The donor potential of twenty six donor bases in the Russian Federation: external audit (a pilot project)

Rationale: The imbalance between the need for donor organs and their current availability is a growing problem for all countries. An assessment of potential donor numbers is considered to be an important step towards better understanding of the problem as a whole at the national scale. This would help to build up a concept of a successful strategy to resolve this inequity.Aim: To analyze the use of external audit of the efficacy of identification of potential organ donors with confirmed brain death.Materials and methods: As a part of a pilot project aimed to increase the efficacy of donor bases of the Russian Federal Medical Biological Agency (FMBA), we retrospectively analyzed 5932 medical files of patients who died from 2014 to 2018 in the departments of resuscitation and intensive care units of 26 medical establishments serving as a donor bases in Moscow, Orenburg, Saratov, Abakan, Stavropol and FMBA of Russia. The probability of brain death was assessed with a special QAPDD (Quality Assurance Program in the Deceased Donation Process) technique focused on organ donation after brain death which is used for external audit in Spanish hospitals.Results: Clinical manifestation of brain death were identified in 20.3% (95% confidence interval (CI) 18.4–22.4) of the patients aged 18 to 65 years with severe primary and secondary brain injury who died in the departments of resuscitation and had been maintained on mechanical ventilation at least 12 hours until their death was confirmed. The rate of potential donor identification with clinical manifestations of brain death in the donating in-patient departments was 12% (95% CI 10.5–13.7) of those who died with severe primary and secondary brain injury. The external audit performed in 26 donating in-patient departments, has shown that 41% (95% CI 35.8–46.4) of potential donors with brain death were not identified.Conclusion: With the use of the QAPDD technique in our study, we found that 41% of potential donors were not identified in the Russian in-patient clinics participating in organ donation. Based on the information obtained during the audit of medical files in intensive care units, we can make realistic conclusions on the current system of organ donation, identify potential pitfalls in the identification procedures of potential donors, increase the efficacy of donation process, and to improve the system as a whole. The process could become effective only through the activities of specially trained donor hospital transplant coordinators.

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Knowledge and Attitudes Toward Organ Donation and Brain Death Among Medical Staff of Intensive Care Units

Transplantation Journal ◽

10.1097/01.tp.0000525162.70330.20 ◽

2017 ◽

Vol 101 ◽

pp. S118

Author(s):

Bilgehan Kahveci ◽

Kenan Topal ◽

Cigdem Gereklioglu ◽

Avsar Zerman ◽

Sibel Tetiker

Keyword(s):

Intensive Care ◽

Brain Death ◽

Organ Donation ◽

Intensive Care Units ◽

Medical Staff ◽

Knowledge And Attitudes

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Brain death and organ donation in Argentine pediatric intensive care units. A multicenter study

Archivos Argentinos de Pediatria ◽

10.5546/aap.2018.eng.e54 ◽

2018 ◽

Vol 116 (1) ◽

Keyword(s):

Intensive Care ◽

Brain Death ◽

Organ Donation ◽

Intensive Care Units ◽

Multicenter Study ◽

Pediatric Intensive Care ◽

Pediatric Intensive Care Units

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Donor Action: A Quality Assurance Program for Intensive Care Units That Increases Organ Donation

Journal of Intensive Care Medicine ◽

10.1177/088506660001500204 ◽

2000 ◽

Vol 15 (2) ◽

pp. 104-114 ◽

Cited By ~ 11

Author(s):

Celia Wight ◽

Bernard Cohen ◽

Leo Roels ◽

Blanca Miranda

Keyword(s):

Quality Assurance ◽

Intensive Care ◽

Organ Donation ◽

Intensive Care Units ◽

Quality Assurance Program ◽

Year Effect ◽

The United Kingdom ◽

Willingness To Donate ◽

Donation Process ◽

Program Modules

Donor Action (DA) is an international initiative that helps intensive care units (ICUs) improve donation. Existing best practices from around the world have been incorporated into this quality assurance program. Following a validated diagnostic review, areas of weakness in donation practices are identified and the appropriate changes introduced. Corrective measures have been developed in the form of five “core” program modules which correspond to critical steps in the donation process and can be used together or alone according to specific identified needs. Medical records review (MRR) and hospital attitude surveys (HAS) were performed in 11 ICUs in Spain (2), The Netherlands (2), the United Kingdom (1), and Canada (6). Baseline data were gathered on the units potential for donation, staff attitudes toward donation, and self-reported skills/confidence in performing a range of donation roles. Analysis of these data were used to customize the program to individual ICU requirements. MRR data from 579 cases showed a 69% (398) potential for donation from which only 31% (124) were realized. Detection and management failures (166; 42%) and refusal to donate (104; 26%) were the major reasons for loss of potential donors. The HAS returns from staff (2,129) showed consistently strong perceptions that organ donation saves lives (97%). Support for donation (94%) and willingness to donate their own organs (79%) were high in all country samples. Ratings of skills/confidence were highest for comforting the family (70%), with much lower comfort levels reported on explaining brain death (44%), introducing organ donation (38%), and presenting a family with the option for donation (31%). Following introduction of the appropriate program modules, a sustained (2–year) effect of a 33% increase in donation rates is demonstrated. The Donor Action HAS and MRR are useful tools in identifying problems within the donation process and lead to the introduction of improvement strategies integral to the Donor Action program that result in an increase in organ donation.

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Magyarországi intenzív osztályok szervdonációval kapcsolatos személyi és tárgyi feltételei

Orvosi Hetilap ◽

10.1556/650.2018.31139 ◽

2018 ◽

Vol 159 (33) ◽

pp. 1360-1367

Author(s):

Sándor Mihály ◽

Anita Egyed-Varga ◽

Emese Holtzinger ◽

Kristóf Kara ◽

Erzsébet Ezer ◽

...

Keyword(s):

Intensive Care ◽

Brain Death ◽

Organ Donation ◽

Intensive Care Units ◽

Night Shift ◽

Transoesophageal Echocardiography ◽

Abdominal Ultrasound ◽

Online Questionnaire ◽

Number Of Patients ◽

Material Conditions

Abstract: Introduction: At the end of 2016, the number of patients on the domestic transplant waiting list was twice as much as the number of the organ transplantations accomplished that year. The institutional prerequisites for functional organ donation programs are the sufficient number of personnel and the adequate material conditions to be provided in relation to the needs. Aim: The goal of the current study was to evaluate the professional environment in Hungary. Method: The Organ Coordination Office at the Hungarian National Blood Transfusion Service compiled a questionnaire survey on the personnel and material conditions of the intensive care units (ICUs) in Hungary in regards to organ donations. The survey applied an online questionnaire including 43 questions. In addition to the number of beds and employees, we investigated the tools needed for the legal and the medical diagnosis of brain death as well as the accessibility of examinations on the donor information form. The data collection spanned from 12 December 2016 to 30 June 2017. Results: 59 intensive care units completed the questionnaire; the investigation involved 640 hospital beds, 816 physicians and 1252 nurses. In the daytime shift, 0.25 doctors and 0.41 nurses work on a patient bed at an average, while in the night shift, the figures are 0.11 and 0.33, respectively. 51.7% of the doctors are registered to access the National Non-Donor Registry, and brain death diagnosis committee is available in 83% of the hospitals. Among the medical imaging methods (cranial, abdominal-thoracic), CT scan in 71–73%, abdominal ultrasound in 75%, transthoracic echocardiograpy (TTE) in 37%, transoesophageal echocardiography (TEE) in 4%, bronchoscopy in 49%, coronarography in 19% are non-stop available, with instant interpretation in 75% of the cases. Transcranial Doppler (TCD) in 30%, four-vessel angiography in 45% and SPECT in 14% of the cases are available. More than 90% of the laboratory examinations on the donor information form are available 24 hours a day. Conclusion: The number of doctors and nurses did not change compared to our 2008 survey (0.18 doctors, 0.37 nurses/ICU beds in 2008), but the care of potential donors needs more resources and time. The standby availability of personnel and material conditions is a prerequisite for organ donation programs in order to save lives. Orv Hetil. 2018; 159(33): 1360–1367.

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Factors influencing consent to organ donation after brain death certification: a survey of 29 Intensive Care Units

Minerva Anestesiologica ◽

10.23736/s0375-9393.18.12658-7 ◽

2018 ◽

Vol 84 (9) ◽

Cited By ~ 1

Author(s):

Guya Piemonte ◽

Maria L. Migliaccio ◽

Stefano Bambi ◽

Marco Bombardi ◽

Lorenzo D'antonio ◽

...

Keyword(s):

Intensive Care ◽

Brain Death ◽

Organ Donation ◽

Intensive Care Units ◽

Death Certification ◽

Factors Influencing ◽

Donation After Brain Death

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Faculty Opinions recommendation of Eligibility for organ donation following end-of-life decisions: a study performed in 43 French intensive care units.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718520688.793502703 ◽

2015 ◽

Author(s):

Rik Gerritsen

Keyword(s):

Intensive Care ◽

Organ Donation ◽

End Of Life ◽

Intensive Care Units ◽

End Of Life Decisions ◽

Life Decisions

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The Association Between Arterial Oxygen Level and Outcome in Neurocritically Ill Patients is not Affected by Blood Pressure

Neurocritical Care ◽

10.1007/s12028-020-01178-w ◽

2021 ◽

Author(s):

Jaana Humaloja ◽

Markus B. Skrifvars ◽

Rahul Raj ◽

Erika Wilkman ◽

Pirkka T. Pekkarinen ◽

...

Keyword(s):

Blood Pressure ◽

Intensive Care ◽

Brain Injury ◽

Hemodynamic Instability ◽

Arterial Oxygen ◽

Admission Diagnosis ◽

Secondary Brain Injury ◽

Multivariable Logistic Regression Model ◽

Mechanically Ventilated ◽

The Relationship

Abstract Background In neurocritically ill patients, one early mechanism behind secondary brain injury is low systemic blood pressure resulting in inadequate cerebral perfusion and consequent hypoxia. Intuitively, higher partial pressures of arterial oxygen (PaO2) could be protective in case of inadequate cerebral circulation related to hemodynamic instability. Study purpose We examined whether the association between PaO2 and mortality is different in patients with low compared to normal and high mean arterial pressure (MAP) in patients after various types of brain injury. Methods We screened the Finnish Intensive Care Consortium database for mechanically ventilated adult (≥ 18) brain injury patients treated in several tertiary intensive care units (ICUs) between 2003 and 2013. Admission diagnoses included traumatic brain injury, cardiac arrest, subarachnoid and intracranial hemorrhage, and acute ischemic stroke. The primary exposures of interest were PaO2 (recorded in connection with the lowest measured PaO2/fraction of inspired oxygen ratio) and the lowest MAP, recorded during the first 24 h in the ICU. PaO2 was grouped as follows: hypoxemia (< 8.2 kPa, the lowest 10th percentile), normoxemia (8.2–18.3 kPa), and hyperoxemia (> 18.3 kPa, the highest 10th percentile), and MAP was divided into equally sized tertiles (< 60, 60–68, and > 68 mmHg). The primary outcome was 1-year mortality. We tested the association between hyperoxemia, MAP, and mortality with a multivariable logistic regression model, including the PaO2, MAP, and interaction of PaO2*MAP, adjusting for age, admission diagnosis, premorbid physical performance, vasoactive use, intracranial pressure monitoring use, and disease severity. The relationship between predicted 1-year mortality and PaO2 was visualized with locally weighted scatterplot smoothing curves (Loess) for different MAP levels. Results From a total of 8290 patients, 3912 (47%) were dead at 1 year. PaO2 was not an independent predictor of mortality: the odds ratio (OR) for hyperoxemia was 1.16 (95% CI 0.85–1.59) and for hypoxemia 1.24 (95% CI 0.96–1.61) compared to normoxemia. Higher MAP predicted lower mortality: OR for MAP 60–68 mmHg was 0.73 (95% CI 0.64–0.84) and for MAP > 68 mmHg 0.80 (95% CI 0.69–0.92) compared to MAP < 60 mmHg. The interaction term PaO2*MAP was nonsignificant. In Loess visualization, the relationship between PaO2 and predicted mortality appeared similar in all MAP tertiles. Conclusions During the first 24 h of ICU treatment in mechanically ventilated brain injured patients, the association between PaO2 and mortality was not different in patients with low compared to normal MAP.

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