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donation after circulation death

Christopher J E Watson, Fiona Hunt, Simon Messer, Ian Currie, Stephen Large, Andrew Sutherland, Keziah Crick, Stephen J Wigmore, Corrina Fear, Sorina Cornateanu, Lucy V Randle, John D Terrace, Sara Upponi, Rhiannon Taylor, Elisa Allen, Andrew J Butler, Gabriel C Oniscu
Livers from controlled donation after circulatory death (DCD) donors suffer a higher incidence of non-function, poor function, and ischemic cholangiopathy. In situ normothermic regional perfusion (NRP) restores a blood supply to the abdominal organs after death using an extracorporeal circulation for a limited period before organ recovery. We undertook a retrospective analysis to evaluate whether NRP was associated with improved outcomes of livers from DCD donors. NRP was performed on 70 DCD donors from which 43 livers were transplanted...
December 27, 2018: American Journal of Transplantation
James L Bernat
Despite the popularity, success, and growth of programs of organ donation after the circulatory determination of death (DCDD), a long-standing controversy persists over whether the organ donor is truly dead at the moment physicians declare death, usually following five minutes of circulatory and respiratory arrest. Advocates of the prevailing death determination standard claim that the donor is dead when declared because of permanent cessation of respiration and circulation. Critics of this standard argue that while the cessation of respiration and circulation may be permanent, it may not be irreversible at the moment death is declared because, if cardiopulmonary resuscitation were performed, it might succeed...
November 2018: Hastings Center Report
Ari Joffe
According to international scientific medical consensus, death is a biological, unidirectional, ontological state of an organism, the event that separates the process of dying from the process of disintegration. Death is not merely a social contrivance or a normative concept; it is a scientific reality. Using this paradigm, the international consensus is that, regardless of context, death is operationally defined as "the permanent loss of the capacity for consciousness and all brainstem function. This may result from permanent cessation of circulation or catastrophic brain injury...
November 2018: Hastings Center Report
Jodie Beuth, Florian Falter, Roberto Vanin Pinto Ribeiro, Mitesh Badiwala, Massimiliano Meineri
Heart transplantation remains the definitive management for end-stage heart failure refractory to medical therapy. While heart transplantation cases are increasing annually worldwide, there remains a deficiency in organ availability with significant patient mortality while on the waiting list. Attempts have therefore been made to expand the donor pool and improve access to available organs by recruiting donors who may not satisfy the standard criteria for organ donation because of donor pathology, anticipated organ ischemic time, or donation after circulatory death...
December 7, 2018: Anesthesia and Analgesia
Nathaniel M Weathington, Diana Álvarez, John Sembrat, Josiah Radder, Nayra Cárdenes, Kentaro Noda, Qiaoke Gong, Hesper Wong, Jay Kolls, Jonathan D'Cunha, Rama K Mallampalli, Bill B Chen, Mauricio Rojas
The acute respiratory distress syndrome (ARDS) causes an estimated 70,000 US deaths annually. Multiple pharmacologic interventions for ARDS have been tested and failed. An unmet need is a suitable laboratory human model to predictively assess emerging therapeutics on organ function in ARDS. We previously demonstrated that the small molecule BC1215 blocks actions of a proinflammatory E3 ligase-associated protein, FBXO3, to suppress NF-κB signaling in animal models of lung injury. Ex vivo lung perfusion (EVLP) is a clinical technique that maintains lung function for possible transplant after organ donation...
October 4, 2018: JCI Insight
Seokjin Haam, Jin Gu Lee, Hyo Chae Paik, Moo Suk Park, Beom Jin Lim
BACKGROUND: Ex vivo lung perfusion (EVLP) is a system that circulates normothermic perfusate into procured lungs, allowing for improved lung function and lung assessment. We investigated whether ventilation with hydrogen gas during EVLP improves the donation after cardiac death lung function and whether this effect persists after actual transplantation. METHODS: Ten pigs were randomly divided into a control group (n = 5) and a hydrogen group (n = 5). No treatment was administered to induce warm ischemic injury for 1 hour after cardiac arrest, and EVLP was applied in procured lungs for 4 hours...
June 21, 2018: Journal of Heart and Lung Transplantation
Stein Foss, Espen Nordheim, Dag W Sørensen, Torgunn B Syversen, Karsten Midtvedt, Anders Åsberg, Thorleif Dahl, Per A Bakkan, Aksel E Foss, Odd R Geiran, Arnt E Fiane, Pål-Dag Line
Background: Donation after circulatory death (DCD) can increase the pool of available organs for transplantation. This pilot study evaluates the implementation of a controlled DCD (cDCD) protocol using normothermic regional perfusion in Norway. Methods: Patients aged 16 to 60 years that are in coma with documented devastating brain injury in need of mechanical ventilation, who would most likely attain cardiac arrest within 60 minutes after extubation, were eligible...
July 2018: Transplantation Direct
D A Cook, N Widdicombe
An audit of ten years' experience in all patients undergoing withdrawal of cardiorespiratory support (WCRS) in the context of donation after circulatory death (DCD) was conducted in Queensland, Australia (2008 to 2017). One hundred and seventy-one patients proceeded to donation after declaration of death by circulatory criteria with loss of pulsatile arterial blood pressure (circulatory arrest) for five minutes. The demographics, times and haemodynamic observations were abstracted, de-identified and collated...
July 2018: Anaesthesia and Intensive Care
J Hunter Mehaffey, Eric J Charles, Adishesh K Narahari, Sarah Schubert, Victor E Laubach, Nicholas R Teman, Kevin R Lynch, Irving L Kron, Ashish K Sharma
BACKGROUND: Sphingosine-1-phosphate regulates endothelial barrier integrity and promotes cell survival and proliferation. We hypothesized that upregulation of sphingosine-1-phosphate during ex vivo lung perfusion would attenuate acute lung injury and improve graft function. METHODS: C57BL/6 mice (n = 4-8/group) were euthanized, followed by 1 hour of warm ischemia and 1 hour of cold preservation in a model of donation after cardiac death. Subsequently, mice underwent 1 hour of ex vivo lung perfusion with 1 of 4 different perfusion solutions: Steen solution (Steen, control arm), Steen with added sphingosine-1-phosphate (Steen + sphingosine-1-phosphate), Steen plus a selective sphingosine kinase 2 inhibitor (Steen + sphingosine kinase inhibitor), or Steen plus both additives (Steen + sphingosine-1-phosphate + sphingosine kinase inhibitor)...
August 2018: Journal of Thoracic and Cardiovascular Surgery
Jose Maria Navalpotro-Pascual, Alfredo Echarri-Sucunza, Alonso Mateos-Rodríguez, Francisco Peinado-Vallejo, Patricia Fernández Del Valle, Daniel Alonso-Moreno, Carmen Del Pozo-Pérez, María V Mier-Ruiz, Jose Ignacio Ruiz-Azpiazu, José Bravo-Castello, Natalia Martinez-Cuellar, Antonia Sáez-Jiménez, Carmen López-Unanua, Roberto Antón-Ramas, María Del Carmen Escriche-López, Jose Manuel Giraldo-Sebastià, Mª José García-Ochoa, Enrique Martín-Sánchez, Diego Borraz-Clares, Marta Martínez Del Valle, Cristina Carriedo-Scher, Fernando Rosell-Ortiz
OBJECTIVE: To determine the number of potential deceased organ donors from out-of- hospital cardiac arrest cases (OHCA) attended by public physician-led emergency medical services in Spain, based on data recorded in the nationwide Spanish OHCA Registry (OHSCAR). MATERIAL AND METHODS: We analysed OHSCAR data on deceased OHCA patients in Spain during 13 months (1/10/2013 to 31/10/2014). Variables included age, sex, estimated OHCA time, cardiopulmonary resuscitation (CPR) start time and outcome...
January 2018: Resuscitation
Simon Messer, Aravinda Page, Richard Axell, Marius Berman, Jules Hernández-Sánchez, Simon Colah, Barbora Parizkova, Kamen Valchanov, John Dunning, Evgeny Pavlushkov, Sendhil K Balasubramanian, Jayan Parameshwar, Yasir Abu Omar, Martin Goddard, Stephen Pettit, Clive Lewis, Anna Kydd, David Jenkins, Christopher J Watson, Catherine Sudarshan, Pedro Catarino, Marie Findlay, Ayyaz Ali, Steven Tsui, Stephen R Large
BACKGROUND: The requirement for heart transplantation is increasing, vastly outgrowing the supply of hearts available from donation after brain death (DBD) donors. Transplanting hearts after donation after circulatory-determined death (DCD) may be a viable additive alternative to DBD donors. This study compared outcomes from the largest single-center experience of DCD heart transplantation against matched DBD heart transplants. METHODS: DCD hearts were retrieved using normothermic regional perfusion (NRP) or direct procurement and perfusion (DPP)...
December 2017: Journal of Heart and Lung Transplantation
Eduardo Miñambres, Juan J Rubio, Elisabeth Coll, Beatriz Domínguez-Gil
PURPOSE OF REVIEW: Donation after circulatory death (DCD) is still performed in a limited number of countries. This article summarizes the development of DCD in Spain and presents recent Spanish contributions to gain knowledge on the potential benefits and the practical use of normothermic regional perfusion (nRP). RECENT FINDINGS: DCD now contributes to 24% of deceased donors in Spain. The development of DCD has been based on an assessment of practices in the treatment of cardiac arrest and end-of-life care to accommodate the option of DCD; the creation of an adequate regulatory framework; and institutional support, professional training and public education...
February 2018: Current Opinion in Organ Transplantation
Matthew Q Schmidt, Frank V Schraml
A 55-year old woman presented in an obtunded state and was found to have a subarachnoid hemorrhage. After endovascular repair, her condition deteriorated, and brain death was suspected. A Tc bicisate brain blood flow study was performed, which showed a complete absence of blood flow to the cerebellum despite intact circulation to the cerebral hemispheres. These atypical findings are likely a result of a transient intracranial pressure differential and the timing of the study. A timely and accurate declaration of brain death has important psychosocial and ethical implications, particularly when organ donation is being considered...
December 2017: Clinical Nuclear Medicine
Andrew McGee, Dale Gardiner, Paul Murphy
PURPOSE OF REVIEW: The recently developed donation after circulatory death (DCD) heart transplant technique, pioneered by Papworth Hospital in the UK, involves the use of extracorporeal perfusion technologies to restart the donor heart in situ and thereby restore the donor's own circulation, after first isolating the donor's cerebral circulation. By restoring the circulation in the deceased donor, even if the cerebral circulation is excluded, the Papworth technique challenges the acceptability of death determination in DCD...
February 2018: Current Opinion in Organ Transplantation
Alisha Burman, Christopher J E Watson, Vasilis Kosmoliaptsis
As the number of patients waiting to receive transplants increases, there is a need to explore all possible donation opportunities. In this case report, we describe the transplantation of a liver from a donor who died after ethylene glycol poisoning into a woman with alcoholic liver disease with cirrhosis and associated ascites. Donor management, including ethanol, fomepizol and haemodialysis, hastened clearance of ethylene glycol from the circulation, and after liver transplantation, the recipient exhibited no adverse effects suggestive of ethylene glycol toxicity, although recipient hepatic artery dissection and thrombosis necessitated retransplantation...
October 2017: Transplantation Direct
Jose Miguel Perez-Villares, Juan José Rubio, Francisco Del Río, Eduardo Miñambres
AIM: The use of abdominal normothermic regional perfusion (nRP) and premortem interventions in controlled donation after circulatory death (cDCD) may represent a significant advance to increase the number and quality of grafts recovered in cDCD. The main limitation for the widespread acceptance of nRP in cDCD is the concerns of restoring circulation to the brain once death has been declared should the thoracic aorta not be adequately blocked. METHODS: We describe and validate a specific methodology to ensure an appropriate blocking of the thoracic aorta in a multicenter study using this technique...
August 2017: Resuscitation
Reema Hasan, Ashraf Abou El Ela, Daniel Goldstein
PURPOSE OF REVIEW: As the number of people living with heart failure continues to grow, future treatments will focus on efficient donor organ donation and ensuring safe and durable outcomes. This review will focus on organ procurement, graft surveillance and emerging therapies. RECENT FINDINGS: Preliminary studies into donation after cardiac death have indicated that this may be an effective means to increase the donor pool. Novel preservation techniques that include ex-vivo perfusion to improve donor metabolic stabilization prior to implantation may also expand the donor pool...
March 16, 2017: Current Opinion in Cardiology
Steven S L Tsui, Gabriel C Oniscu
PURPOSE OF REVIEW: Despite a significant increase in the utilization of donors after circulatory death (DCD), the number of organs recovered and their function are largely inferior to those from donors after brain death. This review summarizes recent advances in in-situ normothermic regional perfusion of DCD organs prior to procurement. RECENT FINDINGS: The combination of warm and cold ischemia in DCD donation are detrimental to organ function. As a consequence, the acceptance criteria are far more restrictive and many organs are discarded...
June 2017: Current Opinion in Organ Transplantation
Anne L Dalle Ave, James L Bernat
Uncontrolled donation after circulatory determination of death (uDCDD) refers to organ donation after a refractory cardiac arrest. We analyzed ethical issues raised by the uDCDD protocols of France, Madrid, and New York City. We recommend: (1) Termination of resuscitation (TOR) guidelines need refinement, particularly the minimal duration of resuscitation efforts before considering TOR; (2) Before enrolling in an uDCDD protocol, physicians must ascertain that additional resuscitation efforts would be ineffective; (3) Inclusion in an uDCDD protocol should not be made in the outpatient setting to avoid error and conflicts of interest; (4) The patient's condition should be reassessed at the hospital and reversible causes treated; (5) A no-touch period of at least 10 minutes should be respected to avoid the risk of autoresuscitation; (6) Once death has been determined, no procedure that may resume brain circulation should be used, including cardiopulmonary resuscitation, artificial ventilation, and extracorporeal membrane oxygenation; (7) Specific consent is required prior to entry into an uDCDD protocol; (8) Family members should be informed about the goals, risks, and benefits of planned uDCDD procedures; and (9) Public information on uDCDD is desirable because it promotes public trust and confidence in the organ donation system...
November 2018: Journal of Intensive Care Medicine
Eugene Park, Elaine Liu, Sam D Shemie, Andrew J Baker
BACKGROUND: Death after withdrawal of mechanical ventilation frequently follows the sequence of progressive hypoxemia and hypotension leading to cardiac arrest. Accurate timing of the determination of death is fundamental to trust in controlled donation after circulatory death (cDCD) programs and is generally based on cessation of circulation (pulselessness), brain function (apnea), and the passage of time. If death is understood to be the unresuscitatable loss of brain function, the clinical determination that death following apnea and pulselessness has occurred is largely inferential...
February 2018: Neurocritical Care
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