scholarly journals Pathophysiological Changes and Systemic Inflammation in Brain Dead Organ Donors: Effect on Graft Quality

2020 ◽  
Author(s):  
Neva Bezeljak ◽  
Željka Večerić-Haler
Keyword(s):  
Brain Death ◽  
Organ Damage ◽  
Active Management ◽  
Definitive Treatment ◽  
Organ Donors ◽  
Brain Functions ◽  
Brain Dead ◽  
End Stage ◽  
Irreversible Cessation

Transplantation is the definitive treatment of end-stage organ disease. As the shortage of suitable organs poses its main limitation, the active management of potential organ donors becomes increasingly more important. The majority of solid organs are still obtained from donors after confirmed brain death. Brain death is the complete and irreversible cessation of all brain functions, and triggers a variety of severe pathophysiological changes in cardiovascular, hormonal and metabolic status that can result in organ damage. Moreover, brain death is associated with massive inflammatory response with a cytokine storm and complement activation that increases graft immunogenicity and adversely affects graft survival. Organs from brain-dead donors are more prone to graft dysfunction and rejection when compared to organs obtained from living donors. Brain death is thus believed to be an important risk factor influencing the quality of organs before procurement.

ANENCEPHALIC ORGAN DONORS

PEDIATRICS ◽  
1989 ◽  
Vol 83 (2) ◽  
pp. A42-A42
Author(s):  
Student
Keyword(s):  
Brain Death ◽  
Low Dose ◽  
Organ Donors ◽  
Policy Choices ◽  
Minute Period ◽  
Definite Time ◽  
Periodic Testing ◽  
Basic Protocol ◽  
Brain Dead ◽  
Canadian Group

[There are] two policy choices: we can abandon attempts to justify use of anencephalic infants as organ donors because there is currently no clinically accepted means to declare brain death in these infants; or we can carry out the research necessary to establish a clinically valid procedure for doing so. A Canadian group has decided to take the second route and experiment on methods to use as organ donors anencephalic newborns who can be validly declared brain-dead on classic criteria. The group has developed a basic protocol that calls for the parents to agree, prior to birth, that: (1) the infant will be resuscitated; (2) periodic testing will be done to determine brain death (removal from the ventilator at six-to-twelve-hour intervals for a ten-minute period to determine ability to breathe spontaneously; (3) organ donation is acceptable; and (4) a definite time limit (to be determined by the parents but not more than fourteen days) after which the infant will be removed from the ventilator and permitted to die. Low-dose morphine is administered to prevent potential suffering on the part of the infant, although whether anencephalic newborns can suffer is unknown.

Chronic morbidities of premature newborns

2013 ◽  
Vol 154 (38) ◽  
pp. 1498-1511 ◽  
Author(s):  
György Balla ◽  
Miklós Szabó
Keyword(s):  
Quality Of Life ◽  
Periventricular Leukomalacia ◽  
Organ Damage ◽  
Detailed Knowledge ◽  
Effective Prevention ◽  
Premature Newborns ◽  
Vascular Growth ◽  
Common Risk Factors ◽  
End Stage

The most important chronic morbidities of premature newborns, deeply influencing quality of life, are retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage and periventricular leukomalacia. Since the rate of premature birth has not decreased in recent years in Hungary, and treatments of these end stage disorders are extremely difficult, prevention gains tremendous significance. Effective prevention is based on detailed knowledge of the pathophysiological mechanisms of these special diseases having multifactorial nature sharing several common risk factors, and one is the pathological angiogenesis. This sensitive system is affected by several stress situations which are the consequences of prematurity leading to abnormal vascular growth. After birth, relative hyperoxia, compared to intrauterine life, and decreasing concentrations of vascular growth factors result in vascular injury, moreover, may cause vessel apoptosis. The consequence of this phenomenon is the activation of hypoxia responsible genes resulting in robust pathological neovascularization and organ damage during the later phase. Saving normal angiogenesis and inhibiting reactive neovascularization may lead to better quality of life in these premature infants. Orv. Hetil., 2013, 154, 1498–1511.

Understanding the effect of corticosteroid pretreatment in brain-dead organ donors: new mechanistic insights for improvement of organ quality in liver transplantation

2017 ◽  
Vol 131 (18) ◽  
pp. 2377-2379
Author(s):  
Carola Dahrenmöller ◽  
Raymond Reding
Keyword(s):  
Liver Transplantation ◽  
Liver Function ◽  
Molecular Mechanisms ◽  
Organ Donors ◽  
Liver Transplants ◽  
Long Time ◽  
Organ Quality ◽  
Brain Dead ◽  
Brain Dead Donor

Transplant surgeons are currently faced with the challenge to accept marginal liver transplants due to steatosis or old age. Improving organ quality by implementing a selective organ protective donor management could be the first step towards a graft of enhanced quality. However, the molecular mechanisms of such treatments are still poorly understood. Glucocorticoid medication in donor medicine has been carried out and discussed for a long time. In a recent study published in Clinical Science, Jiménez-Castro et al. [Clin. Sci. (2017) 131, 733-746] demonstrate how liver histology and transplant liver function can be improved by administration of glucocorticoids to brain-dead donor rats with steatotic livers. This work illustrates the need for further trials in order to selectively improve the quality of steatotic livers with a potential for liver transplantation.

Changes in skin score in early diffuse cutaneous systemic sclerosis are associated with changes in global disease severity

Rheumatology ◽  
2019 ◽  
Vol 59 (2) ◽  
pp. 398-406 ◽  
Author(s):  
Boyang Zheng ◽  
Tatiana Nevskaya ◽  
Carl A Baxter ◽  
Dena R Ramey ◽  
Janet E Pope ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Disease Severity ◽  
Disease Duration ◽  
Short Form ◽  
Organ Damage ◽  
Skin Score ◽  
Sf 36 ◽  
Modified Rodnan Skin Score ◽  
End Stage

Abstract Objective To determine whether skin score changes are associated with changes in overall disease severity, function and quality of life in early dcSSc patients. Methods A total of 154 and 128 dcSSc patients from the Canadian Scleroderma Research Group database with 1 and 2 year follow-up and a disease duration ⩽5 years without end-stage organ damage and/or significant comorbidity at the initial visit were included. Skin was assessed using the modified Rodnan skin score (mRSS) and disease severity by the summed Medsger disease severity score (DSS) (without skin domain), physician and patient global assessments, function [HAQ disability index (HAQ-DI)] and quality of life [36-item Short Form Health Survey (SF-36) physical component summary (PCS)]. Analyses were repeated in patients with a disease duration ⩽3 years. Results At 2 years, 64 (50%) patients had improved skin (mRSS decrease of ⩾5 points and/or ⩾25%). Skin improvers had improved summed DSS (P = 0.002); better physician global assessments of disease activity, severity and damage (all P ⩽ 0.003); better HAQ-DI (P = 0.001) and SF-36 PCS (P = 0.005). Changes in the mRSS were positively correlated with changes in summed DSS (P = 0.006) and other disease outcomes. In the 26 (20.3%) patients with worsened skin (mRSS increase of ⩾5 points and/or ⩾25%), the summed DSS and physician global assessments were worse (P = 0.01 and P ⩽ 0.009, respectively). In the subgroup with a disease duration ⩽3 years, similar associations were found. Conclusion At 1 and 2 years, overall disease improvement parallels skin improvement in early dcSSc. This is important for prognosis and reflects the value of mRSS as an outcome measure in trials with these patients.

scholarly journals A study on knowledge, attitude and practice about organ donation among college students in Telangana state

2019 ◽  
Vol 6 (6) ◽  
pp. 2589
Author(s):  
Parepalli Vinay Kumar ◽  
Kishore Y. Jothula
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Organ Damage ◽  
Adequate Knowledge ◽  
Disease Pattern ◽  
Study Population ◽  
Present Rate ◽  
End Stage ◽  
Structured Questionnaire

Background: The change of disease pattern from communicable to non communicable or chronic diseases leading to end stage organ damage has led to the increase in the requirement of organ transplantation. Though the quality of organ transplantation has improved, the organ transplantation rate in India is 0.26 per million. Such a low rate is due to the lack of knowledge and misconception about organ donation.Methods: A pre-tested, semi-structured questionnaire was prepared, participants were chosen at random from the study population, they were interviewed with the questionnaire and their responses were computed and analysed.Results: In this study population, all of them knew about organ donation. The study shows that 62.7% of the students have adequate knowledge about organ donation. 67% of them would like to donate organs in future and 85% were willing to motivate their family to be an organ donor.Conclusions: The present rate of organ transplantation would be improved only when the society is educated with the knowledge, uncover the myths and misconceptions. It is also important that the organizations as to where and how to approach for the donation is known to all. Media being a powerful weapon of the generation can be a great tool to reach the society.

scholarly journals Organ Donation and Declaration of Death: Combined Neurologic and Cardiopulmonary Standards

2019 ◽  
Vol 86 (4) ◽  
pp. 285-296
Author(s):  
Stephen E. Doran ◽  
Joseph M. Vukov
Keyword(s):  
Brain Death ◽  
Organ Donation ◽  
Conflict Of Interest ◽  
Life Support ◽  
Organ Procurement ◽  
Organ Donors ◽  
Neurologic Injury ◽  
Brain Dead ◽  
Moral Certainty ◽  
Death By Neurologic Criteria

Prolonged survival after the declaration of death by neurologic criteria creates ambiguity regarding the validity of this methodology. This ambiguity has perpetuated the debate among secular and nondissenting Catholic authors who question whether the neurologic standards are sufficient for the declaration of death of organ donors. Cardiopulmonary criteria are being increasingly used for organ donors who do not meet brain death standards. However, cardiopulmonary criteria are plagued by conflict of interest issues, arbitrary standards for candidacy, and the lack of standardized protocols for organ procurement. Combining the neurological and cardiopulmonary standards into a single protocol would mitigate the weaknesses of both and provide greater biologic and moral certainty that a donor of unpaired vital organs is indeed dead. Summary: Before a person’s organs can be used for transplantation, he or she must be declared “brain-dead.” However, sometimes when someone is declared brain-dead, that person can be maintained on life-support for days or even weeks. This creates some confusion about whether the person has truly died. For patients who have a severe neurologic injury but are not brain-dead, organ donation can also occur after his or her heart stops beating. However, this protocol is more ambiguous and lacks standardized protocols. We propose that before a person can donate organs, he or she must first be declared brain-dead, and then his or her heart must irreversibly stop beating before organs are taken.

Organ and Tissue Procurement System: A Novel Intervention to Increase Organ Donation Rates in Venezuela

2003 ◽  
Vol 13 (1) ◽  
pp. 65-68
Author(s):  
Carmen Luisa Milanes ◽  
Eddy Hernández ◽  
Leyda González ◽  
Homero Sivira ◽  
Rafael Mamblona ◽  
...  
Keyword(s):  
Organ Donors ◽  
System A ◽  
Family Approach ◽  
Voluntary Donor ◽  
Tissue Procurement ◽  
Life Threatening ◽  
Phone Service ◽  
End Stage ◽  
Procurement System

The limited number of organs and tissues available for transplantation in Venezuela and the need to improve outcomes for patients with life-threatening end-stage organ failure or inadequate quality of life resulted in the development and implementation of an organ and tissue procurement system by the Venezuelan National Transplant Organization. This procurement system, a 24-hour, nationwide, free phone service for detection of potential organ donors, connects callers with transplant coordinators. The on-call coordinator supervises family approach as well as maintenance, transport, and allocation of the organs and tissues. During a period of 21 months, the phone service received 1191 calls (713 requesting information to become a voluntary donor, 207 requesting information about donation and transplantation, and 271 reporting potential donors). Of the potential donors, 74% were men and 67% were aged between 11 and 40 years, and most came from hospital intensive care units, emergency departments, and trauma shock units. The main causes of death were trauma and stroke. Reasons why donation was not accomplished included early cardiorespiratory arrest and denied consent. In conclusion, establishing the procurement system resulted in an increase in the detection, referral, and maintenance of potential donors; doubling of the number of donors per million population; and an increase in the number of cadaveric transplants.

Inconsistencies Between the Criterion and Tests for Brain Death

2018 ◽  
Vol 35 (8) ◽  
pp. 772-780 ◽  
Author(s):  
Anne L. Dalle Ave ◽  
James L. Bernat
Keyword(s):  
Blood Flow ◽  
Literature Review ◽  
Brain Death ◽  
Case Reports ◽  
Whole Brain ◽  
Brain Functions ◽  
Ancillary Test ◽  
The Brain ◽  
Irreversible Cessation

The whole-brain criterion of death provides that a person who has irreversibly lost all clinical functions of the brain is dead. Bedside brain death (BD) tests permit physicians to determine BD by showing that the whole-brain criterion of death has been fulfilled. In a nonsystematic literature review, we identified and analyzed case reports of a mismatch between the whole-brain criterion of death and bedside BD tests. We found examples of patients diagnosed as BD who showed (1) neurologic signs compatible with retained brain functions, (2) neurologic signs of uncertain origin, and (3) an inconsistency between standard BD tests and ancillary tests for BD. Two actions can resolve the mismatch between the whole-brain criterion of death and BD tests: (1) loosen the whole-brain criterion of death by requiring only the irreversible cessation of relevant brain functions and (2) tighten BD tests by requiring an ancillary test proving the cessation of intracranial blood flow. Because no one knows the precise brain functions whose loss is necessary to fulfill the whole-brain criterion of death, we advocate tightening BD tests by requiring the absence of intracranial blood flow.

Chronic Mechanical Circulatory Support for Patients with End-stage Heart Failure as a Definitive Treatment Option

2010 ◽  
Vol 6 (4) ◽  
pp. 22
Author(s):  
Patrycja Ganslmeier ◽  
Christof Schmid ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Mechanical Circulatory Support ◽  
Definitive Treatment ◽  
Circulatory Support ◽  
Randomized Evaluation ◽  
Fda Approval ◽  
Cerebrovascular Events ◽  
Device Placement ◽  
End Stage Heart Failure ◽  
End Stage

Mechanical circulatory support for end-stage heart failure has become routine and is now increasingly used as definitive treatment. Several small devices qualify for this purpose, but only a few have gained US Food and Drug Administration (FDA) approval as yet. Several studies, including the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) study, the Investigation of Non-transplant-Eligible Patients Who Are Inotrope Dependent (INTrEPID) and the HeartMate (HM) II trial have confirmed a significantly improved quality of life and functional capacity after device placement. However, cerebrovascular events, infection and device malfunction still pose a considerable risk to patients and hinder widespread use.

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