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Lim WH, Dominguez-Gil B. Ethical Issues Related to Donation and Transplantation of Donation After Circulatory Determination of Death Donors. Semin Nephrol 2022; 42:151269. [PMID: 36577644 DOI: 10.1016/j.semnephrol.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With the continuing disparity between organ supply to match the increasing demand for kidney transplants in patients with renal failure, donation after the circulatory determination of death (DCDD) has become an important and increasing global source of kidneys for clinical use. The concern that the outcomes of controlled DCDD donor kidney transplants were inferior to those obtained from donors declared dead by neurologic criteria has largely diminished because large-scale registry and single-center reports consistently have reported favorable outcomes. For uncontrolled DCDD kidney transplants, outcomes are correspondingly acceptable, although there is a greater risk of primary nonfunction. The potential of DCDD remains unrealized in many countries because of the ethical concerns and resource implications in the utilization of these donor kidneys for transplantation. In this review, we discuss the origin and definitions of DCDD donors, and examine the long-term outcomes of transplants from DCDD donor kidneys. We discuss the controversies, challenges, and ethical and legal barriers in the acceptance of DCDD, including the complexities of implementing and sustaining controlled and uncontrolled DCDD donor programs. The lessons learned from global leaders will assist a wider international recognition, acceptance, and development of DCDD transplant programs that will noticeably facilitate and address the global shortages of kidneys for transplantation, and ensure the opportunity for people who had indicated their desires to become organ donors fulfill their final wishes.
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Affiliation(s)
- Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Internal Medicine, University of Western Australia Medical School, Perth, Australia.
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Organs and organisations: Situating ethics in organ donation after circulatory death in the UK. Soc Sci Med 2018; 209:104-110. [PMID: 29852397 DOI: 10.1016/j.socscimed.2018.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 12/29/2022]
Abstract
Controlled organ donation after circulatory death (DCD) has recently been revived in the UK, as part of attempts to increase organ donation rates. The re-introduction of DCD has subsequently become the focus of bioethical controversy, since it necessitates intervening in the care of dying patients to obtain quality donor organs. Transplant policy responses to these concerns have generated new legal and ethical guidelines to address uncertainties around DCD, producing claims that the UK has overcome' the ethical challenge of DCD. In contrast, by drawing on Lynch's call to 'respecify' ethics, this paper argues that ethics in DCD cannot be reduced to abstract directives for practice, but, instead, are composed and dealt with as an organisational problem. To do this, I utilise data from an ethnographic study examining the production of the 'minority ethnic organ donor' within UK organ donation settings; in particular, the data pertains to a case hospital which was in the process of developing a DCD programme during the period of fieldwork. Findings show that the ethics of DCD are encountered as practical sets of problems, constructed in relation to particular institutional locales. I describe how these issues are worked-around by creating conditions to make DCD organisationally possible, and through the animation of standard procedures into acceptable forms of practice. I argue that ethics in DCD go far beyond normative bioethical principles, to encompass concerns around: the reputation of hospital Trusts, public perceptions of organ donation, the welfare of potential donor families, and challenges to the work of health professionals caring for dying patients. The paper enriches understanding of ethics in science and medicine by showing how ethics are assembled and negotiated as a practical-organisational concern, and calls for further examination of how DCD gets constructed as a potential problem and is made to happen in practice.
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Shaw D, Gardiner D, Lewis P, Jansen N, Wind T, Samuel U, Georgieva D, Ploeg R, Broderick A. Conscientious objection to deceased organ donation by healthcare professionals. J Intensive Care Soc 2017; 19:43-47. [PMID: 29456600 DOI: 10.1177/1751143717731230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In this article, we analyse the potential benefits and disadvantages of permitting healthcare professionals to invoke conscientious objection to deceased organ donation. There is some evidence that permitting doctors and nurses to register objections can ultimately lead to attitudinal change and acceptance of organ donation. However, while there may be grounds for conscientious objection in other cases such as abortion and euthanasia, the life-saving nature of donation and transplantation renders objection in this context more difficult to justify. In general, dialogue between healthcare professionals is a more appropriate solution, and any objections must be justified with a strong rationale in hospitals where such policies are put in place.
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Affiliation(s)
- David Shaw
- 1Institute for Biomedical Ethics, University of Basel, Switzerland.,Department of Health, Ethics and Society, CAPHRI Research Institute, Maastricht University, the Netherlands
| | - Dale Gardiner
- Nottingham University Hospitals Trust, Nottingham, UK
| | - Penney Lewis
- Dickson Poon School of Law, Kings College London, UK
| | - Nichon Jansen
- Dutch Transplant Foundation, Leiden, the Netherlands
| | - Tineke Wind
- Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht University, the Netherlands
| | - Undine Samuel
- Eurotransplant International Foundation, Leiden, the Netherlands
| | | | - Rutger Ploeg
- Nuffield Department of Surgical Sciences and Oxford Biomedical Research Centre, University of Oxford, UK
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Cooper J. Problematising the ethics of organ donation after circulatory death in the UK. CRITICAL PUBLIC HEALTH 2016. [DOI: 10.1080/09581596.2016.1225948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jessie Cooper
- Department of Public Health and Policy, The University of Liverpool, Liverpool, UK
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Simon JR, Schears RM, Padela AI. Donation after cardiac death and the emergency department: ethical issues. Acad Emerg Med 2014; 21:79-86. [PMID: 24552527 DOI: 10.1111/acem.12284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/04/2013] [Accepted: 07/17/2013] [Indexed: 11/29/2022]
Abstract
Organ donation after cardiac death (DCD) is increasingly considered as an option to address the shortage of organs available for transplantation, both in the United States and worldwide. The procedures for DCD differ from procedures for donation after brain death and are likely less familiar to emergency physicians (EPs), even as this process is increasingly involving emergency departments (EDs). This article explores the ED operational and ethical issues surrounding this procedure.
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Affiliation(s)
- Jeremy R. Simon
- The Department of Medicine and Center for Bioethics; Columbia University; New York NY
| | - Raquel M. Schears
- The Department of Emergency Medicine; Mayo Clinic College of Medicine; Rochester MN
| | - Aasim I. Padela
- The Department of Medicine, Initiative on Islam and Medicine; Program on Medicine and Religion and Maclean Center for Clinical Medical Ethics; The University of Chicago; Chicago IL
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Fenner H, Buss C, Gardiner D. Intensive Care Staff Attitudes to Deceased Organ Donation. J Intensive Care Soc 2014. [DOI: 10.1177/175114371401500111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intensive care staff may harbour mixed emotions toward organ donation after circulatory death. We wished to compare these attitudes to donation after brainstem death, as well as explore attitudes toward Specialist Nurses in Organ Donation, who have been embedded into UK intensive care units since 2008. At the Mid-Trent Critical Care Network (MTCCN) annual conference, participants were asked, in small group workshops, to write down words they associated with donation after brainstem death, controlled donation after circulatory death and Specialist Nurses in Organ Donation. The words were later collated and assigned to have either a positive or negative association by three blinded individuals: a medical lawyer, a hospital communications manager and a final year medical student. One hundred and eight intensive care staff participated: 24 (22%) doctors, 61 (57%) nurses and 23 (21%) allied health professionals; 75 (69%) of the participants were female. Participants at the workshop offered a total of 211 words, 93 associated with donation after brainstem death (44%) and 118 (56%) associated with controlled donation after circulatory death. The numbers of positive and negative words associated with the two forms of donation were significantly different (p<0.001) (donation after brainstem death - 68 positive words, 25 negative words; donation after circulatory death - 29 positive words, 89 negative words). This difference remained significant (p<0.001) even after all words (n=48) that did not have unanimous agreement between the three blinded word assigners were excluded. Significantly more positive words (95) were attributed to the Specialist Nurse in Organ Donation than negative words (18) (p<0.001). We conclude that this group of intensive care staff were generally positive toward donation after brainstem death and the embedded Specialist Nurse in Organ Donation, but could harbour negative attitudes toward controlled donation after circulatory death. Only by continuing to address the opinions of healthcare professionals will donation after circulatory death become a usual and not an unusual event.
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Affiliation(s)
- Helen Fenner
- Specialist Registrar in Anaesthesia, Nottingham University Hospitals NHS Trust
| | - Charmaine Buss
- Specialist Nurse in Organ Donation, Midlands Organ Donation Services Team
| | - Dale Gardiner
- Adult Intensive Care Consultant Nottingham University Hospitals NHS Trust, Deputy National Clinical Lead for Organ Donation, NHS Blood and Transplant
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Fieux F, Jacob L. Donneurs décédés après arrêt cardiaque: mise au point. MEDECINE INTENSIVE REANIMATION 2013. [DOI: 10.1007/s13546-012-0624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Whose Consent Matters? Controlled Donation After Cardiac Death and Premortem Organ-Preserving Measures. Transplantation 2012; 93:965-9. [PMID: 22576161 DOI: 10.1097/tp.0b013e31824836fa] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gardiner D. Reply from the authors. Br J Anaesth 2012. [DOI: 10.1093/bja/aes109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Manara AR, Murphy PG, O'Callaghan G. Donation after circulatory death. Br J Anaesth 2012; 108 Suppl 1:i108-21. [PMID: 22194426 DOI: 10.1093/bja/aer357] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Donation after circulatory death (DCD) describes the retrieval of organs for the purposes of transplantation that follows death confirmed using circulatory criteria. The persisting shortfall in the availability of organs for transplantation has prompted many countries to re-introduce DCD schemes not only for kidney retrieval but increasingly for other organs with a lower tolerance for warm ischaemia such as the liver, pancreas, and lungs. DCD contrasts in many important respects to the current standard model for deceased donation, namely donation after brain death. The challenge in the practice of DCD includes how to identify patients as suitable potential DCD donors, how to support and maintain the trust of bereaved families, and how to manage the consequences of warm ischaemia in a fashion that is professionally, ethically, and legally acceptable. Many of the concerns about the practice of both controlled and uncontrolled DCD are being addressed by increasing professional consensus on the ethical and legal justification for many of the interventions necessary to facilitate DCD. In some countries, DCD after the withdrawal of active treatment accounts for a substantial proportion of deceased organ donors overall. Where this occurs, there is an increased acceptance that organ and tissue donation should be considered a routine part of end-of-life care in both intensive care unit and emergency department.
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Affiliation(s)
- A R Manara
- The Intensive Care Unit, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK.
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Gardiner D, Shemie S, Manara A, Opdam H. International perspective on the diagnosis of death. Br J Anaesth 2012; 108 Suppl 1:i14-28. [DOI: 10.1093/bja/aer397] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Abstract
Rates of deceased organ donation in the UK fall well short of those reported from other parts of the world, and result in unnecessary deaths and avoidable morbidity. A particular feature of the UK problem is that its total potential for donation is lower than the actual number of donors reported in the highest-donating countries. This implies that while the identification, referral and conversion of recognized potential deceased donors is an important component of any strategic effort to increase donation, more fundamental is an understanding of why some countries have a greater potential for donation, particularly donation after brain death. While it is possible that these differences reflect a difference in the incidence catastrophic brain injury or the outcomes from it, it is also possible that it reflects different approaches to the care that such patients receive when they are dying.
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Affiliation(s)
- Paul G Murphy
- National Clinical Lead for Organ Donation, NHS Blood and Transplant, and Consultant in Neuroanaesthesia and Critical Care, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK
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Bell D. Emergency medicine and organ donation--a core responsibility at a time of need or threat to professional integrity. Resuscitation 2010; 81:1061-2. [PMID: 20650558 DOI: 10.1016/j.resuscitation.2010.06.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Eynon CA, Murphy PG, Smith M, Danbury C, Manara AR. Heart transplantation after declaration of death by cardiorespiratory criteria. J Heart Lung Transplant 2010; 29:232-3; author reply 233-4. [DOI: 10.1016/j.healun.2009.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 09/13/2009] [Indexed: 11/28/2022] Open
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Bell MDD. Ethical Dilemmas Within Intensive Care. Neurocrit Care 2010. [DOI: 10.1007/978-1-84882-070-8_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Death and Donation in Critical Care: Management of Deceased Organ Donation. Neurocrit Care 2010. [DOI: 10.1007/978-1-84882-070-8_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fieux F, Losser MR, Bourgeois E, Bonnet F, Marie O, Gaudez F, Abboud I, Donay JL, Roussin F, Mourey F, Adnet F, Jacob L. Kidney retrieval after sudden out of hospital refractory cardiac arrest: a cohort of uncontrolled non heart beating donors. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R141. [PMID: 19715564 PMCID: PMC2750199 DOI: 10.1186/cc8022] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Revised: 07/01/2009] [Accepted: 08/28/2009] [Indexed: 12/02/2022]
Abstract
Introduction To counter the shortage of kidney grafts in France, a non heart beating donor (NHBD) program has recently been implemented. The aim of this study was to describe this pilot program for kidney retrieval from "uncontrolled" NHBD meaning those for whom attempts of resuscitation after a witnessed out-of-hospital cardiac arrest (CA) have failed (Maastricht 1 and 2), in a centre previously trained for retrieval from brain dead donors. Methods A prospective, monocentric, descriptive study concerning NHBD referred to our institution from February 2007 to June 2008. The protocol includes medical transport of refractory CA under mechanical ventilation and external cardiac massage, kidney protection by insertion of an intraaortic double-balloon catheter (DBC) with perfusion of a hypothermic solution, kidney retrieval and kidney preservation in a hypothermic pulsatile perfusion machine. Results 122 potential NHBD were referred to our institution after a mean resuscitation attempt of 35 minutes (20–95). Regarding the contraindications, 63 were finally accepted and 56 had the DBC inserted. Organ retrieval was performed in 27 patients (43%) and 31 kidneys out of the 54 procured (57%) have been transplanted. Kidney transplantation exclusion was related to family refusal (n = 15), past medical history, time constraints, viral serology, high vascular ex vivo resistance of the graft and macroscopic abnormalities. The 31 kidneys exhibited an expected high delayed graft function rate (92%). Despite these initial results transplanted kidney had good creatinine clearance at six months (66 ± 24 ml/min) with a 89% graft survival rate at six months. Conclusions This study shows the feasibility and efficacy of an organ procurement program targeting NHBD allowing a 10% increase in the kidney transplantation rate over 17 months. With a six months follow-up period, the results of transplanted kidney function were excellent.
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Affiliation(s)
- Fabienne Fieux
- Department of Anesthesia and Critical Care, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris-7 Diderot, 1 Avenue Claude Vellefaux, 75010 Paris, France.
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Sharp TA. The Impact of Trust Study Days on Organ and Tissue Donation among Critical Care Staff. J Intensive Care Soc 2009. [DOI: 10.1177/175114370901000308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The UK has one of the lowest rates of organ donation in Western Europe. Several barriers to the donation process have been identified. Among these are lack of knowledge, failure of staff to identify potential donors and feeling that it is someone else's responsibility to request for donation. Evidence suggests that educational programmes covering issues regarding organ and tissue donation enhance knowledge and confidence in the organ donation process and ultimately increase the number of potential donors. In 2002, Bolton NHS trust made changes aiming to increase donor rates. Trust study days were introduced, aiming to educate staff about aspects of donation. Since then, Bolton has had a significant increase in donor rates. The purposes of this audit were to assess present levels of knowledge and attitudes about organ and tissue donation and to see whether the introduction of trust study days has made a positive impact amongst critical care staff. The findings of this audit are encouraging, showing a positive impact on both staff knowledge and attitudes towards donation and reflecting a change in culture within the trust.
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Dalley K. Improving organ donation rates - what can be done? Nurs Crit Care 2008; 13:221-2. [PMID: 18816306 DOI: 10.1111/j.1478-5153.2008.00296.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
To shorten the transplantation waiting time in the United States, federal regulations have been introduced requiring hospitals to develop policies for organ donation after cardiac (or circulatory) death (DCD). The practice of DCD is invoked based on the validity of the University of Pittsburgh Medical Center (UPMC) protocol and relies on the accuracy of the University of Wisconsin (UW) evaluation tool to appropriately identify organ donors. There is little evidence to support the position that the criteria for organ procurement adopted from the UPMC protocol complies with the dead donor rule. A high false-positive rate of the UW evaluation tool can expose many dying patients to unnecessary perimortem interventions because of donation failure. The medications and/or interventions for the sole purpose of maintaining organ viability can have unintended negative consequences on the timing and quality of end-of-life care offered to organ donors. It is essential to address and manage the evolving conflict between optimal end-of-life care and the necessary sacrifices for the procurement of transplantable organs from the terminally ill. The recipients of marginal organs recovered from DCD can also suffer higher mortality and morbidity than recipients of other types of donated organs. Finally, transparent disclosure to the public of the risks involved to both organ donors and recipients may contribute to open societal debate on the ethical acceptability of DCD.
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Smith M, Murphy P. A historic opportunity to improve organ donation rates in the UK. Br J Anaesth 2008; 100:735-7. [PMID: 18483109 DOI: 10.1093/bja/aen124] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Many potential donor organs are currently lost because of misunderstanding of the law. John Coggon and colleagues clarify what is permissible in non-heart-beating donation
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Affiliation(s)
- John Coggon
- Centre for Social Ethics and Policy and Institute for Science, Ethics and Innovation, School of Law, University of Manchester, Manchester M13 9PL.
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Murphy P, Manara A, Bell D, Smith M. Controlled non-heart beating organ donation: neither the whole solution nor a step too far. Anaesthesia 2008; 63:526-30. [DOI: 10.1111/j.1365-2044.2007.05397.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thomas I, Caborn S, Manara AR. Experiences in the development of non-heart beating organ donation scheme in a regional neurosciences intensive care unit. Br J Anaesth 2008; 100:820-6. [PMID: 18456642 DOI: 10.1093/bja/aen106] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In the UK demand for organ transplantation continues to outstrip supply and one strategy aimed at reversing this trend is the introduction of non-heart beating donor (NHBD) schemes. In this paper we describe our experience after the introduction of the NHBD scheme at a regional neuroscience intensive care unit (ICU) that also provides general intensive care. METHODS We describe the steps taken to establish the scheme and present our results from the time of its implementation in July 2002 until March 2007. RESULTS Of the 100 patients whom we referred to the transplant co-ordinators, 71 were identified as potential NHBDs and of these 29 went on to become actual donors (conversion rate of 40.8%). Fifty-six kidneys were retrieved and 53 successfully transplanted. In addition, two livers were retrieved but subsequently found to be unsuitable for transplantation, while eight pancreas were retrieved and used for islet cell research. The serum creatinine at 1 yr demonstrates that there is no significant difference between transplanted kidney function from NHBDs and heart-beating donors (HBDs). CONCLUSIONS We believe that by establishing the NHBD organ donation scheme we are able to fulfil the wishes of more patients who have indicated that they would like to donate their organs while increasing the availability of solid organs for transplantation. With careful preparation, audit, and communication our experience demonstrates that the NHBD scheme can be successfully introduced in an ICU and expanded to other ICUs in a region.
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Affiliation(s)
- I Thomas
- The Intensive Care Unit, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK
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Abstract
Organ donation rates in the UK are amongst the lowest in Europe and there is a widening gap between the supply of cadaveric organ donors and the demand for solid organ transplants. The Report from the Organ Donation Taskforce has recently been published and its 14 recommendations represent a structured and systematic approach to organ donation in the UK. The proposed changes will ensure that organ donation is considered every time a potential organ donor dies, that the wishes of the potential organ donor or their family are ascertained and respected, and that every opportunity is taken to maximise the number of organs that can be transplanted successfully. Clarification of legal and ethical issues will allow clinicians to embrace these changes with confidence. Taken together, the recommendations will deliver the organ donation service that is so urgently needed in the UK.
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Affiliation(s)
- Martin Smith
- Consultant in Neuroanaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery; Honorary Reader in Anaesthesia and Intensive Care, University College, London
| | - Paul Murphy
- Consultant in Neuroanaesthesia and Intensive Care, Leeds Teaching Hospitals NHS Trust
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Bodenham A, Gratrix A, Pittard A. A reply. Anaesthesia 2007. [DOI: 10.1111/j.1365-2044.2007.05330_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- Paul G Murphy
- Neurosciences Critical Care Unit, The General Infirmary at Leeds, Leeds
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