Transplantation of kidneys from DCD and DBD donors who died after ligature asphyxiation: The UK experience

Trotter, Patrick; Jochmans, Ina; Hulme, William; Robb, Matthew; Watson, Christopher J.; Neuberger, James; Bradley, J. Andrew

doi:10.1111/ajt.14989

Cited by 6 publications

(7 citation statements)

References 13 publications

(26 reference statements)

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“…Therefore, discarded DCD donor kidneys, at least some of them, could be salvaged by NMP. The supportive evidence also demonstrated that DCD kidneys from donors dying of ligature asphyxiation suffered an additional warm ischemic insult that does not adversely influence transplant outcomes [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Risk Factors in Declined Kidneys from Donation after Brain Death and Circulatory Death

et al. 2020

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Background and objectives: Kidneys from donation after circulatory death (DCD) are more likely to be declined for transplantation compared with kidneys from donation after brain death (DBD). The aim of this study was to evaluate characteristics in the biopsies of human DCD and DBD kidneys that were declined for transplantation in order to rescue more DCD kidneys. Materials and Methods: Sixty kidney donors (DCD = 36, DBD = 24) were recruited into the study and assessed using donor demographics. Kidney biopsies taken post cold storage were also evaluated for histological damage, inflammation (myeloperoxidase, MPO), von Willebrand factor (vWF) expression, complement 4d (C4d) deposition and complement 3 (C3) activation using H&E and immunohistochemistry staining, and Western blotting. Results: More DBD donors (16/24) had a history of hypertension compared with DCDs (8/36, p = 0.001). The mean warm ischemic time in the DCD kidneys was 12.9 ± 3.9 min. The mean cold ischemic time was not significantly different between the two groups of kidney donors (DBD 33.3 ± 16.7 vs. DCD 28.6 ± 14.1 h, p > 0.05). The score of histological damage and MPO, as well as the reactivity of vWF, C4d and C3, varied between kidneys, but there was no significant difference between the two donor types (p > 0.05). However, vWF reactivity might be an early indicator for loss of tissue integrity, while C4d deposition and activated C3 might be better predictors for histological damage. Conclusions: Similar characteristics of DCD were shown in comparison with DBD kidneys. Importantly, the additional warm ischemic time in DCD appeared to have no further detectable adverse effects on tissue injury, inflammation and complement activation. vWF, C4d and C3 might be potential biomarkers facilitating the evaluation of donor kidneys.

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Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Risk Factors in Declined Kidneys from Donation after Brain Death and Circulatory Death

et al. 2020

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“…Other studies have shown that suitable organs from many donors who might transmit malignancy or infection are not used [33,34] as are other potential donors who died from, for example, asphyxiation or drowning [35–38]. That fear of risk of disease transmission affects patient survival is amply demonstrated by the fact that many organs with a risk of transmission of cancer of less than 1% are declined by recipients who have a risk of death without a transplant in excess of 10% [34,35].…”

Section: Quantifying Donor Riskmentioning

confidence: 99%

Organ utilization – the next hurdle in transplantation?

Neuberger

Callaghan

2020

Transpl. Int.

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Summary Nonutilization of organs from consented deceased donors remains a significant factor in limiting patient access to transplantation. Critical to reducing waste is a clear understanding of why organs are not used: accurate metrics are essential to identify the extent and causes of waste but use of these measures as targets or comparators between units/jurisdictions must be done with caution as focus on any one measure may result in unintended adverse consequences. Comparison between centres or countries may be misleading because of variation in definitions, patient or graft characteristics. Two of the most challenging areas to improve appropriate deceased donor organ utilization are appetite for risk and lack of validated tools to help identify an organ that will function appropriately. Currently, the implanting surgeon is widely considered to be accountable for the use of a donated organ so guidelines must be clear to allow and support sensible decisions and recognition that graft failure or inadvertent disease transmission are not necessarily attributable to poor decision‐making. Accepting an organ involves balancing risk and benefit for the potential recipient. Novel technologies such as machine perfusion may allow for more robust guidance as to the functioning of the organ.

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“…Nearly every person who dies naturally, or in an accident, is a potential donor. As per Trotter et al (2018), the organ donors could be categorized in the following two types -1. Brainstem dead, heart-beating donors/donation after brain death (DBD) 2.…”

Section: Organ Donation and Transplantmentioning

confidence: 99%

Application of Artificial Intelligence and Blockchain in healthcare management - donor organ transplant system

Morandé

Marzullo²

2020

AMOR

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Purpose: Research ventures to expand the reach of organ transplant mechanisms to improve the abysmally low organ transplant rate in the country. The research deploys state of the art technologies to promote deceased organ donation using the donor organ transplant system. Research methodology: The exploratory study focuses on addressing the limitation of resources using a Socio-material view. The research utilizes qualitative content analysis to reflect on the knowledge drawn from the artifacts. Results: The presented study leverages the capabilities of Artificial Intelligence and Blockchain technologies to benefit from the convergence. In line with the concept of 'Texture of Practices,' research provides recommendations to augment the organ transplant system in terms of procurement, coordination, and transplantation. Limitations: Drawing the knowledge from the case studies, research strives to understand the reality and interaction of actors in a healthcare context. Considering the complex nature of the organ transplant process, the study is limited to the Indian scenario and cannot be generalized. Contribution: Research identifies the requirement of a unified digital interface and encourages the integration of emergency health services to facilitate operational processes during organ transplants. Keywords: Healthcare, Organ transplant, A.I., Blockchain, Texture of practices

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Transplantation of kidneys from DCD and DBD donors who died after ligature asphyxiation: The UK experience

Cited by 6 publications

References 13 publications

Comparative Analysis of Risk Factors in Declined Kidneys from Donation after Brain Death and Circulatory Death

Comparative Analysis of Risk Factors in Declined Kidneys from Donation after Brain Death and Circulatory Death

Organ utilization – the next hurdle in transplantation?

Application of Artificial Intelligence and Blockchain in healthcare management - donor organ transplant system

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