Agonal Period in Potential Non-Heart-Beating Donors

Sohrabi, Soroush; Navarro, Alex; Asher, John; Sanni, Aliu; Wyrley-Birch, H; Anand, Vijay K.; Reddy, Mettu Srinivas; Rix, D.; Jacques, B.; Manas, Derek; Talbot, David

doi:10.1016/j.transproceed.2006.08.005

Cited by 17 publications

(10 citation statements)

References 7 publications

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“…Legislation in some countries allows euthanasia (medically assisted CA) and subsequent organ donation described as the fifth category. [16].…”

Section: Uncontrolled Controlledmentioning

confidence: 99%

“…Functional warm ischaemia (fWIT) [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] True WIT (tWIT) [27] Functional WIT (fWIT) is the time from when the systolic blood pressure drops below 50 mmHg (irrespective of oxygen saturation) for at least 2 min after Withdrawal of Life Sustaining Treatment (WLST) until organ preservation (cold flush/nRP).…”

Section: Postmortem Interventionsmentioning

confidence: 99%

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New classification of donation after circulatory death donors definitions and terminology

et al. 2016

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Summary In the face of a crisis in organ donation, the transplant community are increasingly utilizing donation after circulatory death (DCD) donors. Over the last 10 years, with the increasing usage of DCD donors, we have seen the introduction in a number of new terms and definitions. We report the results of the 6th International Conference in Organ Donation held in Paris in 2013 and report a consensus agreement of an established expert European Working Group on the definitions and terminology regarding DCD donation, including refinement of the Maastricht definitions. This document forms part of a special series where recommendations are presented for uncontrolled and controlled DCD donation and organ specific guidelines for kidney, pancreas, liver and lung transplantation. An expert panel formed a consensus on definitions and terms aiming to establish consistent usage of terms in DCD donation.

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“…Legislation in some countries allows euthanasia (medically assisted CA) and subsequent organ donation described as the fifth category. [16].…”

Section: Uncontrolled Controlledmentioning

confidence: 99%

Section: Postmortem Interventionsmentioning

confidence: 99%

New classification of donation after circulatory death donors definitions and terminology

et al. 2016

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“…However, by extending the stand-by time beyond 2 h it may be possible to increase the number of actual donations. Sohrabi et al [83] reported that even after a 5-h agonal period, kidneys retrieved might still be transplantable provided they passed the viability assessment using machine perfusion. They successfully transplanted 16 kidneys retrieved from donors with an agonal period in excess of 2 h, but the discard rate was high-13% if less than 2 h; 33% if more than 2 h and 45% if more than 5 h.…”

Section: Agonal Phasementioning

confidence: 99%

Kidney donation after cardiac death

Akoh¹

2012

WJN

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There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death (DCD) and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to controlled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (DGF) and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that significantly influences the outcome of allografts, for example, limiting it to < 12 h markedly reduces DGF. DCD kidneys from donors < 50 function like standard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled donation, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kidneys from DCD include: implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.

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“…Lung assessment in controlled NHBDs is done in the hours before the planned withdrawal of life support [11]. The mode of cardiac death and the length of the agonal period may affect the decision regarding lung harvesting, as the withdrawal of life support induces a sympathetic storm that has been demonstrated to be associated with an increase in lung vascular permeability [12,13]. In NHBD categories I and II, chest drains are inserted bilaterally to topically cool the lungs.…”

Section: Lung Transplantationmentioning

confidence: 99%

Anesthetic optimization for nonheartbeating donors

Fanelli¹,

Mascia²

2010

Current Opinion in Anaesthesiology

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In order to increase the number of organs available for transplantation, donation from nonheartbeating donors has been recently proposed. Identification of the key aspects of the donation after cardiac death should be fully achieved by the team involved in the transplantation program. Development of hospital policies and identification of receivers who are most likely to benefit from this strategy require further studies to assess long-term outcome and to identify ethical aspects concerning different religious and cultural backgrounds.

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Agonal Period in Potential Non-Heart-Beating Donors

Cited by 17 publications

References 7 publications

New classification of donation after circulatory death donors definitions and terminology

New classification of donation after circulatory death donors definitions and terminology

Kidney donation after cardiac death

Anesthetic optimization for nonheartbeating donors

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