Type I non-heart-beating donors: Policy and results

Alvarez, J.; Iglesias, J.; Pulido, Olga; Maldonado, Leonel; Juan, Gloria; Sánchez, P; Corral, Ervigio; Medina, Jorge Castro

doi:10.1016/s0041-1345(97)01018-x

Cited by 7 publications

(4 citation statements)

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“…• Maximum time of oligoanuria before cardiac arrest: 60 min • Maximum time of warm ischemia (from the start of cardiac arrest to the start of perfusion): 120 min • Maximum pump perfusion time: 240 min • Donor age Ͻ55 yr A recent addition to the program is the procurement of organs from subjects who die suddenly on the street and are transported to the center for donation (23). To this end, a formal agreement has been established with municipal emergency facilities (SAMUR, phone 061), whereby after unsuccessful CPR patients are transferred to our hospital.…”

Section: Study Populationmentioning

confidence: 99%

Renal Transplantation from Non-Heart Beating Donors

Sánchez‐Fructuoso¹,

Prats²,

Torrente³

et al. 2000

Journal of the American Society of Nephrology

179

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The aim of this study was to compare the survival and midterm function of kidneys from non-heart beating donors (NHBD) with those of kidneys from heart beating donors (HBD). From 1989 to 1998, 144 kidneys were procured from NHBD at the Hospital Clínico San Carlos in Madrid, of which 95 were transplanted. The kidney grafts were maintained from the moment of the diagnosis of cardiac arrest until the time of procurement by cardiopulmonary bypass. There was no significant difference in renal function and the number of rejection episodes between the NHBD and HBD transplants. The NHBD kidneys showed a 5.73-fold increase in the incidence of delayed graft function (adjusted relative risk 95% confidence interval, 2.82 to 11.62). One- and five-year survival rates for NHBD grafts were 84.6 and 82.7%, respectively, compared with 87.5 and 83.9% for HBD (P = 0.5767). Cox analysis showed that the predictive factors for worse NHBD graft survival were type of NHBD donor and the occurrence of corticoresistant rejection. Ninety of the NHBD organs were procured from subjects suffering irreversible cardiac arrest on the street who were transferred to our center for the sole purpose of donation. Fifty-four of these kidneys were transplanted and all showed primary function. When a strict protocol is adhered to, the outcome of renal transplant from NHBD compares well with that from HBD. It is believed that the high number of organs obtained from subjects undergoing irreversible cardiac arrest on the street might encourage the adoption of new criteria for the management of this type of pathology with the ultimate goal of kidney donation.

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Section: Study Populationmentioning

confidence: 99%

Renal Transplantation from Non-Heart Beating Donors

Sánchez‐Fructuoso¹,

Prats²,

Torrente³

et al. 2000

Journal of the American Society of Nephrology

179

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“…En lo referente al trasplante renal con donantes incontrolados tras la muerte cardíaca, el grupo del Hospital Clínico de Madrid ha demostrado una supervivencia del injerto mayor en el grupo de donantes en asistolia (incluso determinada por grupos de edad), y la función delórgano a largo plazo medida a trav es del nivel de creatinina s erica y de proteinuria (figs. 4 y 5) 19,23 . La incidencia de complicaciones entre losórganos procedentes de asistolia y muerte encef alica no presenta diferencias significativas.…”

Section: Resultados Funcionales Deórganos Trasplantados Desde Donanteunclassified

“…En tercer lugar, son pacientes que no han estado ingresados previamente con el consiguiente riesgo de infección nosocomial. Porúltimo, no atraviesan por la fase de tormenta catecolamínica y denervación con hipotensión que acontecen en la muerte encef alica y que tiene efectos delet ereos sobre diferentesórganos [18][19][20][21][22][23][24] . En el procedimiento hay 2 fases bien diferenciadas, que deben estar perfectamente coordinadas.…”

Section: Donante Tipo Iunclassified

Donación tras la muerte cardíaca. Parada cardíaca en el mantenimiento del donante en muerte encefálica

et al. 2009

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Brain death implies the complete cessation of activity in both cerebral hemispheres and in the brainstem; this leads to severe physiopathological disorders that make donor maintenance complex and involve the concomitant risk of rapid organ deterioration. The heart is one of the target organs in this process of multiple organ failure. Myocardial stunning occurs due to a "catecholamine storm" and subsequent release of many proinflammatory mediators, free oxygen radicals, and electrolyte imbalance secondary to insipid diabetes and hypothermia. Cardiac arrest during the maintenance of a donor after brain death is relatively frequent. The shortage of organs for transplantation has led to the broadening of the criteria for organ donation to include donation after cardiac death or non heart beating donation, among others.

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“…A recent addition to the program is the procurement of organs from subjects who die suddenly on the street and are transported to the center for donation [23]. To be accepted as possible donors, these subjects were also required to fulfill the following criteria: (i) known cause of death, ruling out violence, (ii) nonbleeding injuries to the thorax or abdomen, (iii) external cardiac massage and mechanical ventilation performed within 15 min of the start of cardiac arrest, (iv) transfer of subjects to the hospital with external cardiac massage, mechanical ventilation and intravenous liquid perfusion, (v) no external signs of possible intravenous drug addiction to control the risk of HIV or hepatitis C or B positivity.…”

Section: Nhbd Proceduresmentioning

confidence: 99%

Expression of adhesion molecules and RANTES in kidney transplant from nonheart-beating donors

Moral¹,

Aviles²,

Colberger³

et al. 2005

Transplant Int

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Summary The main difference between cadaveric kidneys from donors with a heartbeat (HBD) and kidneys from nonheart‐beating donors (NHBD) is related to warm ischemia/reperfusion time which constitutes an acute inflammatory process. On the contrary, brain death induces in HBD expression of pro‐inflammatory adhesion molecules, making it important to evaluate this kind of molecules in both types of donors. Human renal biopsies from NHBD, HBD and normal kidneys (ischemia time = 0) were taken and frozen just before transplant. A semi‐quantitative RT‐PCR method was used to determine intracellular adhesion molecule 1 (ICAM‐1), vascular cell adhesion molecule 1 (VCAM‐1), lymphocyte function associated antigen (LFA‐1), LFA‐3, CD40, CD40 ligand (CD40L) and RANTES (regulated upon activation, normal T‐cell expressed and secreted) gene expression. We have detected an elevated relative gene expression of ICAM‐1, VCAM‐1 and RANTES in NHBD biopsies compared with normal kidneys. In the case of RANTES, the gene expression from NHBD biopsies was higher than observed in HBD biopsies. The rest of genes were not augmented in any group. Preliminary data about early outcome of transplants indicates a correlation between pretransplant RANTES high gene expression levels and early post‐transplant acute rejection. The gene expression of pro‐inflammatory molecules like adhesion molecules and RANTES is augmented in kidneys from cadaveric NBD just before transplant. The expression is higher probably because of the prolonged warm ischemia period. A larger clinical study is necessary to clarify the effects of these variable expressions on the transplant outcome.

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Type I non-heart-beating donors: Policy and results

Cited by 7 publications

References 0 publications

Renal Transplantation from Non-Heart Beating Donors

Renal Transplantation from Non-Heart Beating Donors

Donación tras la muerte cardíaca. Parada cardíaca en el mantenimiento del donante en muerte encefálica

Expression of adhesion molecules and RANTES in kidney transplant from nonheart-beating donors

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