MDMA Intoxication in a Potential Organ Donor with Cardiac Arrest

Amphetamine and its derivatives’ consumption is still an important public health issue, namely in terms of compounds variability and disposition to consumers. However, some of them, like 3,4-methylenedioxymethamphetamine (MDMA), still live in the illicit market, with continuous success. Nevertheless, there is always new information and data on MDMA intoxication, both in vivo and in postmortem context. The authors report an intoxication case with MDMA, in an 18-year-old male, considered a potential organ donor after a cardiac arrest. Whole blood samples were collected in vivo, at the emergency room (ER), and postmortem, at the National Institute of Legal Medicine and Forensic Sciences. After a general screening procedure, samples were extracted by solid phase extraction (OASIS® MCX), followed by gas chromatography–mass spectrometry analysis. The whole blood postmortem sample was positive for lidocaine (<500 ng/mL), compatible with the ER intervention, and positive for MDMA (2278 ng/mL) and methylenedioxyamphetamine (MDA) (49 ng/mL), while whole blood samples collected in vivo (during the maintenance of the individual under advanced life support), were positive for MDMA (504–1918 ng/mL) and MDA (20–89 ng/mL). Samples were negative for other substances, namely ethanol, other drugs of abuse and medicines. Results interpretation is pivotal to understand the behavior of the substance. Thus, in this case, MDMA postmortem behavior should be carefully evaluated, considering as possible influencers, in the specific context of the case, the time lapse between death verification, maintenance of the advanced life support and body manipulation for organ collection purposes. Also referred and discussed is the antemortem/postmortem ratio of MDMA obtained values, compared with literature references. There is no doubt that death was due to MDMA intoxication, but information from the analysis performed on the in vivo samples suggests that this type of sample should also be considered, in a complementary role, whenever possible.

Identification of separation phenomenon during brain death determination of potential organ donor and analysis of relative factors

Background: With analyzing the incongruent phenomenon of electrical active and cerebral blood flow in brain death determination and screening the related factors, offer correct explanations and countermeasure to ensure the successful implementation of donation after brain death.Methods: Relevant clinical data of potential brain death organ donors were prospectively collected between June 2018 and May 2019. The related parameters of neurological examination, laboratory examination and neuroimaging examination during the period of brain death determination were dynamically recorded. Separation phenomenon was used as grouping factors to screen the factors related to separation phenomena through univariate and multivariate analysis.Results: According to the inclusion criteria, 127 patients were included in the study. Among 22 patients (17.3%) with incongruent phenomenon, 17 (77.3%) had electrical silence earlier than cerebral blood flow arrest, and 9 (22.7%) had cerebral blood flow arrest earlier than electrical silence. Univariate and multivariate analysis showed that age <14 years (OR=6.25, 95%CI 1.21-32.22, p=0.028), SBP≥140 mmHg (OR=7.43, 95%CI 1.62-33.99, p=0.010), primary brainstem injury (OR=15.89, 95%CI 3.04-82.93, p=0.006), spontaneous respiratory arrest time ≤72 hours (OR=11.96, 95%CI 1.59-89.78, p=0.009) and decompression craniotomy(unilateral or bilateral) (OR=16.28, 95%CI 2.25-117.73, p=0.001) were associated with separation phenomenon..Conclusions: Separation phenomenon is a common during the confirmation test of brain death determination in China, and should be correctly recognized. To adopt corresponding measures according to risk factors is useful for successful implementation of donation after brain death.

Social perspective-taking shapes brain hemodynamic activity and eye movements during movie viewing

Putting oneself into the shoes of others is an important aspect of social cognition. We measured brain hemodynamic activity and eye-gaze patterns while participants were viewing a shortened version of the movie ‘My Sister’s Keeper’ from two perspectives: that of a potential organ donor, who violates moral norms by refusing to donate her kidney, and that of a potential organ recipient, who suffers in pain. Inter-subject correlation (ISC) of brain activity was significantly higher during the potential organ donor’s perspective in dorsolateral and inferior prefrontal, lateral and inferior occipital, and inferior–anterior temporal areas. In the reverse contrast, stronger ISC was observed in superior temporal, posterior frontal and anterior parietal areas. Eye-gaze analysis showed higher proportion of fixations on the potential organ recipient during both perspectives. Taken together, these results suggest that during social perspective-taking different brain areas can be flexibly recruited depending on the nature of the perspective that is taken.

When Life Ceases—Relatives’ Experiences When a Family Member Is Confirmed Brain Dead and Becomes a Potential Organ Donor—A Literature Review

Introduction Most healthcare professionals rarely experience situations of a request for organ donation being made to the patient’s family and need to have knowledge and understanding of the relatives’ experiences. Objective To describe relatives’ experiences when a family member is confirmed brain dead and becomes a potential organ donor. Methods A literature review and a thematic data analysis were undertaken, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting process. A total of 18 papers, 15 qualitative and 3 quantitative, published from 2010 to 2019, were included. The electronic search was carried out in January 2019. Results The overarching theme When life ceases emerged as a description of relatives’ experiences during the donation process, including five subthemes: cognitive dissonance and becoming overwhelmed with emotions, interacting with healthcare professionals, being in a complex decision-making process, the need for proximity and privacy, and feeling hope for the future. The relatives had different needs during the donation process. They were often in shock when the declaration of brain death was presented, and the donation request was made, which affected their ability to assimilate and understand information. They had difficulty understanding the concept of brain death. The healthcare professionals caring for the patient had an impact on how the relatives felt after the donation process. Furthermore, relatives needed follow-up to process their loss. Conclusion Caring science with an explicit relative perspective during the donor process is limited. The grief process is individual for every relative, as the donation process affects relatives’ processing of their loss. We assert that intensive care unit nurses should be included when essential information is given, as they often work closest to the patient and her or his family. Furthermore, the relatives need to be followed up afterwards, in order to have questions answered and to process the grief, together with healthcare professionals who have insight into the hospital stay and the donation process.

Organ Donation and the Ars Moriendi

Organ donation is rightly understood as a gift that is a genuine act of love. Organ donation as an act of love requires it to be an act of freedom that honors the integrity of the human person who is in the process of dying. However, the process of organ donation, by necessity, inserts a third party of interest whose primary aim is to assist someone other than the dying person. Caregivers can become “organ focused” instead of “patient focused.” The procurement of organs potentially results in the commodification of the potential organ donor. Furthermore, death is not a momentary event but rather an ontological change in the person where the union of body and soul becomes divided. This Catholic understanding of death is important to assess the impact of organ donation on the process of dying. Family members of organ donors often have traumatic memories associated with the organ donation process, potentially overshadowing the ars moriendi—the art of dying. Summary: While organ donation is an act of love, the donation process can be distraction from the care of the dying patient, who may be treated differently than other dying patients who are not organ donors. A Catholic understanding of death is helpful in assessing the impact of the organ donation process.

Ethical Concerns and Care Before Organ Donation

Organ donation usually proceeds smoothly and compassionately without raising any ethical concerns, and the involved family members are usually very satisfied. When concerns do arise, they typically involve 3 issues: consent for organ donation, critical care of the potential organ donor with brain death, and donation after cardiac death.

Impaired physiological equilibrium syndrome in potential organ donors: identification of defining characteristics

Introducción: La mayor parte de los diagnósticos de enfermería sobre los potenciales donantes de órganos están relacionados a alteraciones fisiológicas. Es común que estos pacientes presenten todos los diagnósticos citados para esta población. Pero todavía no existe en NANDA International un diagnóstico único que sea capaz de plantear este severo caso. Objetivo: Identificar en la literatura las posibles características definitorias para la propuesta de diagnóstico Síndrome del equilibrio fisiológico deteriorado en pacientes con muerte encefálica y potenciales donantes de órganos. Método: Revisión integrativa de la literatura con estudios publicados entre el 1997 y el 2017 en las bases de datos Web of Science, LILACS y PubMed.Resultados: La muestra constó de 37 artículos, de los cuales se identificó 44 posibles características distintas para el diagnóstico de enfermería en desarrollo. Se dividieron las características definitorias en cinco grupos principales: alteraciones endocrino-metabólicas; alteraciones hemodinámicas y/o cardiovasculares; alteraciones respiratorias; alteraciones nutricionales y alteraciones de la coagulación, inflamatorias e/o inmunológicas. Conclusiones: El desarrollo de este diagnóstico puede colaborar con la calificación de la taxonomía de NANDA Internacional, así como ampliar el conocimiento de la enfermería en el campo de mantenimiento del posible donante de órganos, lo que contribuye a la enseñanza e investigación. El empleo de este diagnóstico puede mejorar la sistematización del cuidado, auxilia en el mantenimiento del potencial donante y, en consecuencia, mejora la viabilidad de órganos para trasplante. Introduction: Most of nursing diagnoses for potential organ donors is related to physiological changes. These patients often have all diagnoses cited for this population. However, NANDA International does not have a diagnosis to address this acute condition. Objective: To identify possible defining characteristics for the diagnosis of impaired physiological equilibrium syndrome for brain death patients and for potential organ donors in the literature. Method: Integrative literature review including articles published between 1997 and 2017 in the databases Web of Science, LILACS and PubMed.Results: The sample consisted of 37 articles identifying 44 possible defining characteristics for the nursing diagnosis to be developed. The defining characteristics were divided into five major groups of changes: endocrine-metabolic changes, hemodynamic and/or cardiovascular changes, ventilatory changes, nutritional changes, coagulation changes, inflammatory and/ or immune changes.Conclusions: Developing this diagnosis can collaborate to the taxonomy of NANDA International, as well as to extend the nursing knowledge of the area of maintenance of the potential organ donor, contributing to teaching and research. The practical use of this diagnosis purpose can provide a better systematization of care, enabling the proper maintenance of the potential organ donor and consequently improving the viability of organs for transplantation. Introdução: A maior parte dos diagnósticos de enfermagem prevalentes para potenciais doadores de órgãos está relacionada com alterações fisiológicas. Não raro estes pacientes apresentam todos os diagnósticos citados para esta população. Todavia, não existe na NANDA International um diagnóstico único que aborde este quadro agudo. Objetivo: Identificar na literatura possíveis características definidoras para a proposta de diagnóstico Síndrome do equilíbrio fisiológico prejudicado para pacientes em morte encefálica e potenciais doadores de órgãos. Método: Revisão integrativa da literatura incluindo artigos publicados entre 1997 e 2017 nas bases de dados Web of Science, LILACS e PubMed.Resultados: A amostra foi constituída por 37 artigos identificando 44 possíveis características definidoras para o diagnóstico de enfermagem em desenvolvimento. As características definidoras foram divididas em cinco grandes grupos: alterações endócrino-metabólicas, alterações hemodinâmicas e/ou cardiovasculares, alterações ventilatórias, alterações nutricionais e alterações de coagulação, inflamatórias e/ou imunológicas.Conclusões: O desenvolvimento deste diagnóstico pode colaborar com a qualificação da taxonomia da NANDA International, além de ampliar o conhecimento da enfermagem na área de manutenção do potencial doador de órgãos contribuindo para o ensino e pesquisa. O uso desta proposta de diagnóstico na prática pode proporcionar uma melhor sistematização do cuidado, auxiliando a adequada manutenção do potencial doador e consequentemente melhor viabilidade dos órgãos ofertados para transplantes.