspective on Heart Retransplantation for a Healthy Heart’s Third Life

2021 ◽  
pp. 152692482110246
Author(s):  
Darryl C. Nethercot ◽  
Mita Shah ◽  
Lisa M. Stocks ◽  
Jeffrey M. Trageser ◽  
Victor Pretorius ◽  
...  
Keyword(s):  
United States ◽  
Organ Procurement ◽  
The United States ◽  
Matching Process ◽  
Organ Procurement Organizations ◽  
Third Person ◽  
Adapted Process ◽  
United Network ◽  
Transplanted Hearts

As organ procurement organizations nationwide see an increased opportunity to retransplant already transplanted hearts, we would like to share the overview and process of our 2 successful cases. Heart retransplantation increased our cardiac placement rates by 2.64% and 2% in 2015 and 2019, respectively. Spread across a nation that sees over 3500 heart placements annually, a 2% increase would be substantial. Since 2009, our cases stand as the only documented heart retransplantations in the United States. However, United Network for Organ Sharing data shows that potential exists. From a facilitation perspective, we have developed a protocol to ease the matching process. From a surgical perspective, these cases had no complications and saved 2 lives, with each heart now beating in a third person. We hope that by sharing our process and success, we can familiarize fellow organ procurement organizations and transplant communities with this viable opportunity.

Examining the Relationship Between Food Insecurity and Academic Performance: Implications for Diversity and Equity in Higher Education

2021 ◽  
pp. 152102512110538
Author(s):  
Heather Mechler ◽  
Kathryn Coakley ◽  
Marygold Walsh-Dilley ◽  
Sarita Cargas
Keyword(s):  
Higher Education ◽  
United States ◽  
Food Insecurity ◽  
Educational Equity ◽  
The United States ◽  
Cross Sectional Study ◽  
Drop Out ◽  
Cross Sectional ◽  
Professional Students ◽  
The Relationship

In recent years, researchers have increasingly focused on the experience of food insecurity among students at higher education institutions. Most of the literature has focused on undergraduates in the eastern and midwestern regions of the United States. This cross-sectional study of undergraduate, graduate, and professional students at a Minority Institution in the southwestern United States is the first of its kind to explore food insecurity among diverse students that also includes data on gender identity and sexual orientation. When holding other factors constant, food-insecure students were far more likely to fail or withdraw from a course or to drop out entirely. We explore the role that higher education can play in ensuring students’ basic needs and implications for educational equity.

scholarly journals The Epidemiology of Adult Tracheostomy in the United States 2002–2017: A Serial Cross-Sectional Study

2021 ◽  
Vol 3 (9) ◽  
pp. e0523
Author(s):  
Maria K. Abril ◽  
David M. Berkowitz ◽  
Yunyun Chen ◽  
Lance A. Waller ◽  
Greg S. Martin ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Psychological Responses of Hospital-Based Nurses Working During the COVID-19 Pandemic in the United States: A Cross-sectional Study

2021 ◽  
pp. 151517
Author(s):  
Janell L. Mensinger ◽  
Heather Brom ◽  
Donna S. Havens ◽  
Alexander Costello ◽  
Christine D’Annunzio ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Cross Sectional Study ◽  
Psychological Responses ◽  
Sectional Study ◽  
Cross Sectional

A Cross-sectional Study of the Current Treatment Patterns in Noninfectious Uveitis among Specialists in the United States

Ophthalmology ◽  
2011 ◽  
Vol 118 (1) ◽  
pp. 184-190 ◽  
Author(s):  
Quan Dong Nguyen ◽  
Elham Hatef ◽  
Brian Kayen ◽  
Cynthia P. Macahilig ◽  
Mohamed Ibrahim ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Cross Sectional Study ◽  
Current Treatment ◽  
Treatment Patterns ◽  
Sectional Study ◽  
Cross Sectional
Sign in / Sign up

Export Citation Format

Share Document