Medicine › Public Health, Environmental and Occupational Health

Organ Donation and Transplantation

Works Count: 65422

Wikipedia

Description

This cluster of papers explores the ethical, medical, and societal aspects of organ donation, with a focus on living kidney donors, brain death determination, transplantation outcomes, ethical considerations, donor management, and family decision-making. It also delves into the health risks and long-term consequences for both donors and recipients. The papers provide insights into the global landscape of organ trafficking and the impact of legislation on donation rates.

Keywords

Organ Donation; Living Kidney Donors; Brain Death; Transplantation; Ethical Considerations; Donor Management; Kidney Transplantation; Organ Trafficking; Family Decision-Making; Health Risks

OPTN/SRTR 2013 Annual Data Report: Kidney

2015-01-01

A. J. Matas , Jodi M. Smith , M.A. Skeans +7 more

Oxford textbook of clinical nephrology

2013-12-09

Stewart Cameron

Oxford textbook of clinical nephrology , Oxford textbook of clinical nephrology , کتابخانه دیجیتال جندی شاپور اهواز Oxford textbook of clinical nephrology , Oxford textbook of clinical nephrology , کتابخانه دیجیتال جندی شاپور اهواز

Brain death worldwide

2002-01-08

Eelco F. M. Wijdicks

To survey brain death criteria throughout the world.The clinical diagnosis of brain death allows organ donation or withdrawal of support. Declaration of brain death follows a certain set of examinations. … To survey brain death criteria throughout the world.The clinical diagnosis of brain death allows organ donation or withdrawal of support. Declaration of brain death follows a certain set of examinations. The code of practice throughout the world has not been systematically investigated.Brain death guidelines in adults in 80 countries were obtained through review of literature and legal standards and personal contacts with physicians.Legal standards on organ transplantation were present in 55 of 80 countries (69%). Practice guidelines for brain death for adults were present in 70 of 80 countries (88%). More than one physician was required to declare brain death in half of the practice guidelines. Countries with guidelines all specifically specified exclusion of confounders, irreversible coma, absent motor response, and absent brainstem reflexes. Apnea testing, using a PCO(2) target, was recommended in 59% of the surveyed countries. Differences were also found in time of observation and required expertise of examining physicians. Additional provisions existed when brain death was due to anoxia. Confirmatory laboratory testing was mandatory in 28 of 70 practice guidelines (40%).There is uniform agreement on the neurologic examination with exception of the apnea test. However, this survey found other major differences in the procedures for diagnosing brain death in adults. Standardization should be considered.

Consensus Statement on the Live Organ Donor

2000-12-13

The Authors for the Live Organ Donor Consensus Group

ObjectiveTo recommend practice guidelines for transplant physicians, primary care providers, health care planners, and all those who are concerned about the well-being of the live organ donor.ParticipantsAn executive group representing … ObjectiveTo recommend practice guidelines for transplant physicians, primary care providers, health care planners, and all those who are concerned about the well-being of the live organ donor.ParticipantsAn executive group representing the National Kidney Foundation, and the American Societies of Transplantation, Transplant Surgeons, and Nephrology formed a steering committee of 12 members to evaluate current practices of living donor transplantation of the kidney, pancreas, liver, intestine, and lung. The steering committee subsequently assembled more than 100 representatives of the transplant community (physicians, nurses, ethicists, psychologists, lawyers, scientists, social workers, transplant recipients, and living donors) at a national conference held June 1-2, 2000, in Kansas City, Mo.Consensus ProcessAttendees participated in 7 assigned work groups. Three were organ specific (lung, liver, and kidney) and 4 were focused on social and ethical concerns (informed consent, donor source, psychosocial issues, and live organ donor registry). Work groups' deliberations were structured by a series of questions developed by the steering committee. Each work group presented its deliberations to an open plenary session of all attendees. This information was stored and shaped into a statement circulated electronically to all attendees for their comments, and finally approved by the steering committee for publication. The term consensus is not meant to convey universal agreement of the participants. The statement identifies issues of controversy; however, the wording of the entire statement is a consensus by approval of all attendees.ConclusionThe person who gives consent to be a live organ donor should be competent, willing to donate, free from coercion, medically and psychosocially suitable, fully informed of the risks and benefits as a donor, and fully informed of the risks, benefits, and alternative treatment available to the recipient. The benefits to both donor and recipient must outweigh the risks associated with the donation and transplantation of the living donor organ.

SUCCESSFUL HOMOTRANSPLANTATION OF THE HUMAN KIDNEY BETWEEN IDENTICAL TWINS

1956-01-28

John P. Merrill

• A patient whose illness had begun with edema and hypertension was found to have suffered extreme atrophy of both kidneys. Because of the steady worsening of the condition and … • A patient whose illness had begun with edema and hypertension was found to have suffered extreme atrophy of both kidneys. Because of the steady worsening of the condition and the appearance of uremia with other unfavorable prognostic signs, transplantation of one kidney from the patient's healthy identical twin brother was undertaken. Preparations included collection of evidence of monozygosity and experimental transplantation of a skin graft from the twin. During the transfer of the healthy kidney it was totally ischemic for 82 minutes. Evidence of functional activity in the transplanted kidney was obtained. The hypertension persisted until the patient's diseased kidneys were both removed. The homograft has survived for 11 months, and the marked clinical improvement in the patient has included disappearance of the signs of malignant hypertension.

High Survival Rates of Kidney Transplants from Spousal and Living Unrelated Donors

1995-08-10

Paul I. Terasaki , J. Michael Cecka , David W. Gjertson +1 more

In the United States, increasing numbers of persons are donating kidneys to their spouses. Despite greater histoincompatibility, the survival rates of these kidneys are higher than those of cadaveric kidneys. … In the United States, increasing numbers of persons are donating kidneys to their spouses. Despite greater histoincompatibility, the survival rates of these kidneys are higher than those of cadaveric kidneys. We examined the factors influencing the high survival rates of spousal-donor kidneys.

View PDF Chat

The Role of Cell Swelling in Ischemic Renal Damage and the Protective Effect of Hypertonic Solute

1972-01-01

Jorge Flores , Donald R. DiBona , Clyde H. Beck +1 more

The failure of blood flow to return to the kidney following a transient period of ischemia has long been recognized. The cause of this "no-reflow" has been investigated in the … The failure of blood flow to return to the kidney following a transient period of ischemia has long been recognized. The cause of this "no-reflow" has been investigated in the rat after a transient period of total obstruction of the renal arteries. The vascular pattern of the kidneys as visualized with silicone rubber injection shows a diffuse patchy ischemia throughout the kidney, which persists after release of the obstructed renal artery. Electron microscopic studies of ischemic kidneys showed that all cellular elements were swollen and limiting the available vascular space. Functional studies revealed an increase in plasma urea nitrogen and creatinine after 1 hr or longer ischemic periods. The ischemia, cell swelling, "no-reflow," and subsequent renal dysfunction occurring after obstruction to the renal arteries were corrected by the administration of hypertonic mannitol, but were unaffected by an equivalent expansion of the extracellular fluid volume either with isotonic saline or isotonic mannitol, showing that the osmotic effect was primary. The hypothesis is presented that ischemic swelling of cells may occlude small blood vessels so that recirculation does not resume even after the initial cause of the ischemia is no longer present; solutes which do not penetrate cell membranes are able to shrink swollen cells, increase the available vascular space and thus permit reflow of blood to the ischemic organ.

View PDF Chat

Risk of End-Stage Renal Disease Following Live Kidney Donation

2014-02-11

Abimereki D. Muzaale , Allan B. Massie , Mei‐Cheng Wang +4 more

Risk of end-stage renal disease (ESRD) in kidney donors has been compared with risk faced by the general population, but the general population represents an unscreened, high-risk comparator. A comparison … Risk of end-stage renal disease (ESRD) in kidney donors has been compared with risk faced by the general population, but the general population represents an unscreened, high-risk comparator. A comparison to similarly screened healthy nondonors would more properly estimate the sequelae of kidney donation.To compare the risk of ESRD in kidney donors with that of a healthy cohort of nondonors who are at equally low risk of renal disease and free of contraindications to live donation and to stratify these comparisons by patient demographics.A cohort of 96,217 kidney donors in the United States between April 1994 and November 2011 and a cohort of 20,024 participants of the Third National Health and Nutrition Examination Survey (NHANES III) were linked to Centers for Medicare & Medicaid Services data to ascertain development of ESRD, which was defined as the initiation of maintenance dialysis, placement on the waiting list, or receipt of a living or deceased donor kidney transplant, whichever was identified first. Maximum follow-up was 15.0 years; median follow-up was 7.6 years (interquartile range [IQR], 3.9-11.5 years) for kidney donors and 15.0 years (IQR, 13.7-15.0 years) for matched healthy nondonors.Cumulative incidence and lifetime risk of ESRD.Among live donors, with median follow-up of 7.6 years (maximum, 15.0), ESRD developed in 99 individuals in a mean (SD) of 8.6 (3.6) years after donation. Among matched healthy nondonors, with median follow-up of 15.0 years (maximum, 15.0), ESRD developed in 36 nondonors in 10.7 (3.2) years, drawn from 17 ESRD events in the unmatched healthy nondonor pool of 9364. Estimated risk of ESRD at 15 years after donation was 30.8 per 10,000 (95% CI, 24.3-38.5) in kidney donors and 3.9 per 10,000 (95% CI, 0.8-8.9) in their matched healthy nondonor counterparts (P < .001). This difference was observed in both black and white individuals, with an estimated risk of 74.7 per 10,000 black donors (95% CI, 47.8-105.8) vs 23.9 per 10,000 black nondonors (95% CI, 1.6-62.4; P < .001) and an estimated risk of 22.7 per 10,000 white donors (95% CI, 15.6-30.1) vs 0.0 white nondonors (P < .001). Estimated lifetime risk of ESRD was 90 per 10,000 donors, 326 per 10,000 unscreened nondonors (general population), and 14 per 10,000 healthy nondonors.Compared with matched healthy nondonors, kidney donors had an increased risk of ESRD over a median of 7.6 years; however, the magnitude of the absolute risk increase was small. These findings may help inform discussions with persons considering live kidney donation.

View PDF Chat

Comparison of Open and Laparoscopic Live Donor Nephrectomy

1997-10-01

John L. Flowers , Stephen C. Jacobs , Eugene Cho +5 more

Objective This study compares an initial group of patients undergoing laparoscopic live donor nephrectomy to a group of patients undergoing open donor nephrectomy to assess the efficacy, morbidity, and patient … Objective This study compares an initial group of patients undergoing laparoscopic live donor nephrectomy to a group of patients undergoing open donor nephrectomy to assess the efficacy, morbidity, and patient recovery after the laparoscopic technique. Summary Background Data Recent data have shown the technical feasibility of harvesting live renal allografts using a laparoscopic approach. However, comparison of donor recovery, morbidity, and short-term graft function to open donor nephrectomy has not been performed previously. Methods An initial series of patients undergoing laparoscopic live donor nephrectomy were compared to historic control subjects undergoing open donor nephrectomy. The groups were matched for age, gender, race, and comorbidity. Graft function, intraoperative variables, and clinical outcome of the two groups were compared. Results Laparoscopic donor nephrectomy was attempted in 70 patients and completed successfully in 94% of cases. Graft survival was 97% versus 98% (p = 0.6191), and immediate graft function occurred in 97% versus 100% in the laparoscopic and open groups, respectively (p = 0.4961). Blood loss, length of stay, parenteral narcotic requirements, resumption of diet, and return to normal activity were significantly less in the laparoscopic group. Mean warm ischemia time was 3 minutes after laparoscopic harvest. Morbidity was 14% in the laparoscopic group and 35% in the open group. There was no mortality in either group. Conclusions Laparoscopic live donor nephrectomy can be performed with morbidity and mortality comparable to open donor nephrectomy, with substantial improvements in patient recovery after the laparoscopic approach. Initial graft survival and function rates are equal to those of open donor nephrectomy, but longer follow-up is necessary to confirm these observations.

KIDNEY PRESERVATION FOR TRANSPORTATION

1969-12-01

Geoffrey M. Collins , Maria Bravo‐Shugarman , Paul I. Terasaki

Comparison of Mortality in All Patients on Dialysis, Patients on Dialysis Awaiting Transplantation, and Recipients of a First Cadaveric Transplant

1999-12-02

Robert A. Wolfe , Valarie B. Ashby , Edgar L. Milford +5 more

The extent to which renal allotransplantation — as compared with long-term dialysis — improves survival among patients with end-stage renal disease is controversial, because those selected for transplantation may have … The extent to which renal allotransplantation — as compared with long-term dialysis — improves survival among patients with end-stage renal disease is controversial, because those selected for transplantation may have a lower base-line risk of death.

View PDF Chat

On the Definition and Criterion of Death

1981-03-01

James L. Bernat

The permanent cessation of functioning of the organism as a whole is the definition underlying the traditional understanding of death. We suggest the total and irreversible loss of functioning of … The permanent cessation of functioning of the organism as a whole is the definition underlying the traditional understanding of death. We suggest the total and irreversible loss of functioning of the whole brain as the sole criterion of death; this has always been an implicit criterion of death. If artificial ventilation is present, only completely validated brain dysfunction tests should be used to show that this criterion of death is satisfied. In most cases without artificial ventilation, permanent loss of cardiopulmonary function is sufficient. We propose a statutory definition of death based on the criterion of total and irreversible cessation of whole brain functions but allowing physicians to declare death according to their customary practices in most cases.

Long-Term Outcome of Renal Transplantation from Older Donors

2006-01-25

Giuseppe Remuzzi , Paolo Cravedi , Annalisa Perna +7 more

Long-term survival of kidney grafts from older donors is inferior to that of grafts from younger donors. We sought to determine whether selecting older kidneys according to their histologic characteristics … Long-term survival of kidney grafts from older donors is inferior to that of grafts from younger donors. We sought to determine whether selecting older kidneys according to their histologic characteristics before implantation would positively influence long-term outcome.

View PDF Chat

The Physician's Responsibility toward Hopelessly Ill Patients

1984-04-12

Wanzer Sh , Adelstein Sj , Cranford Re +7 more

EFFORTS to define policies on withholding or withdrawing life-sustaining procedures from hopelessly ill patients are a relatively recent development. In 1976, when two major hospitals publicly announced their protocols in … EFFORTS to define policies on withholding or withdrawing life-sustaining procedures from hopelessly ill patients are a relatively recent development. In 1976, when two major hospitals publicly announced their protocols in treating the hopelessly ill, the Journal marked the event with an editorial titled "Terminating Life Support: Out of the Closet!"1 Since then, the subject of permitting patients to die has emerged into the open. The courts have issued several well-publicized decisions since the 1976 Quinlan case,2 3 4 5 6 7 8 9 and legislatures in 15 states and the District of Columbia have enacted "natural death" acts (California, 1976; Idaho, 1977; Arkansas, 1977; New Mexico, 1977; . . .

Oxford Textbook of Clinical Nephrology

1992-11-04

George Dunea

It is the common fate of accumulating human knowledge that periodically large tracts of it become enshrined in beautifully bound volumes engraved with golden letters, to be neatly arranged on … It is the common fate of accumulating human knowledge that periodically large tracts of it become enshrined in beautifully bound volumes engraved with golden letters, to be neatly arranged on shelves by generally shortsighted librarians. Such volumes have adorned the massive halls of famous libraries at least since the time of the great library of Alexandria and certainly since the Middle Ages, giving rise to the nagging question of how so many people could have written so much when so little was known. In nephrology, however, much has been learned since the early days after World War II, when dialysis, transplantation, and renal biopsy began to transform a once sleepy academic pursuit into a dynamic subspecialty that has affected and saved the lives of thousands. All this knowledge Professor Cameron and his collaborators have now assembled into three excellent volumes written by some 210 collaborators from all over the world,

20 years or more of follow-up of living kidney donors

1992-10-01

John S. Najarian

DELAYED GRAFT FUNCTION: RISK FACTORS AND IMPLICATIONS FOR RENAL ALLOGRAFT SURVIVAL1

1997-04-01

Akinlolu Ojo , Robert A. Wolfe , Philip J. Held +2 more

Delayed graft function (DGF) may be associated with diminished kidney allograft survival. We studied the risk factors that lead to nonimmediate function of a renal allograft and the consequences of … Delayed graft function (DGF) may be associated with diminished kidney allograft survival. We studied the risk factors that lead to nonimmediate function of a renal allograft and the consequences of DGF on short- and long-term renal transplant survival. Data from the U.S. Renal Data System were used to measure the relationships among cold ischemia time, delayed graft function, acute rejection, and graft survival in 37,216 primary cadaveric renal transplants (1985-1992). These relationships were investigated using the unconditional logistic and Cox multivariate regression methods. Cold ischemia time was strongly associated with DGF, with a 23% increase in the risk of DGF for every 6 hr of cold ischemia (P<0.001). Acute transplant rejection occurred more frequently in grafts with delayed function (37% vs. 20%; odds ratio=2.25, P=0.001). DGF was independently predictive of 5-year graft loss (relative risk=1.53, P<0.001). The presence of both early acute rejection and DGF portended a dismal 5-year graft survival rate of 35%. Zero-HLA mismatch conferred a 10-15% improvement in 1- and 5-year graft survival regardless of early functional status of the allograft. However, the 5-year graft survival rate in HLA-mismatched kidneys without DGF was significantly higher than that of zero-mismatched kidneys with DGF (63% vs. 51%; P<0.001). DGF independently portends a significant reduction in short- and long-term graft survival. Delayed function and early rejection episodes exerted an additive adverse effect on allograft survival. The deleterious impact of delayed function is comparatively more severe than that of poor HLA matching.

Twice Dead: Organ Transplants and the Reinvention of Death

2003-05-01

Kathy Charmaz , Margaret Lock

Acknowledgments Preamble: Accidental Death Trauma The Procurement The Gift Death's Shadow 1. Boundary Transgressions and Moral Uncertainty Reanimation 2. Technology in Extremis Narrow Escapes 3. Locating the Moment of Death … Acknowledgments Preamble: Accidental Death Trauma The Procurement The Gift Death's Shadow 1. Boundary Transgressions and Moral Uncertainty Reanimation 2. Technology in Extremis Narrow Escapes 3. Locating the Moment of Death Jumping the Gun 4. Making Death Uniform Tragedy 5. The Brain-Death Problem Aggressive Harvesting 6. Technology as Other: Japanese Modernity and Technology Born of a Brain-Dead Mother 7. Prevailing against Inertia Organ Donor Card 8. Situated Departures Disconcerting Movements 9 Imaginative Continuities Memory Work 10.When Bodies Outlive Persons Procurement Anxiety 11. When Persons Linger in Bodies Musical Feat 12. The Body Transcendent A Court Order 13. The Social Life of Human Organs A Reliable Man An Unsatisfactory Intelligence 14. Revisiting Vivisection Almost Full Circle Reflections Bibliography Index

View PDF Chat

Factors Influencing Families' Consent for Donation of Solid Organs for Transplantation

2001-07-04

Laura A. Siminoff

ContextTransplantation has become the therapy of choice for patients with organ failure. However, the low rate of consent by families of donor-eligible patients is a major limiting factor in the … ContextTransplantation has become the therapy of choice for patients with organ failure. However, the low rate of consent by families of donor-eligible patients is a major limiting factor in the success of organ transplantation.ObjectiveTo explore factors associated with the decision to donate among families of potential solid organ donors.Design and SettingData collection via chart reviews, telephone interviews with health care practitioners (HCPs) or organ procurement organization (OPO) staff, and face-to-face interviews with family for all donor-eligible deaths at 9 trauma hospitals in southwestern Pennsylvania and northeastern Ohio from 1994 to 1999.ParticipantsFamily members, HCPs, and OPO staff involved in the donation decision for 420 donor-eligible patients.Main Outcome MeasureFactors associated with family decision to donate or not donate organs for transplantation.ResultsA total of 238 of the 420 cases led to organ donation; 182 did not. Univariate analysis revealed numerous factors associated with the donation decision. Multivariable analysis of associated variables revealed that family and patient sociodemographics (ethnicity, patient's age and cause of death) and prior knowledge of the patients' wishes were significantly associated with willingness to donate (adjusted odds ratio [OR], 7.68; 95% confidence interval [CI], 6.55-9.01). Families who discussed more topics and had more conversations about organ donation were more likely to donate (adjusted OR, 5.22; 95% CI, 4.32-6.30), as were families with more contact with OPO staff (adjusted OR, 3.08; 95% CI, 2.63-3.60) and those who experienced an optimal request pattern (adjusted OR, 2.96; 95% CI, 2.58-3.40). Socioemotional and communication variables acted as intervening variables.ConclusionsPublic education is needed to modify attitudes about organ donation prior to a donation opportunity. Specific steps can be taken by HCPs and OPO staff to maximize the opportunity to persuade families to donate their relatives' organs.

View PDF Chat

Outcomes among 562 Recipients of Placental-Blood Transplants from Unrelated Donors

1998-11-26

Pablo Rubinstein , Carmelita Carrier , Andromachi Scaradavou +7 more

A program for banking, characterizing, and distributing placental blood, also called umbilical-cord blood, for transplantation provided grafts for 562 patients between August 24, 1992, and January 30, 1998. We evaluated … A program for banking, characterizing, and distributing placental blood, also called umbilical-cord blood, for transplantation provided grafts for 562 patients between August 24, 1992, and January 30, 1998. We evaluated this experience.

View PDF Chat

THE ORIGIN AND GROWTH OF RENAL CALCULI

1937-06-01

Alexander Randall

Evidence-based guideline update: Determining brain death in adults

2010-06-07

Eelco F. M. Wijdicks , Panayiotis N. Varelas , Gary Gronseth +1 more

To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who … To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death?A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults.In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and false-positive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain.

View PDF Chat

Long-Term Consequences of Kidney Donation

2009-01-28

Hassan N. Ibrahim , Robert N. Foley , Liping Tan +5 more

The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that of … The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that of nondonors and that their risk of end-stage renal disease (ESRD) is not increased. Previous studies have included relatively small numbers of donors and a brief follow-up period.We ascertained the vital status and lifetime risk of ESRD in 3698 kidney donors who donated kidneys during the period from 1963 through 2007; from 2003 through 2007, we also measured the glomerular filtration rate (GFR) and urinary albumin excretion and assessed the prevalence of hypertension, general health status, and quality of life in 255 donors.The survival of kidney donors was similar to that of controls who were matched for age, sex, and race or ethnic group. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, as compared with a rate of 268 per million per year in the general population. At a mean (+/-SD) of 12.2+/-9.2 years after donation, 85.5% of the subgroup of 255 donors had a GFR of 60 ml per minute per 1.73 m(2) of body-surface area or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and higher body-mass index, but not a longer time since donation, were associated with both a GFR that was lower than 60 ml per minute per 1.73 m(2) and hypertension. A longer time since donation, however, was independently associated with albuminuria. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic group, and body-mass index.Survival and the risk of ESRD in carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved GFR, normal albumin excretion, and an excellent quality of life.

View PDF Chat

A Survey of Vascular Access for Haemodialysis in The Netherlands

1991-01-01

H. Burger , G. Kootstra , FT de Charro +1 more

Journal Article A Survey of Vascular Access for Haemodialysis in The Netherlands Get access H. Burger, H. Burger 1Department of Surgery, Diakonessenhuis RefajaDordrecht Correspondence and offprint request to: H. Burger, … Journal Article A Survey of Vascular Access for Haemodialysis in The Netherlands Get access H. Burger, H. Burger 1Department of Surgery, Diakonessenhuis RefajaDordrecht Correspondence and offprint request to: H. Burger, Diakonessenhuis Refaja, P.O. Box 444, 3300 AK Dordrecht, The Netherlands. Search for other works by this author on: Oxford Academic PubMed Google Scholar G. Kootstra, G. Kootstra 2Department of Surgery, The University Hospital MaastrichtNetherlands Rotterdam Search for other works by this author on: Oxford Academic PubMed Google Scholar F. de Charro, F. de Charro 3Department of Surgery, The Renal Replacement RegistryNetherlands Rotterdam Search for other works by this author on: Oxford Academic PubMed Google Scholar P. Letters P. Letters 4The Department of Epidemiology, University of Limburg Search for other works by this author on: Oxford Academic PubMed Google Scholar Nephrology Dialysis Transplantation, Volume 6, Issue 1, 1991, Pages 5–10, https://doi.org/10.1093/ndt/6.1.5 Published: 01 January 1991 Article history Received: 08 May 1990 Accepted: 02 October 1990 Published: 01 January 1991

EXPERIENCES WITH RENAL HOMOTRANSPLANTATION IN THE HUMAN: REPORT OF NINE CASES 1

1955-02-01

David M. Hume , John P. Merrill , Benjamin F. Miller +1 more

View PDF Chat

Barriers to Cadaveric Renal Transplantation Among Blacks, Women, and the Poor

1998-10-07

G. Caleb Alexander

Context.-Cadaveric renal transplantation rates differ greatly by race, sex, and income.Previous efforts to lessen these differences have focused on the transplant waiting list.However, the transplantation process involves a series of … Context.-Cadaveric renal transplantation rates differ greatly by race, sex, and income.Previous efforts to lessen these differences have focused on the transplant waiting list.However, the transplantation process involves a series of steps related to medical suitability, interest in transplantation, pretransplant workup, and movement up a waiting list to eventual transplantation.Objective.-Todetermine the relative importance of each step in explaining differences in cadaveric renal transplantation rates.Design.-Prospective cohort study. Setting andPatients.-Atotal of 7125 patients beginning long-term dialysis between January 1993 and December 1996 in Indiana, Kentucky, and Ohio.Main Outcome Measures.-Completion of 4 separate steps during each patient-year of follow-up: (A) being medically suitable and possibly interested in transplantation; (B) being definitely interested in transplantation; (C) completing the pretransplant workup; and (D) moving up a waiting list and receiving a transplant.Results.-Compared with whites, blacks were less likely to complete steps B (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.61-0.76),C (OR, 0.56; 95% CI, 0.48-0.65),and D (OR, 0.50; 95% CI, 0.40-0.62)after adjustment for age, sex, cause of renal failure, years receiving dialysis, and median income of patient ZIP code.Compared with men, women were less likely to complete each of the 4 steps, with ORs of 0.90, 0.89, 0.80, and 0.82, respectively.Poor individuals were less likely than wealthy individuals to complete steps A, B, and C, with ORs of 0.67, 0.78, and 0.77, respectively.Conclusions.-Barriers at several steps are responsible for sociodemographic differences in access to cadaveric renal transplantation.Efforts to allocate kidneys equitably must address each step of the transplant process.

Estimating the Number of Potential Organ Donors in the United States

2003-08-14

Ellen Sheehy , Suzanne L. Conrad , Lori E. Brigham +5 more

As the need for transplantable organs increases, waiting lists of patients become longer. We studied the size and composition of the national pool of brain-dead organ donors during a three-year … As the need for transplantable organs increases, waiting lists of patients become longer. We studied the size and composition of the national pool of brain-dead organ donors during a three-year period and, on the basis of these data, considered ways to increase the rate of donation.

View PDF Chat

Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients

1996-12-01

M. L. Cittanova , Isabelle Leblanc , C. Legendre +3 more

Laparoscopic Live Donor Nephrectomy

1996-06-01

Peter G. Schulam , Louis R. Kavoussi , Adam D. Cheriff +4 more

A laparoscopic live-donor nephrectomy was performed on a 40-year-old man. The kidney was removed intact via a 9-cm infraumbilical midline incision. Warm ischemia was limited to less than 5 min. … A laparoscopic live-donor nephrectomy was performed on a 40-year-old man. The kidney was removed intact via a 9-cm infraumbilical midline incision. Warm ischemia was limited to less than 5 min. Immediately upon revascularization, the allograft produced urine. By the second postoperative day, the recipient's serum creatinine had decreased to 0.7 mg/dl. The donor's postoperative course was uneventful. He experienced minimal discomfort and was discharged home on the first postoperative day. We conclude that laparoscopic donor nephrectomy is feasible. It can be performed without apparent deleterious effects to either the donor or the recipient. The limited discomfort and rapid convalescence enjoyed by our patient indicate that this technique may prove to be advantageous.

Care of the Potential Organ Donor

2004-12-22

Kenneth E. Wood , Bryan N. Becker , John G. McCartney +2 more

Organ transplantation often depends on obtaining functioning organs from a donor who has recently died. This review presents a structured approach to management of the care of the brain-dead donor … Organ transplantation often depends on obtaining functioning organs from a donor who has recently died. This review presents a structured approach to management of the care of the brain-dead donor so as to achieve the greatest chance of a successful outcome in the recipient of the organs. Hypotension, hypothermia, diabetes insipidus, and cardiac dysfunction are common challenges to management. Brain death affects both hormone production and physiological responses in the donor.

Report on Management of Renal Failure in Europe, XXIV, 1993

1995-01-01

Fernando Valderrábano , Elizabeth H. Jones , N.P. Mallick

Report on Management of Renal Failure in Europe, XXIV, 1993 Get access F. Valderrábano, F. Valderrábano Search for other works by this author on: Oxford Academic PubMed Google Scholar E. … Report on Management of Renal Failure in Europe, XXIV, 1993 Get access F. Valderrábano, F. Valderrábano Search for other works by this author on: Oxford Academic PubMed Google Scholar E. H. P. Jones, E. H. P. Jones Search for other works by this author on: Oxford Academic PubMed Google Scholar N. P. Mallick N. P. Mallick Search for other works by this author on: Oxford Academic PubMed Google Scholar Nephrology Dialysis Transplantation, Volume 10, Issue supp5, 1995, Pages 1–25, https://doi.org/10.1093/ndt/10.supp5.1 Published: 01 January 1995

Long-term risks for kidney donors

2013-11-27

Geir Mjøen , Stein Hallan , Anders Hartmann +7 more

View PDF Chat

Determining brain death in adults [RETIRED]

1995-05-01

Eelco F. M. Wijdicks

Overview.The Quality Standards Subcommittee of the American Academy of Neurology (AAN) is charged with developing guidelines for neurologists for diagnostic procedures, treatment modalities, and clinical disorders.The present document is intended … Overview.The Quality Standards Subcommittee of the American Academy of Neurology (AAN) is charged with developing guidelines for neurologists for diagnostic procedures, treatment modalities, and clinical disorders.The present document is intended to provide background for the report "Practice Parameters for Determining Brain Death in Adults" (in this issue), which has been produced by the Quality Standards Subcommittee of the AAN and approved by the AAN Executive Board.This document outlines diagnostic criteria for the c h ical diagnosis of brain death in patients older than 18 years.The recommendations for diagnosis in neonates and children have been published as a position paper by the American Academy of Pediatrics'; in addition, a review paper can be consulted.'The sensitivity and specificity of laboratory tests that confirm the clinical diagnosis of brain death are discussed.Justification.Brain death is seen frequently as a result of severe head injury, aneurysmal subarachnoid hemorrhage, and intracerebral h e m ~r r h a g e .~. ~ In medical and surgical intensive care units, large ischemic strokes associated with brain swelling and herniation, hypoxic-ischemic encephalopathy after prolonged cardiac resuscitation or asphyxia, and massive brain edema in patients with fulminant hepatic necrosis are the most common causes of brain death.7-9In large referral hospitals, neurologists or neurosurgeons may diagnose brain death from 25 to 30 times a year.1°-14The clinical diagnosis of brain death has never been easy for most physicians, including neurologists and neurosurgeons.Brain death was selected as a topic for practice parameters because of a perceived need for standardized clinical examination criteria for the diagnosis of brain death in adults, large differences in practice in performing the apnea test," and controversies over appropriate utilization of confirmatory tests."In addition, government and third-party payers are demanding well-defined practice parameters in the clinical examination or confirmatory testing.New parameters are needed to add to the

View PDF Chat

Report of a National Conference on Donation after Cardiac Death

2006-01-19

James L. Bernat , Anthony M. D’Alessandro , F K Port +7 more

A national conference on organ donation after cardiac death (DCD) was convened to expand the practice of DCD in the continuum of quality end-of-life care. This national conference affirmed the … A national conference on organ donation after cardiac death (DCD) was convened to expand the practice of DCD in the continuum of quality end-of-life care. This national conference affirmed the ethical propriety of DCD as not violating the dead donor rule. Further, by new developments not previously reported, the conference resolved controversy regarding the period of circulatory cessation that determines death and allows administration of pre-recovery pharmacologic agents, it established conditions of DCD eligibility, it presented current data regarding the successful transplantation of organs from DCD, it proposed a new framework of data reporting regarding ischemic events, it made specific recommendations to agencies and organizations to remove barriers to DCD, it brought guidance regarding organ allocation and the process of informed consent and it set an action plan to address media issues. When a consensual decision is made to withdraw life support by the attending physician and patient or by the attending physician and a family member or surrogate (particularly in an intensive care unit), a routine opportunity for DCD should be available to honor the deceased donor's wishes in every donor service area (DSA) of the United States.

View PDF Chat

Perioperative Mortality and Long-term Survival Following Live Kidney Donation

2010-03-09

Dorry L. Segev

More than 6000 healthy US individuals every year undergo nephrectomy for the purposes of live donation; however, safety remains in question because longitudinal outcome studies have occurred at single centers … More than 6000 healthy US individuals every year undergo nephrectomy for the purposes of live donation; however, safety remains in question because longitudinal outcome studies have occurred at single centers with limited generalizability.To study national trends in live kidney donor selection and outcome, to estimate short-term operative risk in various strata of live donors, and to compare long-term death rates with a matched cohort of nondonors who are as similar to the donor cohort as possible and as free as possible from contraindications to live donation.Live donors were drawn from a mandated national registry of 80 347 live kidney donors in the United States between April 1, 1994, and March 31, 2009. Median (interquartile range) follow-up was 6.3 (3.2-9.8) years. A matched cohort was drawn from 9364 participants of the third National Health and Nutrition Examination Survey (NHANES III) after excluding those with contraindications to kidney donation.Surgical mortality and long-term survival.There were 25 deaths within 90 days of live kidney donation during the study period. Surgical mortality from live kidney donation was 3.1 per 10,000 donors (95% confidence interval [CI], 2.0-4.6) and did not change during the last 15 years despite differences in practice and selection. Surgical mortality was higher in men than in women (5.1 vs 1.7 per 10,000 donors; risk ratio [RR], 3.0; 95% CI, 1.3-6.9; P = .007), in black vs white and Hispanic individuals (7.6 vs 2.6 and 2.0 per 10,000 donors; RR, 3.1; 95% CI, 1.3-7.1; P = .01), and in donors with hypertension vs without hypertension (36.7 vs 1.3 per 10,000 donors; RR, 27.4; 95% CI, 5.0-149.5; P < .001). However, long-term risk of death was no higher for live donors than for age- and comorbidity-matched NHANES III participants for all patients and also stratified by age, sex, and race.Among a cohort of live kidney donors compared with a healthy matched cohort, the mortality rate was not significantly increased after a median of 6.3 years.

Aging and the kidney.

1996-08-01

Murray Epstein

A host of abnormalities of renal structure and function accompanies advancing age. An appreciation of methodologic considerations, including population selection, that might confound the assessment of the effects of aging … A host of abnormalities of renal structure and function accompanies advancing age. An appreciation of methodologic considerations, including population selection, that might confound the assessment of the effects of aging on renal function has prompted a recent reappraisal. Earlier studies assessed the effects of aging by utilizing cross-sectional studies and institutionalized elderly subjects, with their attendant drawbacks. Recent longitudinal studies have utilized appropriate patient cohorts, selected for lock of renal disease, including potential kidney transplant donors. These studies indicate that the morphological and functional changes of aging tend to be less marked than previously thought. The common denominator of these functional changes is a diminution in renal reserve, along with constraints on the kidney's ability to respond appropriately to challenges of either excesses or deficits. Although these alterations are unlikely to be of major clinical consequence under everyday conditions, they attain clinical significance when residual renal function is challenged by the superimposition of an acute illness. Finally, it should be emphasized that elderly patients frequently suffer from comorbid conditions, such as hypertension and heart disease, that may be additive to the changes of aging, thereby amplifying these abnormalities.

Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate

2015-11-07

Morgan E. Grams , Yingying Sang , Andrew S. Levey +7 more

Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we … Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney.We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States.A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation.Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).

View PDF Chat

The Diagnosis of Brain Death

2001-04-19

Eelco F. M. Wijdicks

Physicians, health care workers, members of the clergy, and laypeople throughout the world have accepted fully that a person is dead when his or her brain is dead. In the … Physicians, health care workers, members of the clergy, and laypeople throughout the world have accepted fully that a person is dead when his or her brain is dead. In the United States, the principle that death can be diagnosed by neurologic criteria (designated as brain death) is the basis of the Uniform Determination of Death Act,1 although the law does not define any of the specifics of the clinical diagnosis. There is a clear difference between severe brain damage and brain death. The physician must understand this difference, because brain death means that life support is useless, and brain death . . .

A Report of the Amsterdam Forum On the Care of the Live Kidney Donor: Data and Medical Guidelines.

2005-03-27

Francis L. Delmonico

Kidney transplant physicians and surgeons met in Amsterdam, The Netherlands, from April 1-4, 2004 for the International Forum on the Care of the Live Kidney Donor. Forum participants included over … Kidney transplant physicians and surgeons met in Amsterdam, The Netherlands, from April 1-4, 2004 for the International Forum on the Care of the Live Kidney Donor. Forum participants included over 100 experts and leaders in transplantation representing more than 40 countries from around the world, including participants from the following continents: Africa, Asia, Australia, Europe, North America, and South America.

Racial Disparities in Access to Renal Transplantation — Clinically Appropriate or Due to Underuse or Overuse?

2000-11-23

Arnold M. Epstein , John Z. Ayanian , Joseph H. Keogh +7 more

Despite abundant evidence of racial disparities in the use of surgical procedures, it is uncertain whether these disparities reflect racial differences in clinical appropriateness or overuse or underuse of inappropriate … Despite abundant evidence of racial disparities in the use of surgical procedures, it is uncertain whether these disparities reflect racial differences in clinical appropriateness or overuse or underuse of inappropriate care.We performed a literature review and used an expert panel to develop criteria for determining the appropriateness of renal transplantation for patients with end-stage renal disease. Using data from five states and the District of Columbia on patients who had started to undergo dialysis in 1996 or 1997, we selected a random sample of 1518 patients (age range, 18 to 54 years), stratified according to race and sex. We classified the appropriateness of patients as data on candidates for transplantation and analyzed rates of referral to a transplantation center for evaluation, placement on a waiting list, and receipt of a transplant according to race.Black patients were less likely than white patients to be rated as appropriate candidates for transplantation according to appropriateness criteria based on expert opinion (71 blacks [9.0 percent] vs. 152 whites [20.9 percent]) and were more likely to have had incomplete evaluations (368 [46.5 percent] vs. 282 [38.8 percent], P<0.001 for the overall chi-square). Among patients considered to be appropriate candidates for transplantation, blacks were less likely than whites to be referred for evaluation, according to the chart review (90.1 percent vs. 98.0 percent, P=0.008), to be placed on a waiting list (71.0 percent vs. 86.7 percent, P=0.007), or to undergo transplantation (16.9 percent vs. 52.0 percent, P<0.001). Among patients classified as inappropriate candidates, whites were more likely than blacks to be referred for evaluation (57.8 percent vs. 38.4 percent), to be placed on a waiting list (30.9 percent vs. 17.4 percent), and to undergo transplantation (10.3 percent vs. 2.2 percent, P<0.001 for all three comparisons).Racial disparities in rates of renal transplantation stem from differences in clinical characteristics that affect appropriateness as well as from underuse of transplantation among blacks and overuse among whites. Reducing racial disparities will require efforts to distinguish their specific causes and the development of interventions tailored to address them.

View PDF Chat

Oxford Textbook of Clinical Nephrology

2015-10-01

With expert input from additional section editors William G. Bennett, Jeremy R. Chapman, Adrian Covic, Marc E. De Broe, Vivekanand Jha, Neil Sheerin, Robert Unwin, and Adrian Woolf, the Oxford … With expert input from additional section editors William G. Bennett, Jeremy R. Chapman, Adrian Covic, Marc E. De Broe, Vivekanand Jha, Neil Sheerin, Robert Unwin, and Adrian Woolf, the Oxford Textbook of Clinical Nephrology is a three-volume international textbook of nephrology with an unrivalled clinical approach backed up by science. It has been completely rewritten in 365 chapters for its fourth edition to bring it right up to date, make it easier to obtain rapid answers to questions, and to suit delivery in electronic formats as well as in print. This edition offers increased focus on the medical aspects of transplantation, HIV-associated renal disease, and infection and renal disease, alongside entirely new sections on genetic topics and clinical and physiological aspects of fluid/electrolyte and tubular disorders. The emphasis throughout is on marrying advances in scientific research with clinical management. The target audience is primarily the nephrologist in clinical practice and training as well as other healthcare professionals with an interest in renal disease.

Practice parameters for determining brain death in adults

1995-05-01

of the American Academy of Neurology Overview.Brain death is defined as the irreversible loss of function of the brain, including the brainstem.Brain death from primary neurologic disease usually is caused … of the American Academy of Neurology Overview.Brain death is defined as the irreversible loss of function of the brain, including the brainstem.Brain death from primary neurologic disease usually is caused by severe head injury or aneurysmal subarachnoid hemorrhage.In medical and surgical intensive care units, however, hypoxic-ischemic brain insults and fulminant hepatic failure may result in irreversible loss of brain function.In large referral hospitals, neurologists make the diagnosis of brain death 25 to 30 times a year.Justification.Brain death was selected as a topic for practice parameters because of the need for standardization of the neurologic examination cri- teria for the diagnosis of brain death.Currently, there are differences in clinical practice in performing the apnea test and controversies over appropriate confirmatory laboratory tests.This document outlines the clinical criteria for brain death and the procedures of testing in patients older than 18 years. Description of the process.All literature pertaining to brain death identified by MEDLINE for the years 1976 to 1994 was reviewed.The key words "brain death" and "apnea test" (subheading, "adult") were used.Peer-reviewed articles with original work were selected.Current textbooks of neurology, medicine, pulmonology, intensive care, and anesthesia were reviewed for opinion.On the basis of this review and expert opinion, recommendations are presented as standards, guidelines, or options.The recommendations in this document are guidelines unless otherwise specified (see boxed Definitions at end). I. Diagnostic criteria for clinical diagnosis of brain deathA. Prerequisites.Brain death is the absence of

View PDF Chat

Organ Donation and Utilization in the United States, 1996–2005

2007-04-26

Jeffrey D. Punch , D.H. Hayes , Franck Laporte +2 more

The number of deceased donors has increased by almost 40% since 1996; most of the increase has occurred since 2000. There are numerous possible factors for this increase: clinical advances … The number of deceased donors has increased by almost 40% since 1996; most of the increase has occurred since 2000. There are numerous possible factors for this increase: clinical advances and changes in policy now allow the transplantation of organs that might have been unusable a decade ago; efforts to improve the efficiency and effectiveness of the donation recovery system, most notably the Organ Donation Breakthrough Collaborative, have brought new attention to best practices at hospitals and OPOs nationwide. The role of these factors on the rising number of deceased donors remains untested. The number of living donors dropped slightly from 2004 to 2005, but it is still 82% greater than it was in 1996.

View PDF Chat

KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

2017-07-25

Krista L. Lentine , Bertram L. Kasiske , Andrew S. Levey +7 more

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney … The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a “proof-in-concept” risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided. In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1–S109.

View PDF Chat

Determination of Brain Death/Death by Neurologic Criteria

2020-08-03

David M. Greer , Sam D. Shemie , Ariane Lewis +7 more

<h3>Importance</h3> There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries. <h3>Objective</h3> To formulate a consensus statement of recommendations … <h3>Importance</h3> There are inconsistencies in concept, criteria, practice, and documentation of brain death/death by neurologic criteria (BD/DNC) both internationally and within countries. <h3>Objective</h3> To formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel. <h3>Process</h3> Relevant international professional societies were recruited to develop recommendations regarding determination of BD/DNC. Literature searches of the Cochrane, Embase, and MEDLINE databases included January 1, 1992, through April 2020 identified pertinent articles for review. Because of the lack of high-quality data from randomized clinical trials or large observational studies, recommendations were formulated based on consensus of contributors and medical societies that represented relevant disciplines, including critical care, neurology, and neurosurgery. <h3>Evidence Synthesis</h3> Based on review of the literature and consensus from a large multidisciplinary, international panel, minimum clinical criteria needed to determine BD/DNC in various circumstances were developed. <h3>Recommendations</h3> Prior to evaluating a patient for BD/DNC, the patient should have an established neurologic diagnosis that can lead to the complete and irreversible loss of all brain function, and conditions that may confound the clinical examination and diseases that may mimic BD/DNC should be excluded. Determination of BD/DNC can be done with a clinical examination that demonstrates coma, brainstem areflexia, and apnea. This is seen when (1) there is no evidence of arousal or awareness to maximal external stimulation, including noxious visual, auditory, and tactile stimulation; (2) pupils are fixed in a midsize or dilated position and are nonreactive to light; (3) corneal, oculocephalic, and oculovestibular reflexes are absent; (4) there is no facial movement to noxious stimulation; (5) the gag reflex is absent to bilateral posterior pharyngeal stimulation; (6) the cough reflex is absent to deep tracheal suctioning; (7) there is no brain-mediated motor response to noxious stimulation of the limbs; and (8) spontaneous respirations are not observed when apnea test targets reach pH <7.30 and Paco<sub>2</sub>≥60 mm Hg. If the clinical examination cannot be completed, ancillary testing may be considered with blood flow studies or electrophysiologic testing. Special consideration is needed for children, for persons receiving extracorporeal membrane oxygenation, and for those receiving therapeutic hypothermia, as well as for factors such as religious, societal, and cultural perspectives; legal requirements; and resource availability. <h3>Conclusions and Relevance</h3> This report provides recommendations for the minimum clinical standards for determination of brain death/death by neurologic criteria in adults and children with clear guidance for various clinical circumstances. The recommendations have widespread international society endorsement and can serve to guide professional societies and countries in the revision or development of protocols and procedures for determination of brain death/death by neurologic criteria, leading to greater consistency within and between countries.

Pairwise kidney exchange

2005-06-01

Alvin E. Roth , Tayfun Sönmez , M. Utku Ünver

View PDF Chat

The impact of presumed consent legislation on cadaveric organ donation: A cross-country study

2006-02-22

Alberto Abadie , Sebastien Gay

View PDF Chat

A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death

1968-08-05

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor … Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal

FairAlloc: Learning Fair Organ Allocation Policy for Liver Transplant

2025-06-25

Sirui Ding , Daochen Zha , Kai Zhang +4 more | Journal of Healthcare Informatics Research

Costly Mistakes in Rejecting a Transplant

2025-06-24

Simon Beck | Routledge eBooks

Implementation of Kidney Transplantation in a Low-income Country: Experience of Senegal

2025-06-24

Bacary Bâ , Maria Faye , Baratou Coundoul +7 more | Transplantation

Chronic kidney disease poses a major health challenge in sub-Saharan Africa, with high morbidity and mortality rates. Kidney transplantation (KT) is the most effective treatment for end-stage kidney disease. However, … Chronic kidney disease poses a major health challenge in sub-Saharan Africa, with high morbidity and mortality rates. Kidney transplantation (KT) is the most effective treatment for end-stage kidney disease. However, until recently, this option was not available in Senegal. In response, the government enacted a law authorizing KTs from living donors and also established a supervisory committee called "Comité National du Don et de la Transplantation d'organe." After this approval, the Aristide Le Dantec Hospital and the Ouakam Military Hospital consortium successfully performed the first transplants in November 2023, with the support of international partners. Despite the high cost associated with transplantation, the challenge remains to make it affordable to all patients in need. The creation of a national registry also marks a significant step toward more scientific, transparent, and rigorous management of KT data.

Mort et sorcellerie : une approche systémique d’analyse du rituel funéraire comme dispositif immunitaire et performatif. L’exemple des Toraja d’Indonésie

2025-06-24

Ian Gonzalez Alaña | Etudes sur la mort/Études sur la mort

Cet article propose une grille d’analyse systémique des rituels funéraires en tant que dispositifs immunitaires et performatifs, appliqués aux funérailles toraja. Contrairement aux modèles transitionnels classiques de Van Gennep et … Cet article propose une grille d’analyse systémique des rituels funéraires en tant que dispositifs immunitaires et performatifs, appliqués aux funérailles toraja. Contrairement aux modèles transitionnels classiques de Van Gennep et Turner, qui considèrent le rituel comme un simple passage, nous montrons que les pratiques funéraires intègrent et régulent les tensions sociales et spirituelles liées à la mort et à la sorcellerie. S’appuyant sur des concepts tels que l’immunité sociale et la performativité rituelle, nous analysons comment le rituel absorbe, reformule et transforme entre autres les peurs collectives associées aux forces occultes et aux esprits errants. Cette approche met en évidence une ritualité non figée mais évolutive, capable d’intégrer des ajustements en réponse aux mutations religieuses, politiques et économiques. L’étude des funérailles toraja avec cette nouvelle approche systémique illustre ainsi une gestion dynamique du désordre post-mortem, dans lequel la sorcellerie n’est pas une force extérieure, mais un élément structurant du rituel. Cette approche renouvelle l’anthropologie de la mort en proposant une lecture des rituels comme technologies sociales de régulation et d’adaptation.

NELL-1-positive membranous nephropathy following gastric cancer in an older living kidney donor: a case report

2025-06-24

Mamiko Hashimoto , Erika Hishida , Yuko Ono +6 more | CEN Case Reports

Global Observatory on Donation and Transplantation on Gender Disparity in Organ Transplantation in India From 2019 to 2023

2025-06-24

Vivek Kute , Anil Kumar , Beatriz Domínguez‐Gil +5 more | Transplantation

Transplant Thought Experiments

2025-06-24

Simon Beck | Routledge eBooks

Risk Factors for One-Year Post-Nephrectomy Decline in Renal Function of Living Kidney Donors: Quantile Regression Analysis Based on Estimated Glomerular Filtration Rate Reduction Percentiles

2025-06-23

Alfonso H. Santos , Hisham Ibrahim , Kawther F. Alquadan +5 more | Transplant International

Evaluating the Diagnostic Utility of dd-cfDNA in Renal Allograft Surveillance: A Single-Center Perspective

2025-06-21

Avinash Aravamudhan , Kevin S. Krug , Michelle Stoffel +1 more | Genes

Background: Donor-derived cell-free DNA (dd-cfDNA) testing offers a non-invasive approach for monitoring allograft health in transplant recipients. However, its diagnostic performance and clinical utility remain insufficiently characterized across diverse populations. … Background: Donor-derived cell-free DNA (dd-cfDNA) testing offers a non-invasive approach for monitoring allograft health in transplant recipients. However, its diagnostic performance and clinical utility remain insufficiently characterized across diverse populations. Objectives: This study assesses concordance between dd-cfDNA, donor-specific antibody (DSA) testing, and biopsy, while also comparing two commercial assays (AlloSure and Prospera) in kidney and pancreas transplant recipients. Methods: We retrospectively analyzed 271 transplant patient records from 2019 to 2024 at our institution, focusing on dd-cfDNA testing. Statistical analyses evaluated assay performance in relation to DSA and biopsy results. The impact of multi-organ transplantation (MOT) on dd-cfDNA levels was also assessed. Results: In our predominantly Caucasian cohort (61.5%) with a mean age of 53 years, increased levels of dd-cfDNA were significantly associated with DSA positivity, particularly within the Prospera group (p = 0.002), and were particularly higher in patients with HLA class II DSA. Both assays showed a limited correlation with biopsy-confirmed rejection. AlloSure had high specificity (80%) but low sensitivity (19%), whereas Prospera showed higher sensitivity (75%) with moderate specificity (60%). Dd-cfDNA levels were elevated in MOT recipients in a vendor-dependent manner. Conclusions: Our findings highlight the differing clinical strengths of dd-cfDNA assays: AlloSure demonstrates greater preference for ruling out rejection, whereas Prospera appears better suited for early detection. Dd-cfDNA interpretation in MOT recipients warrants cautious consideration. Overall, tailoring assay selection and optimizing diagnostic thresholds to clinical context may enhance transplant surveillance and patient management strategies.

Recommendations from the 2024 Minimally Invasive Organ Transplant Consensus Conference – MIOT.CC

2025-06-20

Dieter Broering , Enrico Benedetti | Annals of Surgery

Objectives: The Minimally Invasive Organ Transplant Consensus Conference (MIOT.CC) aimed to develop evidence-based recommendations for advancing minimally invasive techniques in organ transplantation. Background: Minimally invasive approaches (laparoscopic/robotic) are underutilized in … Objectives: The Minimally Invasive Organ Transplant Consensus Conference (MIOT.CC) aimed to develop evidence-based recommendations for advancing minimally invasive techniques in organ transplantation. Background: Minimally invasive approaches (laparoscopic/robotic) are underutilized in transplantation compared to other specialties, despite potential advantages such as reduced morbidity and faster recovery. Methods: The conference Held in Riyadh, Saudi Arabia (December 2024) included international experts in minimally invasive donation and/or transplantation of the kidney, liver, pancreas, lung, heart, and uterus. Using the Danish Model of Consensus, participants reviewed current practice and evidence to formulate recommendations. The process included systematic literature reviews according to PRISMA guidelines and assessment of evidence quality using the GRADE approach. Results: Minimally invasive approaches consistently reduced postoperative pain, complications, and hospital stay. Specific recommendations were derived for each organ, with particular attention to donor safety and to the expansion of robotic techniques, if appropriately supported by locally available technology and experience. Conclusion: MIOT.CC delineated a framework to disseminate minimally invasive techniques in both organ donation and transplantation. These recommendations can guide centers worldwide to first implement and subsequently optimize minimally invasive approaches through ongoing evaluation and adaptation based on emerging evidence and technological advancements.

Impact of a collaborative approach on family consent rate for paediatric organ donors: a population-based registry study

2025-06-19

Elena Cavazzoni , Lukas Staub , M. J. O’Leary | Intensive Care Medicine – Paediatric and Neonatal

Launching the Donation, Retrieval and Transplantation Academy

2025-06-19

Dominic Simpson , Olive McGowan , Cathy Miller +4 more | British Journal of Nursing

Contextualizing India’s Medicolegal Controversies Related to Brain Death/Death by Neurologic Criteria: Regulation, Religion, and Resource Allocation

2025-06-19

Ariane Lewis , Kapil Zirpe | Neurocritical Care

Deceased Donation Disparities in East Asia—A Tale of Two Systems

2025-06-18

Shinji Itoh , Yuki Bekki , Takeo Toshima +1 more | Hepatology Research

From Lumbotomy to Robotic surgery: Narrative review of comparative studies of Surgical techniques in living donor nephrectomy

2025-06-18

Thibaut Waeckel , Nicolas Surga , X. Tillou | International Urology and Nephrology

The role of neuroimaging in brain death diagnosis: a review of radiological protocols and the need for standardization

2025-06-18

Giulia Iacobellis , A Leggio , Cecilia Salzillo +2 more | European Journal of Radiology

Brain death, defined as the irreversible cessation of all brain functions, including the brainstem, is a critical concept in modern medicine, particularly in the context of organ transplantation. The diagnosis … Brain death, defined as the irreversible cessation of all brain functions, including the brainstem, is a critical concept in modern medicine, particularly in the context of organ transplantation. The diagnosis of brain death relies primarily on a thorough clinical neurological examination, which assesses the absence of brainstem reflexes, coma, and apnoea. This paper underscores the critical role of neuroimaging-based ancillary tests in enhancing the accuracy of brain death determination and calls for harmonization of protocols to address existing disparities and improve clinical practice worldwide. The use of ancillary tests, particularly neuroimaging techniques plays a crucial role in confirming the diagnosis, especially in cases where clinical examination is inconclusive or confounded by factors such as drug intoxication or hypothermia. These tests provide objective evidence of the absence of cerebral blood, thereby supporting the clinical determination of brain death. Despite global consensus on the importance of the clinical neurological examination in diagnosing brain death, significant variations exist between countries regarding the use of ancillary tests, the number of required clinical examinations, observation periods, and the number of physicians involved in the determination process. The discrepancies among international guidelines, highlight the need for standardized to ensure consistency and reliability in brain death diagnosis, particularly in the context of organ transplantation, where timely and accurate diagnosis is essential. This literature review examines brain death in the context of organ donation, highlighting the differences in diagnostic protocols worldwide. It emphasises the importance of clinical and neuroimaging tests for accurate diagnosis and the need to standardise international guidelines to improve clinical practice and ensure timely and reliable decisions, particularly in organ transplantation.

Epochal changes and ethical issues, reflections on kidney transplantation

2025-06-18

Jadranka Buturović‐Ponikvar , Alejandra Orozco-Guillén , Giorgina Barbara Piccoli | Journal of Nephrology

An In-depth overview of artificial intelligence (AI) tool utilization across diverse phases of organ transplantation

2025-06-18

Shiva Arjmandmazidi , Hamid Reza Heidari , Tohid Ghasemnejad +6 more | Journal of Translational Medicine

Artificial Intelligence (AI) offers a revolutionary approach to improve decision-making in medicine through the use of advanced computational tools. Its ability to analyze large and complex datasets enables a thorough … Artificial Intelligence (AI) offers a revolutionary approach to improve decision-making in medicine through the use of advanced computational tools. Its ability to analyze large and complex datasets enables a thorough evaluation of multiple factors, leading to a deeper understanding of medical procedures. Numerous studies have demonstrated that AI has made significant advancements in areas such as organ allocation, donor-recipient matching, and immunosuppression protocols in organ transplantation. The transplantation process consists of three key stages: pre-transplant evaluation, the surgical procedure, and post-transplant management. AI can enhance all three stages by analyzing and integrating data from histopathological reports, lab results, radiological features, and patient demographics to aid in matching donors and recipients. Additionally, AI supports robotic-assisted surgery and optimizes post-transplant regimens while evaluating complications. Various researches have utilized machine learning (ML) to predict medication bioavailability immediately after transplantation and assess the risk of post-transplant complications based on factors like genetic phenotypes, age, gender, and body mass index. This review aims to gather information on AI applications across various stages of organ transplantation and elaborate the strategies and tools relevant to these processes.

Once upon a time in nephrology - Episode 1: Management of thrombotic microangiopathy<

2025-06-18

Simon Ville , Pierre Delanaye , Christophe Mariat | PubMed

Introductory Chapter: Puzzle of Brain Death and Coma

2025-06-18

Amit Agrawal | IntechOpen eBooks

Optimized Surgical Outcomes in Living Donor Nephrectomy: A Single-Center Experience with 250 Cases Using a Novel Technique

2025-06-17

Anil Kmar , Aviral Sivastava , R. M. Tripathy +5 more | Urology Research and Practice

Organ donation attitudes of relatives of patients in the wards and intensive care units: Will you be a life?

2025-06-16

Gülsüm Altuntaş , Fatma Çelik , Ahmet Aksu +3 more | Türk yoğun bakım derneği dergisi/Türk yoğun bakım dergisi

Objective: Inadequate organ donation rate is still an obstacle to organ transplantation. Lack of information and negative attitudes are the most important obstacles. Having a patient in intensive care unit … Objective: Inadequate organ donation rate is still an obstacle to organ transplantation. Lack of information and negative attitudes are the most important obstacles. Having a patient in intensive care unit may change the perspective and create sensitivity. We aimed to compare the perspectives on organ donation between relatives of patients in intensive care and inpatient services. Material and Method: It is a cross-sectional descriptive survey study. Group I: relatives of patients hospitalized in the 3rd level intensive care unit, and Group II: relatives of patients at inpatient services. Written informed consents were obtained. Questions were consisted of;1-Demographic data, 2- Level of knowledge about organ donation, 3-Attitudes and behaviors regarding organ donation. Results: There was a significant difference between the groups regarding the purpose of organ donation (p=0.006). The overall rate of support for organ donation by Group I (75.9%) was significantly higher than the Group II (18.7%) (p

Should Nurses Talk to Brain‐Dead Patients?

2025-06-16

Michael Clinton | Nursing in Critical Care

ABSTRACT Speaking to the deceased is a sign of respect in Middle Eastern countries. However, talking to the brain‐dead can create false hope for families and undermine medical authority. While … ABSTRACT Speaking to the deceased is a sign of respect in Middle Eastern countries. However, talking to the brain‐dead can create false hope for families and undermine medical authority. While examining moral issues through other ethical frameworks is possible, intensive care unit nurses should prioritize relational ethics when mediating conflicts between physicians and grieving families. By fostering trust with brain‐dead patients' families, nurses can create a supportive environment that may encourage consent for organ donation.

Bioethical Issues as Triggers of Religious Transformation in Orthodox Christianity

2025-06-15

Roman Tarabrin | Bioethics

ABSTRACT The advent of new biomedical technologies has given rise to an emerging area of sociocultural discourse. The sociocultural perception of these technologies is contingent upon a number of factors, … ABSTRACT The advent of new biomedical technologies has given rise to an emerging area of sociocultural discourse. The sociocultural perception of these technologies is contingent upon a number of factors, including the prevailing attitudes within dominant religious traditions. Religious bioethics is fundamentally distinct from secular bioethics. The former is grounded in unchanging sacred scriptures and traditions, which inform its normative provisions. Consequently, a shift in the perception of technology must be accompanied by a corresponding shift in how religious institutions interpret scripture and tradition. This article employs the Russian Orthodox Church (ROC) as a case study to investigate how religious institutions can adapt to changing societal and cultural demands, and whether religious moral decrees can evolve in response to shifting sociocultural discourse. A discourse analysis of the ROC's interactions with the medical community and the general public reveals the following: To maintain influence with its followers, a religious institution should not categorically reject new advances in biomedicine. Rather, it should engage in a comprehensive bioethical analysis of the challenges posed by each emerging technology. In this process, it is valuable to define boundaries based on religious doctrine—limits that a believer must not exceed to maintain communion with the deity—while allowing for the use of new biomedical solutions.

From planar to SPECT-CT brain perfusion study in brain death determination: our experience from 2010 to 2023

2025-06-15

Mathieu Charest , Marc‐André Bélair | Annals of Nuclear Medicine

ORGAN TRANSPLANT DISPARITIES: RACIAL, GENDER AND SOCIO-ECONOMIC INEQUITIES IN ACCESS AND OUTCOMES

2025-06-14

A. K. Mishra , Anshuman Mishra | International Journal For Multidisciplinary Research

Organ transplantation is a pinnacle in medical progress in India, which provides life-saving solutions for end-stage organ failure. However, this breakthrough has been undermined by the deeply rooted social disparities … Organ transplantation is a pinnacle in medical progress in India, which provides life-saving solutions for end-stage organ failure. However, this breakthrough has been undermined by the deeply rooted social disparities shaping access and outcomes. This paper examines how socio-economic factors like caste, class, gender, geography, and the financial situation of a person continue to affect the transplant ecosystem. The institutional inefficiencies, biased allocation, and ethical concerns around organ trade and commercialisation have been highlighted in this paper through various government data and real-life case studies, and peer-reviewed journals. It emphasises that only policy reform is not the solution; systemic inequities need to be addressed too. The paper concludes that equity in transplantation is not just a medical necessity but a moral imperative for just healthcare in India.

Objeciones éticas a la «Donación gestacional de cuerpo entero»

2025-06-13

Montserrat Crespín Perales | DOXA Cuadernos de Filosofía del Derecho

Este texto presenta objeciones y responde al artículo de Anna Smajdor «Whole body gestational donation» (2023). Se demuestra la insostenibilidad de su propuesta mostrando los defectos entre la argumentación analógica … Este texto presenta objeciones y responde al artículo de Anna Smajdor «Whole body gestational donation» (2023). Se demuestra la insostenibilidad de su propuesta mostrando los defectos entre la argumentación analógica entre la donación de órganos y la donación gestacional de cuerpo entero para, luego, defender que esta propuesta gestacional no es una solución aceptable ni para solucionar los problemas de la gestación por sustitución ni para hacer frente a las altas tasas de morbilidad y mortalidad materna.

An Integrative Review on Exploring Organ Donation After Death by Circulatory Criteria in Canada

2025-06-13

Kendra-Lee Dupuis , Amina Silva , Vanessa Silva e Silva | Progress in Transplantation

Introduction: Rising discrepancies between supply and demand of lifesaving organs necessitates considering advancements to improve the health outcomes of Canadians. There is an increased use of organs after death by … Introduction: Rising discrepancies between supply and demand of lifesaving organs necessitates considering advancements to improve the health outcomes of Canadians. There is an increased use of organs after death by circulatory criteria, however the evolution of this treatment should be explored to continue to advance practices and save lives. Objective: To summarize the literature on the evolution and use of organ donation after death by circulatory criteria in Canada, to highlight how this donation modality may support future advancements. Methods: A search of electronic databases for any date until June 1st, 2024, was performed. Additional searches of grey literature using Google Scholar and the snowball technique were performed. Applicable documents underwent a multi-phase screening process, and data were extracted, analyzed, and evaluated. Results: There were 793 documents located, and 50 were included in this review. Three main categories emerged among the documents that described the evolution of guidelines for death by circulatory criteria organ donation, experiences with program development and delivery for death by circulatory criteria organ donation and Canadian perspectives of this donation modality. Discussion: Canada has made strides in circulatory criteria organ donation practices through consensus meetings and discussions on key topics, yet variations in practice exist across the country that warrant further investigation when considering future advancements. Conclusion: While national efforts have advanced practices, ongoing variations across programs highlighted the need for continued evaluation, education and harmonization to maximize the life-saving potential of organ donation practices.

Effect of intravenous mannitol on renal function in patients undergoing laparoscopic nephron-sparing surgery: a randomized, double-blinded trial

2025-06-13

Abhilash Cheriyan , Ramamani Mariappan , Lakshmanan Jeyaseelan +6 more | International Urology and Nephrology

Computed Tomography Perfusion and Angiography for Death by Neurologic Criteria

2025-06-13

Michaël Chassé , Jai Shankar , Dean Fergusson +7 more | JAMA Neurology

Importance Accurate and timely confirmation of death by neurologic criteria (DNC) is essential for clinical decision-making and organ-donation processes, yet currently available ancillary tests have suboptimal diagnostic performance or limited … Importance Accurate and timely confirmation of death by neurologic criteria (DNC) is essential for clinical decision-making and organ-donation processes, yet currently available ancillary tests have suboptimal diagnostic performance or limited validation. Objectives To determine the diagnostic accuracy, interrater reliability, and safety of brain computed tomography (CT) perfusion and CT angiography as ancillary investigations for DNC. Design, Setting, and Participants Between April 25, 2017, and March 10, 2021, a prospective, multicenter, blinded diagnostic accuracy cohort study was conducted in 15 adult intensive care units across Canada. Consecutive, critically ill adults (aged ≥18 years) with a Glasgow Coma Scale score of 3 and no confounding factors who were at high risk of DNC were included. Data collection and analysis were performed from April 2021 to July 2024. Exposure Contrast-enhanced brain CT perfusion with CT angiography reconstructions performed within 2 hours of a blinded, standardized clinical DNC examination. Main Outcomes and Measures The primary outcomes were the sensitivity and specificity of qualitative and quantitative brainstem CT perfusion for DNC determination, assessed by 2 independent neuroradiologists blinded to clinical findings; the prespecified validation threshold was greater than 98%. Secondary outcomes were the diagnostic accuracy of whole-brain CT perfusion and CT angiography, interrater reliability (Cohen κ), and adverse events associated with imaging. Results A total of 282 patients (mean [SD] age, 57.8 [15.4] years; 133 [47%] female) completed the study protocol and were included in the primary analysis; 204 (72%) of these were ultimately declared deceased by standardized clinical criteria. Qualitative brainstem CT perfusion showed a sensitivity of 98.5% (95% CI, 95.8%-99.7%) and a specificity of 74.4% (95% CI, 63.2%-83.6%); quantitative brainstem CT perfusion was not diagnostically accurate. Qualitative whole-brain CT perfusion yielded a sensitivity of 93.6% (95% CI, 89.3%-96.6%) and a specificity of 92.3% (95% CI, 84.0%-97.1%). CT angiography sensitivity ranged from 75.5% (95% CI, 69.0%-81.2%) to 87.3% (95% CI, 81.9%-91.5%), and its specificity ranged from 89.7% (95% CI, 80.8%-95.5%) to 91.0% (95% CI, 82.4%-96.3%). Interrater reliability was excellent for all ancillary tests (κ ranged from 0.81 [95% CI, 0.73-0.89] to 0.84 [95% CI, 0.78-0.91]). Fourteen patients (5%) experienced minor, self-limited adverse events; no serious adverse events occurred. Conclusions and Relevance The observed sensitivity and specificity measures for CT perfusion and CT angiography as an ancillary test for DNC did not meet the prespecified validation threshold of greater than 98%. Clinical examination remains the cornerstone of DNC, and ancillary imaging should be interpreted cautiously within a comprehensive clinical assessment.

The New Era of Organ Transplantation in Greece: Time to Converge With the Western World

2025-06-12

Demetrios Moris , Emmanouil Giorgakis | Transplant International

Bridging the Gap: The State of Global Transplant Research Collaboration

2025-06-12

Isabella Faria , Stalin Cañizares , Adriana Montalvan +4 more | Transplantation Direct

Background. The field of transplant research has long been recognized for its innovative approaches and international collaborations. This study aims to dissect the landscape of global collaborations within transplant research … Background. The field of transplant research has long been recognized for its innovative approaches and international collaborations. This study aims to dissect the landscape of global collaborations within transplant research during a past decade. Methods. Through a comprehensive bibliometric and network analysis of 5 high-impact factor transplantation journals from 2012 to 2021, we evaluated scientific production and collaboration patterns in 9 250 articles. International, national, and single-institution collaboration types were analyzed, using coauthorship as a measure of scientific collaboration. Results. The data set revealed 40 622 authors from 2 094 institutions across 94 countries, with a marked increase in international collaborations during the past decade. The United States and Western European countries emerged as central nodes in the global network, facilitating the majority of collaborative efforts. Only 2.2% of potential institutional collaborations were explored during the decade. We found a lower chance of citations for single-institution research over time. Low- and middle-income countries were underrepresented in high-impact transplant research. Conclusions. The findings underscore the necessity of fostering inclusive, equitable research collaborations that bridge the gap between high-income countries and low- and middle-income countries, limiting their contributions to advancing global patient care. Practical recommendations for enhancing global collaboration in transplant research include facilitating academic exchanges, equitable collaboration practices, and increased funding opportunities. This study calls for a strategic shift toward a more inclusive and integrated global research landscape, aiming to advance transplant research and patient care universally. Addressing these disparities could lead to a more integrated global research landscape, benefiting transplant research and patient care universally.

Avaliação da usabilidade do ambiente virtual de aprendizagem protótipo sobre doação e transplante de órgãos

2025-06-12

Úrsula Marcondes Westin , Sílvia Helena Zem-Mascarenhas , Yolanda Dóra Martinez Évora | Contribuciones a las Ciencias Sociales

Há uma necessidade de ressignificação do processo de ensino aprendizagem na sociedade tecnológica atual, permitindo novas formas de reflexões, proporcionando que os atores envolvidos sejam ativos na construção do seu … Há uma necessidade de ressignificação do processo de ensino aprendizagem na sociedade tecnológica atual, permitindo novas formas de reflexões, proporcionando que os atores envolvidos sejam ativos na construção do seu próprio conhecimento. Objetivo: avaliar a usabilidade de um ambiente virtual de aprendizagem protótipo sobre doação e transplante de órgãos. Método: trata-se de estudo descritivo, com abordagem quantitativa sobre a avaliação da usabilidade de um protótipo, baseada nas dez heurísticas de Nielsen. Participaram desta avaliação três especialistas da área de interação humano-computador que foram cadastrados, temporariamente, no ambiente virtual disponível na plataforma moodle, a fim de terem acesso e realizarem a avaliação. Resultados: a avaliação de usabilidade resultou em cinco heurísticas violadas e quinze problemas de usabilidade no decorrer das telas do protótipo do curso, divididos em diferentes graus de severidade. Conclusão: a avaliação heurística possibilitou que os problemas encontrados na interface fossem solucionados. As sugestões para melhoria foram incorporadas ao protótipo final, antes de ser disponibilizado ao usuário.

Eligible DBD Donors Proceeding via the DCD Pathway: Incidence, Cause, and Outcomes in the United Kingdom

2025-06-12

Mark Burgess , Laura Silsby , Susanna Madden +7 more | Transplantation Direct

Background. Eligible donation after brain death (DBD) donors may rarely proceed via the donation after circulatory death (DCD) pathway. The incidence, reasons for pathway divergence, and graft and recipient outcomes … Background. Eligible donation after brain death (DBD) donors may rarely proceed via the donation after circulatory death (DCD) pathway. The incidence, reasons for pathway divergence, and graft and recipient outcomes in the United Kingdom of this cohort are unknown. We aimed to establish the incidence of eligible DBD to DCD donors in the United Kingdom, the reasons for pathway divergence, organ donation and utilization rates, and the renal graft and recipient outcomes for this cohort. Methods. UK electronic and article records were reviewed for all eligible DBD donors proceeding via the DCD pathway from 2012 to 2022. Incidence and stated reasons for pathway divergence, including direct family quotations and time to mechanical asystole, were recorded. These data, in addition to organ donation and utilization rates and those pertaining to renal graft and recipient survival rates, were compared with “standard DCD” and “standard DBD” control groups. Results. One hundred twenty-three eligible DBD donors proceeded via the DCD pathway, overwhelmingly due to a familial desire to be present at mechanical asystole. Median time to asystole was comparable between the cohort and DCD control groups, but the range of times was considerably shorter in the cohort group. Donation and utilization rates were similar between all groups except for the notably lower rates in liver donation for DCD control. Graft and recipient survival rates were similar for all groups, but there was a nonsignificant reduction in delayed graft function (DGF) for the cohort versus DCD control and a significant reduction in DGF for the DBD versus DCD control groups. Conclusions. Eligible DBD donors proceeding via the DCD pathway is a rare event in the United Kingdom and overwhelmingly occurs due to a familial desire to witness asystole. This cohort proceeded to asystole more reliably within acceptable time periods for donation, have higher donation and utilization rates for liver grafts, and may show reduced rates of DGF for renal grafts versus “standard DCD” groups.

Exploring Italians' knowledge of, and perceptions and feelings about stem cell donation: a GITMO-IBMDR nationwide survey.

2025-06-11

Stefano Botti , Roberto Lupo , Simona Pollichieni +7 more | PubMed

The current stem cell donor shortage is likely partially due to many individuals' lack of knowledge, beliefs and feelings about the donation process. The aim of this study was to … The current stem cell donor shortage is likely partially due to many individuals' lack of knowledge, beliefs and feelings about the donation process. The aim of this study was to explore these factors to provide the Italian Bone Marrow Donor Registry with information to guide and optimize their awareness campaigns. A nationwide anonymous online survey was developed on behalf of the Gruppo Italiano Trapianto di Midollo Osseo and shared on various online platforms. The data were analysed for frequencies and central tendency values, and geographic areas (Northern, Central and Southern Italy), sex and median age were compared. The average age of the 1,518 recruited participants was 37.6 (±13.3) years, and 1,142 (75.2%) were females. Half of the sample (No.=759) was from Southern Italy, 213 (14%) from Central Italy and 546 (36.0%) from Northern Italy. Of the sample, 87.9% knew about The Italian Bone Marrow Donor Registry, and 72.4% were aware that donor centres recruit donors. Respondents from the north, females and older individuals knew significantly more about the stem cell donation process; on a 4-point Likert scale, 55.7% of the sample reported the strongest sense of solidarity, 36.8% felt the most gratification and 39.4% the most satisfaction. Respondents from Southern Italy systematically had significantly higher levels of negative feelings. Our findings identified a specific group of potential donors who systematically correlated with lower awareness about stem cell donation; educational campaigns should target this group.

Charles Bernard (Bernie) Carpenter, a giant of a mentor

2025-06-11

Mohamed H. Sayegh | Frontiers in Transplantation

At the Crossroads of Culture and Medicine: Navigating Brain Death and Organ Donation Ethics in Contemporary India

2025-06-11

Shibu Sasidharan , Shalendra Singh , Harpreet Dhillon +3 more | Developing World Bioethics

ABSTRACT The concept of brain death as death remains contentious in many societies, particularly in India, where cultural, religious, and social factors significantly influence end‐of‐life decisions. This article examines the … ABSTRACT The concept of brain death as death remains contentious in many societies, particularly in India, where cultural, religious, and social factors significantly influence end‐of‐life decisions. This article examines the ethical complexities surrounding brain death determination and organ donation in the Indian context, focusing on three critical areas: diagnostic dilemmas in brain death declaration, conflicts between familial beliefs and medical protocols, and emerging ethical concerns in donation after circulatory death (DCD). Despite legislative frameworks like the Transplantation of Human Organs Act (THOA), significant challenges persist in reconciling traditional Indian perspectives on death with contemporary biomedical definitions. The paper analyzes how cultural perceptions of bodily integrity, religious beliefs about the soul's departure, and family‐centered decision‐making create unique ethical tensions in the Indian organ donation landscape. We argue that an ethically sound approach to organ donation in India requires culturally sensitive protocols, improved communication frameworks, enhanced medical education, and public awareness initiatives that respect pluralistic perspectives while advancing life‐saving transplantation practices.