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Gambardella I, Nappi F, Worku B, Tranbaugh RF, Ibrahim AM, Balaram SK, Bernat JL. Taking the pulse of brain death: A meta-analysis of the natural history of brain death with somatic support. Eur J Neurol 2024; 31:e16243. [PMID: 38375732 DOI: 10.1111/ene.16243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/02/2023] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE The conceptualization of brain death (BD) was pivotal in the shaping of judicial and medical practices. Nonetheless, media reports of alleged recovery from BD reinforced the criticism that this construct is a self-fulfilling prophecy (by treatment withdrawal or organ donation). We meta-analyzed the natural history of BD when somatic support (SS) is maintained. METHODS Publications on BD were eligible if the following were reported: aggregated data on its natural history with SS; and patient-level data that allowed censoring at the time of treatment withdrawal or organ donation. Endpoints were as follows: rate of somatic expiration after BD with SS; BD misdiagnosis, including "functionally brain-dead" patients (FBD; i.e. after the pronouncement of brain-death, ≥1 findings were incongruent with guidelines for its diagnosis, albeit the lethal prognosis was not altered); and length and predictors of somatic survival. RESULTS Forty-seven articles were selected (1610 patients, years: 1969-2021). In BD patients with SS, median age was 32.9 years (range = newborn-85 years). Somatic expiration followed BD in 99.9% (95% confidence interval = 89.8-100). Mean somatic survival was 8.0 days (range = 1.6 h-19.5 years). Only age at BD diagnosis was an independent predictor of somatic survival length (coefficient = -11.8, SE = 4, p < 0.01). Nine BD misdiagnoses were detected; eight were FBD, and one newborn fully recovered. No patient ever recovered from chronic BD (≥1 week somatic survival). CONCLUSIONS BD diagnosis is reliable. Diagnostic criteria should be fine-tuned to avoid the small incidence of misdiagnosis, which nonetheless does not alter the prognosis of FBD patients. Age at BD diagnosis is inversely proportional to somatic survival.
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Affiliation(s)
| | - Francesco Nappi
- Cardiac Surgery Center, Cardiologique du Nord de Saint-Denis, Paris, France
| | - Berhane Worku
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Robert F Tranbaugh
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Aminat M Ibrahim
- Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Sandhya K Balaram
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - James L Bernat
- Department of Neurology, Dartmouth Geisel School of Medicine, Hanover, New York, USA
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Deana C, Biasucci DG, Aspide R, Brasil S, Vergano M, Leonardis F, Rica E, Cammarota G, Dauri M, Vetrugno G, Longhini F, Maggiore SM, Rasulo F, Vetrugno L. Transcranial Doppler and Color-Coded Doppler Use for Brain Death Determination in Adult Patients: A Pictorial Essay. J Ultrasound Med 2024; 43:979-992. [PMID: 38279568 DOI: 10.1002/jum.16421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 01/28/2024]
Abstract
Transcranial Doppler (TCD) is a repeatable, at-the-bedside, helpful tool for confirming cerebral circulatory arrest (CCA). Despite its variable accuracy, TCD is increasingly used during brain death determination, and it is considered among the optional ancillary tests in several countries. Among its limitations, the need for skilled operators with appropriate knowledge of typical CCA patterns and the lack of adequate acoustic bone windows for intracranial arteries assessment are critical. The purpose of this review is to describe how to evaluate cerebral circulatory arrest in the intensive care unit with TCD and transcranial duplex color-coded doppler (TCCD).
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Affiliation(s)
- Cristian Deana
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Daniele G Biasucci
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
- Emergency Department, "Tor Vergata" University Hospital, Rome, Italy
- Catholic University of the Sacred Heart (UCSC), Rome, Italy
| | - Raffaele Aspide
- Anesthesia and Neurointensive Care Unit, Istituto delle Scienze Neurologiche IRCCS, Bologna, Italy
| | - Sergio Brasil
- Neurosurgical Division, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Marco Vergano
- Department of Anesthesia and Intensive Care, San Giovanni Bosco Hospital, Torino, Italy
| | - Francesca Leonardis
- Emergency Department, "Tor Vergata" University Hospital, Rome, Italy
- Department of Surgical Science, "Tor Vergata" University, Rome, Italy
| | - Ermal Rica
- Department of Anesthesia and Intensive Care, Health Integrated Agency of Friuli Centrale, Udine, Italy
| | - Gianmaria Cammarota
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria "Maggiore della Carità", Novara, Italy
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy
| | - Mario Dauri
- Department of Clinical Science and Translational Medicine, "Tor Vergata" University, Rome, Italy
- Emergency Department, "Tor Vergata" University Hospital, Rome, Italy
| | - Giuseppe Vetrugno
- Catholic University of the Sacred Heart (UCSC), Rome, Italy
- Risk Management, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Federico Longhini
- Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy
| | - Salvatore Maurizio Maggiore
- Department of Innovative Technologies in Medicine & Dentistry, Section of Anesthesia and Intensive Care, "G. D'Annunzio" University, "SS. Annunziata" Hospital, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, "SS. Annunziata" Hospital, Chieti, Italy
| | - Frank Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Vetrugno
- Department of Anesthesiology, Critical Care Medicine and Emergency, "SS. Annunziata" Hospital, Chieti, Italy
- Department of Medical, Oral and Biotechnological Science, "G. d'Annunzio" Chieti-Pescara University, Chieti, Italy
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Salim A, Cotton BA. Victory out of tragedy: organ donation. Trauma Surg Acute Care Open 2024; 9:e001408. [PMID: 38646028 PMCID: PMC11029243 DOI: 10.1136/tsaco-2024-001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Major improvements in trauma care during the last decade have improved survival rates in the severely injured. The unintended consequence is the presentation of patients with non-survivable injuries in a time frame in which intervention is considered and often employed due to prognostic uncertainty. In light of this, discerning survivability in these patients remains increasingly problematic. Evidence-based cut-points of futility can guide early decisions for discontinuing aggressive treatment and use of precious resources in severely injured patients arriving in extremis.
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Affiliation(s)
- Ali Salim
- Trauma, Burn, Surgical Critical Care and Emergency General Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Bryan A Cotton
- Surgery, University of Texas John P and Katherine G McGovern Medical School, Houston, Texas, USA
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Sarna MK, Shah S, Rijhwani P, Goyal G, Jain AK, Goel P. Guillain Barre syndrome mimicking brain death. J R Coll Physicians Edinb 2024:14782715241244839. [PMID: 38576167 DOI: 10.1177/14782715241244839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
A 49-year-old female patient presented at the hospital with a history of herpetic blisters, frequent episodes of vomiting and loose stools, bilateral upper and lower limb weakness, and diminishing sensorium. She was diagnosed with hyponatraemia and respiratory failure and later became unconscious with absent brainstem reflexes. The patient was initially treated for herpetic encephalitis, a chronic obstructive pulmonary disease with acute exacerbation, hyponatraemia and neuroparalytic snake bite. Further evaluation, however, identified the uncommon Guillain Barre syndrome presentation with overlap of Bickerstaff brainstem encephalitis. This is an uncommon disorder characterised by the involvement of higher mental functions, fixed dilated pupils, absent brainstem reflexes and quadriplegia that resembles a neuroparalytic snake bite and brain death. After receiving intravenous immunoglobulins for treatment, the patient completely recovered.
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Affiliation(s)
- Mukesh Kumar Sarna
- Department of General Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Sarthak Shah
- Department of General Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Puneet Rijhwani
- Department of General Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Gourav Goyal
- Department of Neurology, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Anand Kumar Jain
- Department of Organ Transplant Anaesthesia and Critical Care Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
| | - Pallaavi Goel
- Department of General Medicine, Mahatma Gandhi University of Medical Science & Technology, Jaipur, RJ, India
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Cooper DKC, Kobayashi T. Xenotransplantation experiments in brain-dead human subjects-A critical appraisal. Am J Transplant 2024; 24:520-525. [PMID: 38158188 DOI: 10.1016/j.ajt.2023.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
Brain-dead human subjects (decedents) were recently introduced as a potential preclinical experimental model in xenotransplantation. Brain death is associated with major pathophysiological changes, eg, structural injury and cell infiltration in vital organs, and major hormonal, metabolic, inflammatory, and hemodynamic changes. In 2 of the 3 initial experiments, the design of the experiments resulted in little or no new information becoming available. In the third, the experiment was unfortunately unsuccessful as neither of the 2 pig kidneys transplanted into the decedent functioned adequately. Failure may well have been associated with the effects of brain death, but an immune/inflammatory response to the xenograft could not be excluded. Subsequently, 2 further pig kidney transplants and 2 pig heart transplants have been carried out in human decedents, but again the data obtained do not add much to what is already known. In view of the profound changes that take place during and after brain death, it may prove difficult to determine whether graft failure or dysfunction results from the effects of brain death or from an immune/inflammatory response to the xenograft. A major concern is that, if the results are confusing, they may impact decisions relating to the introduction of clinical xenotransplantation.
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Affiliation(s)
- David K C Cooper
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA.
| | - Takaaki Kobayashi
- Department of Renal Transplant Surgery, Aichi University School of Medicine, Nagakute, Japan
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Fan L, Li W, Du R, Hu Y, Li W, Zhu W, Zhang L, Su Y. Apnea Testing Practice to Increase Baseline PaCO 2 and Frequency of Blood Gas Analyses. J Cardiothorac Vasc Anesth 2024; 38:1006-1010. [PMID: 38246819 DOI: 10.1053/j.jvca.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To study the influence of the initial partial pressure of carbon dioxide (PaCO2) and frequency of blood gas analyses on the positivity rate and safety of apnea testing (AT). DESIGN A prospective multicenter cohort study. SETTING Seven teaching hospitals. PARTICIPANTS A total of 55 patients who underwent AT. INTERVENTIONS Patients were divided into 2 groups according to their initial PaCO2-the experimental group (≥40 mmHg, 27 patients) and the control group (<40 mmHg, 28 patients). Blood gas analysis was performed at 3, 5, and 8 minutes, and vital signs were taken. AT results and complications were compared between the groups. RESULTS The initial PaCO2 of the experimental group was 42.8 ± 2.2 mmHg v 36.4 ± 2.9 mmHg in the controls. The AT positivity rate was 100%. The experimental group needed less time to reach the target PaCO2 than the control group (4.07 ± 1.27 minutes v 5.68 ± 2.06 minutes; p = 0.001). Twenty-six patients (96.3%) in the experimental group reached the target PaCO2 in 5 minutes v 17 in the control group (60.7%) (p = 0.001). Seven patients (12.7%) were unable to complete 8-minute disconnection due to hypotension. The experimental group had a slightly lower incidence of hypotension than the control group, but there was no statistical difference (7.4% v 17.9%, p = 0.245). CONCLUSION Increasing the baseline PaCO2 and doing more blood gas analyses can significantly shorten the time needed for AT and improve the AT positivity rate.
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Affiliation(s)
- Linlin Fan
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Wei Li
- Department of Neurology, Army Medical Center of PLA, Chongqing, China
| | - Ran Du
- Neurological Intensive Care Unit, First Affiliated Hospital of Anhui Medical University, Zhengzhou, China
| | - Yajuan Hu
- Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wenchen Li
- First Hospital of Jilin University, Changchun, China
| | - Wenhao Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Zhang
- First People's Hospital of Yunnan Province, Kunming, Yunnan Province, China
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing, China.
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Hoffmann O, Salih F, Masuhr F. Computed tomography angiography in the diagnosis of brain death: Implementation and results in Germany. Eur J Neurol 2024; 31:e16209. [PMID: 38217344 DOI: 10.1111/ene.16209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/06/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Computed tomography angiography (CTA) has been investigated as a confirmatory study (CS) for the diagnosis of brain death (BD). International consensus regarding its use, study parameters, and evaluation criteria is lacking. In the German BD guideline, a CTA protocol was first introduced in 2015. METHODS The authors obtained a comprehensive dataset of all BD examinations in adults from the German organ procurement organization to investigate implementation, results, and impact of CTA on BD determination during the first 4 years. RESULTS In 5152 patients with clinically absent brain function, 1272 CTA were reported by 676 hospitals. Use of CTA increased from 17.2% of patients in the first year to 29.7% in the final year. CTA replaced other CS such as electroencephalography without increasing overall CS frequency. Technical failure was rare (0.9%); 89.3% of studies were positive. Negative results (9.8%) were more frequent with secondary brain injury, longer duration of the clinical BD syndrome, or unreliable clinical assessment. Median time to diagnosis was longer with CTA (2.6 h) versus other CS (1.6 h). CTA had no differential impact on the rate of confirmed BD and did not improve access of small hospitals to CS for BD determination. CONCLUSIONS CTA expands the range of available CS for the diagnosis of BD in adults. Real-world evidence from a large cohort confirms usability of the German CTA protocol within the guideline-specified context.
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Affiliation(s)
- Olaf Hoffmann
- Department of Neurology, Alexianer St. Josefs Hospital, Potsdam, Germany
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Farid Salih
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Florian Masuhr
- Klinik für Neurologie, Bundeswehrkrankenhaus Berlin, Berlin, Germany
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8
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Sulmasy DP, DeCock CA, Tornatore CS, Roberts AH, Giordano J, Donovan GK. A Biophilosophical Approach to the Determination of Brain Death. Chest 2024; 165:959-966. [PMID: 38599752 DOI: 10.1016/j.chest.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/30/2023] [Accepted: 12/09/2023] [Indexed: 04/12/2024] Open
Abstract
Technical and clinical developments have raised challenging questions about the concept and practice of brain death, culminating in recent calls for revision of the Uniform Determination of Death Act (UDDA), which established a whole brain standard for neurologic death. Proposed changes range from abandoning the concept of brain death altogether to suggesting that current clinical practice simply should be codified as the legal standard for determining death by neurologic criteria (even while acknowledging that significant functions of the whole brain might persist). We propose a middle ground, clarifying why whole brain death is a conceptually sound standard for declaring death, and offering procedural suggestions for increasing certainty that this standard has been met. Our approach recognizes that whole brain death is a functional, not merely anatomic, determination, and incorporates an understanding of the difficulties inherent in making empirical judgments in medicine. We conclude that whole brain death is the most defensible standard for determining neurologic death-philosophically, biologically, and socially-and ought to be maintained.
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Affiliation(s)
- Daniel P Sulmasy
- Kennedy Institute of Ethics, Georgetown University, Washington, DC; Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC; Department of Medicine, Georgetown University, Washington, DC; Department of Philosophy, Georgetown University, Washington, DC.
| | - Christopher A DeCock
- Essentia Health, Grand Forks, ND; University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND
| | | | - Allen H Roberts
- Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC; Department of Medicine, Georgetown University, Washington, DC
| | - James Giordano
- Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC; Department of Neurology, Georgetown University, Washington, DC
| | - G Kevin Donovan
- Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC
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Joye R, Cousin VL, Wacker J, Hoskote A, Gebistorf F, Tonna JE, Rycus PT, Thiagarajan RR, Polito A. Death by Neurologic Criteria in Children Undergoing Extracorporeal Cardiopulmonary Resuscitation: Retrospective Extracorporeal Life Support Organization Registry Study, 2017-2021. Pediatr Crit Care Med 2024; 25:e149-e157. [PMID: 37982691 PMCID: PMC10903996 DOI: 10.1097/pcc.0000000000003406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To determine factors associated with brain death in children treated with extracorporeal cardiopulmonary resuscitation (E-cardiopulmonary resuscitation). DESIGN Retrospective database study. SETTINGS Data reported to the Extracorporeal Life Support Organization (ELSO), 2017-2021. PATIENTS Children supported with venoarterial extracorporeal membrane oxygenation (ECMO) for E-cardiopulmonary resuscitation. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS Data from the ELSO Registry included patient characteristics, blood gas values, support therapies, and complications. The primary outcome was brain death (i.e., death by neurologic criteria [DNC]). There were 2,209 children (≥ 29 d to < 18 yr of age) included. The reason for ECMO discontinuation was DNC in 138 patients (6%), and other criteria for death occurred in 886 patients (40%). Recovery occurred in 1,109 patients (50%), and the remaining 76 patients (4%) underwent transplantation. Fine and Gray proportional subdistribution hazards' regression analyses were used to examine the association between variables of interest and DNC. Age greater than 1 year ( p < 0.001), arterial blood carbon dioxide tension (Pa co2 ) greater than 82 mm Hg ( p = 0.022), baseline lactate greater than 15 mmol/L ( p = 0.034), and lactate 24 hours after cannulation greater than 3.8 mmol/L ( p < 0.001) were independently associated with greater hazard of subsequent DNC. In contrast, the presence of cardiac disease was associated with a lower hazard of subsequent DNC (subdistribution hazard ratio 0.57 [95% CI, 0.39-0.83] p = 0.004). CONCLUSIONS In children undergoing E-cardiopulmonary resuscitation, older age, pre-event hypercarbia, higher before and during ECMO lactate levels are associated with DNC. Given the association of DNC with hypercarbia following cardiac arrest, the role of Pa co2 management in E-cardiopulmonary resuscitation warrants further studies.
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Affiliation(s)
- Raphael Joye
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Vladimir L Cousin
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Julie Wacker
- Pediatric Cardiology Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Aparna Hoskote
- Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Fabienne Gebistorf
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
- Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT
| | - Peter T Rycus
- Extracorporeal Life Support Organization, Ann Arbor, MI
| | - Ravi R Thiagarajan
- Division of Cardiac Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Angelo Polito
- Pediatric Intensive Care Unit, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospital, Geneva, Switzerland
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Aziz Rizk A, Farhani N, Shankar J. Computed Tomography Perfusion for the Diagnosis of Brain Death: A Technical Review. Can J Neurol Sci 2024; 51:173-178. [PMID: 37462465 DOI: 10.1017/cjn.2023.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Timely diagnosis of brain death (BD) is critical as it prevents unethical and futile continuation of support of vital organ functions when the patient has passed. Furthermore, it helps with avoiding the unnecessary use of resources and provides early opportunity for precious organ donation. The diagnosis of BD is mainly based on careful neurological assessment of patients with an established underlying diagnosis of neurological catastrophe capable of causing BD.Ancillary testing, however, is tremendously helpful in situations when the presence of confounders prevents or delays comprehensive neurological assessment. Traditionally, four-vessel digital subtraction angiography and computed tomography angiography have been used for blood flow (BF) examinations of the brain. The lack of BF in the intracranial arteries constitutes conclusive evidence that the brain is dead. However, there is an apparent discrepancy between the BF and sufficient cerebral perfusion; several studies have shown that in 15% of patients with confirmed clinical diagnosis of BD, BF is still preserved. In these patients, cerebral perfusion is significantly impaired. Hence, measurement of cerebral perfusion rather than BF will provide a more precise assessment of the brain function.In this review article, we discuss a brief history of BD, our understanding of its complex pathophysiology, current Canadian guidelines for the clinical diagnosis of BD, and the ancillary tests-specifically CT perfusion of the brain that help us with the prompt and timely diagnosis of BD.
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Affiliation(s)
| | - Nahal Farhani
- Department of Internal Medicine, Division of Neurology, University of MB, Winnipeg, MB, Canada
| | - Jai Shankar
- Department of Radiology, University of Manitoba, Winnipeg, MB, Canada
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Englbrecht JS, Schrader D, Alders JB, Schäfer M, Soehle M. Post-COVID-19 pandemic organ donation activities in Germany: a multicenter retrospective analysis. Front Public Health 2024; 12:1356285. [PMID: 38444435 PMCID: PMC10912160 DOI: 10.3389/fpubh.2024.1356285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction The COVID-19 pandemic had a negative impact on the number of solid organ transplantations. After a global decline of 16% in 2020, their numbers subsequently returned to pre-pandemic levels. In contrast, numbers in Germany remained almost constant in 2020 and 2021 but fell by 6.9% in 2022. The reasons for this divergent development are unknown. Methods The number of deceased with a severe brain damage, potential and utilized donors after braindeath and the intensive care unit treatment capacity were retrospectively compared for the years 2022 and 2021 at five university hospitals in North Rhine-Westphalia, Germany. Reasons for a donation not utilized were reviewed. To enable a comparison of the results with the whole of Germany and the pre-pandemic period, numbers of potential and utilized donors were extracted from official organ donation activity reports of all harvesting hospitals in Germany for the years 2019-2022. Results The numbers of deceased with a severe brain damage (-10%), potential (-9%), and utilized donors after braindeath (-44%), and intensive care unit treatment capacities (-7.2%) were significantly lower in 2022 than 2021. A COVID-19 infection was a rarer (-79%), but donor instability (+44%) a more frequent reason against donation in 2022, whereas preserved brain stem reflexes remained the most frequent reason in both years (54%). Overall numbers of potential and utilized donations in Germany were lower in 2022 than in the pre-pandemic period, but this was mainly due to lower numbers in hospitals of lower care. The number of potential donors in all university hospitals were higher in 2022 but utilized donations still lower than in 2019. Conclusion The decrease in potential and utilized donations was a result of reduced intensive care unit treatment capacities and a lower conversion rate at the five university hospitals. A COVID-19 infection did not play a role in 2022. These results indicate that ICU treatment capacities must be restored to increase donations. The lower number of potential donors and the even lower conversion rate in 2022 throughout Germany show that restructuring the organ procurement process in Germany needs to be discussed to increase the number of donations.
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Affiliation(s)
- Jan Sönke Englbrecht
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany
| | - Daniel Schrader
- The Medical Director's Staff Division of Organ Donation Coordination, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jörg Benedikt Alders
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany
| | - Melanie Schäfer
- Department of Intensive Care Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Martin Soehle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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12
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Buchman AS. Untangling a taxonomy of living from the science of the continuum of life. Curr Opin Behav Sci 2024; 55:101345. [PMID: 38223539 PMCID: PMC10783655 DOI: 10.1016/j.cobeha.2023.101345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Medical innovation and technologic advances enrich daily living and occur within our normative worlds, that are socially constructed. These advances confront society with critical questions about the nature of human life, laying bare the inadequacies of extant norms and boundaries. Yet, society has been unable to develop consensus about when life ends. Scientific studies highlight that life is best characterized by continua without natural boundaries. Thus, scientific information alone cannot be employed to justify the socially constructed health categories required for setting norms and boundaries. An iterative process that integrates a broad range of non-scientific data with advancing scientific information is needed to facilitate consensus for updating social norms and boundaries. This can lead to a new taxonomy of living across the measurable continuum of life and align our normative worlds with the dizzying pace of medical innovation and advances in technologies transforming the world in which we live.
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Affiliation(s)
- Aron S Buchman
- Rush Alzheimer's Disease Center, Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
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13
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Chambers M, Deutsch G. Perfusion Pressure and the Histology of Brain Death: A Unique Case in an Infant Maintained on Life Support. Pediatr Dev Pathol 2024:10935266231223276. [PMID: 38291872 DOI: 10.1177/10935266231223276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Brain death is a not uncommon phenomena in the adult and pediatric population. Most cases are removed from life support soon after brain death is declared. Less commonly, systemic perfusion is maintained by life support for some time after neurologic function stops. These cases present uncommon opportunities to explore the histology of necrosis and autolysis in the context of global hypoxic ischemic damage. Here, we describe the unusual case of an infant maintained on life support for 2 weeks after brain death was declared with an emphasis on the resulting gross and histologic findings including a discussion of their underlying physiology.
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Affiliation(s)
- Meagan Chambers
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Gail Deutsch
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, USA
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14
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Hongo T, Yumoto T, Kosaki Y, Hiraoka T, Tsukahara K, Nojima T, Obara T, Ageta K, Yamasaki Y, Taniguchi K, Miura M, Miyaishi S, Naito H, Nakao A. Successful Cardiac, Lung, and Kidney Transplantation from a Methanol-poisoned Donor. JMA J 2024; 7:133-135. [PMID: 38314411 PMCID: PMC10834169 DOI: 10.31662/jmaj.2023-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/24/2023] [Indexed: 02/06/2024] Open
Abstract
Massive methanol exposure can lead to severe and detrimental effects that can result in death or brain death. As organs from patients with brain death after methanol ingestion are less likely to be recovered, these patients have been considered marginal donors. We present a case of successful multiple organ transplantation (heart, lungs, and kidneys) from a methanol-poisoned patient. Our experience illustrates that donor death from methanol intoxication does not preclude organ transplantation.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tomohiro Hiraoka
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Ageta
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yukie Yamasaki
- Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kaori Taniguchi
- Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Masanobu Miura
- Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
- Department of Legal Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Satoru Miyaishi
- Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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15
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Kida S, Nagata I, Takei T, Yoshizawa K, Suzuki T, Yamada H, Nakayama Y. Respiratory-like movements during an apnea test. Acute Med Surg 2024; 11:e959. [PMID: 38665594 PMCID: PMC11043618 DOI: 10.1002/ams2.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Background Despite the possible occurrence of spontaneous movements during an apnea test, respiratory-like movements are rare. Case Presentation A 51-year-old man was transferred to our hospital when a sudden disturbance of consciousness developed into cardiac arrest. After spontaneous circulation returned, we diagnosed bilateral cerebellar hemorrhage. He remained comatose with dilated pupils, absent brainstem reflexes, spontaneous breathing, and electrocerebral activity. After being considered brain dead, his family opted for organ donation. The first legal brain death examination on day 5 was aborted because of respiratory-like movements mimicking repetitive abdominal respiration during the apnea test. However, an enhanced magnetic resonance image of the head indicated no blood flow and somatosensory evoked potential testing revealed no brain-derived potentials. Conclusion Respiratory-like movements can occur during the apnea test in patients considered brain dead. Further research is required to understand this phenomenon.
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Affiliation(s)
- Shinichi Kida
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaJapan
| | - Isao Nagata
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaJapan
| | - Tetsuhiro Takei
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaJapan
| | - Kazuhiro Yoshizawa
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaJapan
| | - Taketo Suzuki
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaJapan
| | - Hiroyuki Yamada
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaJapan
| | - Yusuke Nakayama
- Department of Emergency and Critical Care MedicineYokohama City Minato Red Cross HospitalYokohamaJapan
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16
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Becerril-Gaitan A, Bindal S, Parker SL, Mullarkey MP, Zeineddine HA, Chen JM, Choi HA, Chen PR, Blackburn S, Day A, Torres LF, Brown RJ, Bowry R, Chen CJ. Cerebrovascular Complications Associated With Iatrogenic Fungal Meningitis Following Surgical Procedures in Mexico. Stroke 2024; 55:177-181. [PMID: 38018835 DOI: 10.1161/strokeaha.123.044768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND The current fungal meningitis outbreak caused by contaminated epidural anesthesia with Fusarium solani among patients who underwent surgical procedures in Matamoros, Mexico remains a cause of concern. Its association with an increased susceptibility for cerebrovascular complications (CVC) has not been reported. This single-center study describes 3 patients with a unique pattern of CVC attributed to fungal meningitis. METHODS A retrospective case series of patients diagnosed with fungal meningitis following surgical procedures under contaminated epidural anesthesia who developed a unique pattern of CVC during their hospitalization. RESULTS Three female patients (mean age, 35 years) with CVC due to iatrogenic fungal meningitis were included. Positive Fungitell β-D-glucan assay in cerebrospinal fluid was documented in all cases, and F. solani was confirmed by polymerase chain reaction in case 3. All cases were complicated by severe vertebrobasilar circulation vasculopathy and arterial dissections with resultant subarachnoid hemorrhage and intraventricular hemorrhage, ultimately leading to patients' death. CONCLUSIONS The death toll from the ongoing fungal meningitis outbreak keeps rising, underscoring the need for early recognition and aggressive treatment. We highlight the risk for vertebrobasilar circulation CVC among these patients. The angioinvasive nature of F. solani is yet to be clarified; however, a clear pattern has been observed. Public health awareness should be raised and a strong response should be pursued.
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Affiliation(s)
- Andrea Becerril-Gaitan
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Shivani Bindal
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Samantha L Parker
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Matthew P Mullarkey
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Hussein A Zeineddine
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | | | - Huimahn A Choi
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Peng R Chen
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Spiros Blackburn
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Arthur Day
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Luis F Torres
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Robert J Brown
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Ritvij Bowry
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
| | - Ching-Jen Chen
- Neurosurgery Department (A.B.-G., S.B., S.L.P., M.P.M., H.A.Z., H.A.C., P.R.C., S.B., A.D., L.F.T., R.J.B., R.B., C.-J.C.), UTHealth Houston, TX
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17
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Deniz İ, Ayhan H. The effectiveness of video training in improving intensive care nurses' knowledge about brain death identification. Nurs Crit Care 2024; 29:80-89. [PMID: 36414015 DOI: 10.1111/nicc.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Because patients diagnosed with brain death in intensive care units constitute a potential cadaveric donor group for organ transplantation, intensive care units are potential donor sources. Nurses who closely monitor the patient collaborate with medical personnel in the recognition and early diagnosis of brain death. Nurses also have an important role in supporting the patient's family. Therefore, it is very important for nurses to know the diagnostic criteria for brain death. AIM The aim of this study was to compare the effectiveness of theoretical education and video-assisted education in equipping intensive care nurses to recognize brain death. STUDY DESIGN A randomized, experimental study was conducted between February and May 2020 with a total of 50 intensive care nurses, split into 25 in the video-assisted training group and 25 in the theoretical training group. In study, intensive care nurses were given a theoretical training and video-assisted training on brain death criteria. One group was trained theoretically and the other group used a video showing criteria for brainstem reflexes (pupil assessment, spontaneous breathing, corneal reflex, retching and coughing assessments) and deep tendon reflexes in a simulated patient, supported by animation. The data were collected before, immediately after and 3 months after the training using the Brain Death Criteria Knowledge Test, the Brain Death Case Test, and the Training Effectiveness Evaluation Form. The independent samples t-test, Mann-Whitney U test, Friedman test, Wilcoxon test, and Chi-square test were used for statistical analysis of data. RESULTS It was found that the knowledge scores of both groups immediately after training and 3 months after training were higher than before the training (p < .001). However, the post-training knowledge scores of the video-assisted training group were significantly higher than those of the theoretical training group (p = .011). CONCLUSIONS To enable intensive care nurses to identify brain death, video-assisted training with a simulated patient is recommended, as is repeating the training at regular intervals. RELEVANCE TO CLINICAL PRACTICE The simulated patient video-assisted training method can be used for in-service training to provide intensive care nurses with the ability to identify brain death. The training may be repeated at regular intervals (e.g., every 3 months) to increase nurse recall.
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Affiliation(s)
- İsmail Deniz
- Dialysis Department, Hakkari University Vocational School of Health Services, Hakkari, Turkey
| | - Hatice Ayhan
- Department of Surgical Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
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18
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Ekici B, Ersayoğlu İ, Yazıcı Özkaya P, Cebeci K, Koç G, Eda Turanlı E. Impact of Decompressive Craniectomy on Diagnosing Brain Death in Children. Turk Arch Pediatr 2024; 59:93-97. [PMID: 38454266 PMCID: PMC10837520 DOI: 10.5152/turkarchpediatr.2024.23136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/28/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVE In this study, we aimed to evaluate the effects of decompressive craniectomy (DC) on the brain death (BD) determination process in the pediatric intensive care unit (PICU). MATERIALS AND METHODS All children who were diagnosed with BD in the PICU between 2009 and 2020 were included in this study. Patient demographics, causative mechanisms, BD examinations, and ancillary tests used were recorded. The time intervals (from PICU admission to first BD examination, from first BD examination to BD diagnosis) and number of BD examinations were compared between patients with and without DC. RESULTS During the study period, 70 pediatric cases were diagnosed with BD among 513 total deaths (13.6%). Their median age was 54.5 months [interquartile range (IQR): 24-140]. Transcranial Doppler ultrasound (TCD) was performed in 66 patients (94.3%). The most common combination of ancillary tests was the apnea test and TCD combination, which was performed in 56 patients (80%). Thirty-four children (48.6%) experienced immediate surgery for DC. Patients with DC had a higher median number of BD examinations than patients without DC [3 (IQR: 2-3) vs. 2 (IQR: 1-2), P < .001]. The patients with DC had a longer time interval between the first examination and declaration of BD than patients without DC [45.5 hours (IQR: 21.7-91.7) versus 15 hours (IQR: 2-31.2), P < .006]. CONCLUSION Decompressive craniectomy may complicate BD determination and cause challenges for brain death diagnosis based on cerebral flow imaging techniques. The lack of specific recommendations for this patient group in the guidelines causes a delayed diagnosis of BD. Cite this article as: Ekici B, Ersayoğlu İ, Yazıcı Özkaya P, Cebeci K, Koç G, Turanlı EE. Impact of decompressive craniectomy on diagnosing brain death in children. Turk Arch Pediatr. 2024;59(1):93-97.
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Affiliation(s)
- Betül Ekici
- Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey
| | - İrem Ersayoğlu
- Division of Pediatric Intensive Care, Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey
| | - Pınar Yazıcı Özkaya
- Division of Pediatric Intensive Care, Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey
| | - Kübra Cebeci
- Division of Pediatric Intensive Care, Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey
| | - Gülizar Koç
- Division of Pediatric Intensive Care, Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey
| | - Eşe Eda Turanlı
- Division of Pediatric Intensive Care, Department of Pediatrics, Ege University School of Medicine, İzmir, Turkey
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Shemie SD. In reply: Brain death is more than technical. Can J Anaesth 2023; 70:2011-2012. [PMID: 37784007 DOI: 10.1007/s12630-023-02571-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 10/04/2023] Open
Affiliation(s)
- Sam D Shemie
- Division of Pediatric Intensive Care, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
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20
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Lerman JB, Guidot DM, Green CL, Patel CB, Agarwal R, Sweitzer NK, Keenan JE, Milano CA, Schroder JN, DeVore AD. Longitudinal Trends in Donor and Recipient Risk Profile, and Clinical Outcomes, for Donation After Circulatory Death Heart Transplantation. Circ Heart Fail 2023; 16:e011213. [PMID: 37929577 PMCID: PMC10844982 DOI: 10.1161/circheartfailure.123.011213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Joseph B Lerman
- Division of Cardiology (J.B.L., C.B.P., R.A., A.D.D.), Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC (J.B.L., D.M.G., C.L.G., A.D.D.)
| | - Daniel M Guidot
- Duke Clinical Research Institute, Durham, NC (J.B.L., D.M.G., C.L.G., A.D.D.)
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics (C.L.G.), Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC (J.B.L., D.M.G., C.L.G., A.D.D.)
| | - Chetan B Patel
- Division of Cardiology (J.B.L., C.B.P., R.A., A.D.D.), Duke University School of Medicine, Durham, NC
| | - Richa Agarwal
- Division of Cardiology (J.B.L., C.B.P., R.A., A.D.D.), Duke University School of Medicine, Durham, NC
| | - Nancy K Sweitzer
- Department of Medicine, Washington University School of Medicine, St. Louis, MO (N.K.S.)
| | - Jeffrey E Keenan
- Department of Surgery (J.E.K., C.A.M., J.N.S.), Duke University School of Medicine, Durham, NC
| | - Carmelo A Milano
- Department of Surgery (J.E.K., C.A.M., J.N.S.), Duke University School of Medicine, Durham, NC
| | - Jacob N Schroder
- Department of Surgery (J.E.K., C.A.M., J.N.S.), Duke University School of Medicine, Durham, NC
| | - Adam D DeVore
- Division of Cardiology (J.B.L., C.B.P., R.A., A.D.D.), Duke University School of Medicine, Durham, NC
- Duke Clinical Research Institute, Durham, NC (J.B.L., D.M.G., C.L.G., A.D.D.)
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21
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Machado C. Comment on: Canadian clinical practice guideline on brain death. Can J Anaesth 2023; 70:2013-2014. [PMID: 37989938 DOI: 10.1007/s12630-023-02660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 11/23/2023] Open
Affiliation(s)
- Calixto Machado
- Institute of Neurology and Neurosurgery, 10400, 29 y D, Vedado, Havana, Cuba.
- Institute of Neurology and Neurosurgery, Havana, Cuba.
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22
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Shemie SD. In reply: Comment on: Canadian clinical practice guideline on brain death. Can J Anaesth 2023; 70:2015. [PMID: 37989937 DOI: 10.1007/s12630-023-02661-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/23/2023] Open
Affiliation(s)
- Sam D Shemie
- Division of Pediatric Intensive Care, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
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23
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Atreya A, Bastola P, Bhandari S, Nepal S, Bhandari PS. Brain Death and Organ Transplantation in Nepal: Navigating Cultural, Legal, and Ethical Landscapes. Transpl Int 2023; 36:11882. [PMID: 38089003 PMCID: PMC10713729 DOI: 10.3389/ti.2023.11882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023]
Abstract
Organ transplantation after brain death is challenging in Nepal due to cultural beliefs, legal frameworks, and ethical considerations. The Human Body Organ Transplantation (Regulation and Prohibition) Act (HBOTA) has not met with substantial success after its amendment. This review critically appraises the current state of brain death and organ transplantation in Nepal. It explores challenges, evaluates progress, and provides recommendations. Literature review of databases was conducted to find articles on brain death, organ donation, and transplantation in Nepal. Analysis of cultural, legal, ethical, and practical factors influencing implementation. Key challenges include limited awareness, religious beliefs, infrastructure gaps, and family consent barriers. HBOTA amendments in 2016 enabled brain death donations, however, donation rates remain low. Strategies are needed to improve public education, resources, personnel training, and collaboration. Cultural sensitivity and stakeholder engagement are crucial. A multifaceted approach addressing cultural, legal, ethical and practical dimensions is essential to improve organ donation rates in Nepal. Despite progress, substantial challenges persist requiring evidence-based strategies focused on awareness, capacity building, policy improvements, and culturally appropriate community engagement.
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Affiliation(s)
- Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College, Palpa, Nepal
| | - Priska Bastola
- Department of Cardiothoracic and Vascular Anaesthesiology, Maharajgunj Medical Campus, Kathmandu, Nepal
| | | | - Samata Nepal
- Department of Community Medicine, Lumbini Medical College, Palpa, Nepal
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24
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Cotrău P, Negrău M, Hodoșan V, Vladu A, Daina CM, Dulău D, Pantiș C, Daina LG. Organ Donation Awareness among Family Members of ICU Patients. Medicina (Kaunas) 2023; 59:1966. [PMID: 38004015 PMCID: PMC10673166 DOI: 10.3390/medicina59111966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/19/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: With one of the lowest donation rates in the European Union, Romania faces challenges in organ donation from brain death donors, within an opt-in system. This study aims to measure the attitudes and knowledge of ICU patient's relatives toward organ donation. Materials and Methods: A descriptive cross-sectional study was conducted in the intensive care unit of the Emergency Clinical County Hospital of Oradea, Romania. A 24-item self-administered questionnaire (N = 251) was used to collect data on knowledge about organ and tissue donation and transplantation, as well as the willingness to donate. Results: A high degree of awareness and willingness for organ donation and transplantation was recorded. The main positive predictor of willingness to donate was the perception of helping others by donating their organs after brain death (β = 0.537, OR = 1.711, p < 0.05), and the main negative predictor was the idea that the whole body should be buried intact (β = -0.979, OR = 0.376, p < 0.01). Conclusions: A basic understanding of organ donation and transplantation and favorable attitudes toward organ donation were registered. Families' interviews for organ donation consent may be affected due to extreme emotional distress.
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Affiliation(s)
- Petru Cotrău
- Faculty of Medicine and Pharmacy, Doctoral School of Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania; (V.H.); (A.V.); (D.D.)
- Emergency Clinical County Hospital of Oradea, 410169 Oradea, Romania; (M.N.); (C.M.D.); (C.P.); (L.G.D.)
| | - Marcel Negrău
- Emergency Clinical County Hospital of Oradea, 410169 Oradea, Romania; (M.N.); (C.M.D.); (C.P.); (L.G.D.)
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 University Street, 410087 Oradea, Romania
| | - Viviana Hodoșan
- Faculty of Medicine and Pharmacy, Doctoral School of Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania; (V.H.); (A.V.); (D.D.)
- Emergency Clinical County Hospital of Oradea, 410169 Oradea, Romania; (M.N.); (C.M.D.); (C.P.); (L.G.D.)
| | - Adriana Vladu
- Faculty of Medicine and Pharmacy, Doctoral School of Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania; (V.H.); (A.V.); (D.D.)
- Emergency Clinical County Hospital of Oradea, 410169 Oradea, Romania; (M.N.); (C.M.D.); (C.P.); (L.G.D.)
| | - Cristian Marius Daina
- Emergency Clinical County Hospital of Oradea, 410169 Oradea, Romania; (M.N.); (C.M.D.); (C.P.); (L.G.D.)
- Psycho-Neurosciences and Recovery Department, Faculty of Medicine and Pharmacy, University of Oradea, 1 University Street, 410097 Oradea, Romania
| | - Dorel Dulău
- Faculty of Medicine and Pharmacy, Doctoral School of Biomedical Sciences, University of Oradea, 1 University Street, 410087 Oradea, Romania; (V.H.); (A.V.); (D.D.)
| | - Carmen Pantiș
- Emergency Clinical County Hospital of Oradea, 410169 Oradea, Romania; (M.N.); (C.M.D.); (C.P.); (L.G.D.)
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 University Street, 410087 Oradea, Romania
| | - Lucia Georgeta Daina
- Emergency Clinical County Hospital of Oradea, 410169 Oradea, Romania; (M.N.); (C.M.D.); (C.P.); (L.G.D.)
- Psycho-Neurosciences and Recovery Department, Faculty of Medicine and Pharmacy, University of Oradea, 1 University Street, 410097 Oradea, Romania
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Pinney SP, Costanzo MR. Donation After Circulatory Death: Shifting the Paradigm in Heart Transplantation. J Am Coll Cardiol 2023; 82:1521-1523. [PMID: 37793749 DOI: 10.1016/j.jacc.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Sean P Pinney
- The Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Shiraishi T, Midorikawa K, Miyahara S, Waseda R, Sato T. The history of Japanese lung transplantation: the unique pathway to establishing the program and its initial success. J Thorac Dis 2023; 15:5204-5212. [PMID: 37868876 PMCID: PMC10586964 DOI: 10.21037/jtd-22-1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 07/07/2023] [Indexed: 10/24/2023]
Abstract
Japan is a unique country in terms of organ transplantation. Despite the impressive progress in transplant medicine achieved during the late 20th century in many Western countries, Japan was unable to implement a program for organ transplants from brain-dead donors due to persistent public distrust regarding the ethical understanding of "brain death as human death". In 1997, the Japanese Organ Transplant Law was enacted, and organ transplantation from brain-dead donors was finally legalized. However, this law was strongly opposed by religious leaders, philosophers, politicians, and even medical personnel who did not accept the idea that brain death is human death, so transplant physicians had to start performing transplants in the face of strong social resistance. The Japanese National Lung Transplant System was established based on the following three philosophies: (I) an institutional certification system based on strict standards; (II) a rigorous central monitoring system for transplant results; and (III) a third-party review system to determine eligibility for patient registration. The purpose of these policies was to avoid ethical issues at lung transplant institutes, and to achieve high-quality transplant results. The actual progress of Japanese lung transplantation has been quite unusual compared to other countries. The number of brain-dead organ donations was extremely limited at first, so more than 60% of lung transplants were performed as living-donor transplants during the first 9 years [1998-2006]. The number of brain-dead donations subsequently increased, particularly after the revision of the Organ Transplant Law in 2010 such that the majority of lung transplants are now performed as brain-dead transplantations. Regarding the results of lung transplants, the most recent national registry report indicated that a total of 668 lung transplants including 447 from brain-dead donors and 221 from living donors, had been performed as of 2018. The 5- and 10-year survival rates for brain-dead donor lung transplantation were 71.9% and 57.8%, respectively, with no significant difference between the living-donor and brain-dead-donor groups. These results are comparable with the outcome of preceding programs in the US and European countries.
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Affiliation(s)
- Takeshi Shiraishi
- Center of Organ Transplant Medicine (Lung Transplant Unit), Fukuoka University Hospital, Fukuoka, Japan
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kensuke Midorikawa
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - So Miyahara
- Center of Organ Transplant Medicine (Lung Transplant Unit), Fukuoka University Hospital, Fukuoka, Japan
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Ryuichi Waseda
- Center of Organ Transplant Medicine (Lung Transplant Unit), Fukuoka University Hospital, Fukuoka, Japan
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Toshihiko Sato
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan
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Özbek İ, Gürler H, Gültürk EA. Turkish Validity and Reliability Study of "Intensive Care Nurses" Attitude Scale Toward Brain Death and Organ Transplantation. Omega (Westport) 2023:302228231203347. [PMID: 37740729 DOI: 10.1177/00302228231203347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023]
Abstract
This study was carried out to analyze the validity and reliability of the Turkish adaptation of the "Intensive Care Nurses" Attitude Scale towards Brain Death and Organ Transplantation". The research was carried out as a methodological study and 256 nurses were included in the study. Language, content validity, explanatory and confirmatory factor analyzes were used to analyze data. Twenty-one point 5% of nurses stated that they had an organ donation card. It was determined that the Cronbach alpha coefficient of scale was .85, and item-total score correlations were between .143 and .700. It was established that the scale showed three-factor structure and the first factor was named as "Approving Organ Donation", the second factor as "Discomfort" and the third factor as "Improving The Quality of Life". The Turkish version of the scale was found to be an valid and reliable measurement tool.
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Affiliation(s)
| | - Hesna Gürler
- A Vocational School of Health Care Services, Sivas Cumhuriyet University, Sivas, Turkey
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Abstract
This paper provides a new rationale for equating brain death with the death of the human organism, in light of well-known criticisms made by Alan D Shewmon, Franklin Miller and Robert Truog and a number of other writers. We claim that these criticisms can be answered, but only if we accept that we have slightly redefined the concept of death when equating brain death with death simpliciter. Accordingly, much of the paper defends the legitimacy of redefining death against objections, before turning to the specific task of defending a new rationale for equating brain death with death as slightly redefined.
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Affiliation(s)
- Andrew McGee
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Australia
| | - Dale Gardiner
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Melanie Jansen
- Gold Coast University Hospital, Gold Coast, Australia and Queensland Children's Hospital, Brisbane, Australia
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29
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Abstract
The mainstream concept of death-the biological one-identifies death with the cessation of an organism. In this article, I challenge the mainstream position, showing that there is no single well-established concept of an organism and no universal concept of death in biological terms. Moreover, some of the biological views on death, if applied in the context of bedside decisions, might imply unacceptable consequences. I argue the moral concept of death-one similar to that of Robert Veatch-overcomes such difficulties. The moral view identifies death with the irreversible cessation of a patient's moral status, that is, a state when she can no longer be harmed or wronged. The death of a patient takes place when she is no longer capable of regaining her consciousness. In this regard, the proposal elaborated herein resembles that of Veatch yet differs from Veatch's original project since it is universal. In essence, it is applicable in the case of other living beings such as animals and plants, provided that they have some moral status.
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Abstract
There are currently two legally established criteria for death: the irreversible cessation of circulation and respiration and the irreversible cessation of neurologic function. Recently, there have been technological developments that could undermine the irreversibility requirement. In this paper, I focus both on whether death should be identified as an irreversible state and on the proper scope of irreversibility in the biological definition of death. In this paper, I tackle the distinction between the commonsense definition of death and the biological definition of death to show that even the commonsense concept of death is specified by biological facts. Resting on this argument, I argue that any definition of death is a posteriori. Thus, irreversibility is part of any definition of death because the actual phenomenon of death is irreversible. In addition, I show that the proper domain of irreversibility in a definition of death is circumscribed by physical possibilities and that irreversibility in the definition of death refers to current possibilities for the reversal of relevant biological processes. I conclude that, despite recent technological advancements, death is still irreversible.
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Affiliation(s)
- Nada Gligorov
- Alden March Bioethics Institute at Albany Medical College, Albany, New York, USA
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31
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Khush KK, Malinoski D, Luikart H, Wayda B, Groat T, Nguyen J, Belcher J, Nieto J, Neidlinger N, Salehi A, Geraghty PJ, Nicely B, Jendrisak M, Pearson T, Wood RP, Zhang S, Weng Y, Zaroff J. Left Ventricular Dysfunction Associated With Brain Death: Results From the Donor Heart Study. Circulation 2023; 148:822-833. [PMID: 37465972 PMCID: PMC10529108 DOI: 10.1161/circulationaha.122.063400] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Left ventricular dysfunction in potential donors meeting brain death criteria often results in nonuse of donor hearts for transplantation, yet little is known about its incidence or pathophysiology. Resolving these unknowns was a primary aim of the DHS (Donor Heart Study), a multisite prospective cohort study. METHODS The DHS enrolled potential donors by neurologic determination of death (n=4333) at 8 organ procurement organizations across the United States between February 2015 and May 2020. Data included medications administered, serial diagnostic tests, and transthoracic echocardiograms (TTEs) performed: (1) within 48 hours after brain death was formally diagnosed; and (2) 24±6 hours later if left ventricular (LV) dysfunction was initially present. LV dysfunction was defined as an LV ejection fraction <50% and was considered reversible if LV ejection fraction was >50% on the second TTE. TTEs were also examined for presence of LV regional wall motion abnormalities and their reversibility. We assessed associations between LV dysfunction, donor heart acceptance for transplantation, and recipient 1-year survival. RESULTS An initial TTE was interpreted for 3794 of the 4333 potential donors by neurologic determination of death. A total of 493 (13%) of these TTEs showed LV dysfunction. Among those donors with an initial TTE, LV dysfunction was associated with younger age, underweight, and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) and troponin levels. A second TTE was performed within 24±6 hours for a subset of donors (n=224) with initial LV dysfunction; within this subset, 130 (58%) demonstrated reversibility. Sixty percent of donor hearts with normal LV function were accepted for transplant compared with 56% of hearts with reversible LV dysfunction and 24% of hearts with nonreversible LV dysfunction. Donor LV dysfunction, whether reversible or not, was not associated with recipient 1-year survival. CONCLUSIONS LV dysfunction associated with brain death occurs in many potential heart donors and is sometimes reversible. These findings can inform decisions made during donor evaluation and help guide donor heart acceptance for transplantation.
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Affiliation(s)
- Kiran K. Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Darren Malinoski
- Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland, OR
| | - Helen Luikart
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Brian Wayda
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Tahnee Groat
- Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health and Science University, Portland, OR
| | - John Nguyen
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | | | - Javier Nieto
- LifeGift Organ Procurement Organization, Houston, TX
| | - Nikole Neidlinger
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | | | | | | | | - Shiqi Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Yingjie Weng
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jonathan Zaroff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Vachiéry-Lahaye F, Petit R, Lê GB. [Interviewing relatives with a view to organ donation from a deceased person]. Soins 2023; 68:29-32. [PMID: 37657867 DOI: 10.1016/j.soin.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Talking to a deceased patient's next of kin about organ donation is a sensitive, emotionally-charged collective practice. It must be prepared and organized by the coordination and resuscitation team. The quality of the support and follow-up offered to the deceased's family and friends remains essential.
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Affiliation(s)
- Florence Vachiéry-Lahaye
- Coordination hospitalière du don pour la greffe, centre hospitalier universitaire de Montpellier, 191 avenue du Doyen Giraud, 34295 Montpellier, France.
| | - Rahmouna Petit
- Coordination hospitalière du don pour la greffe, centre hospitalier universitaire de Montpellier, 191 avenue du Doyen Giraud, 34295 Montpellier, France
| | - Guy-Bernard Lê
- Coordination hospitalière du don pour la greffe, centre hospitalier universitaire de Montpellier, 191 avenue du Doyen Giraud, 34295 Montpellier, France
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Santiago LE, Alvi AT, Nadeem Z, Chaudhry A. Acute Fulminant Cerebral Edema Caused by Influenza Type B in an 18-Year-Old Female: A Rare Case. Cureus 2023; 15:e45501. [PMID: 37868552 PMCID: PMC10584662 DOI: 10.7759/cureus.45501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Most influenza B infections are self-limited, but in some instances, they can cause substantial morbidity and mortality due to complications. Acute fulminant cerebral edema (AFCE) is one of the rare complications. AFCE, a consequence of acute encephalitis, presents as acute onset of alteration in mental status, seizure, and/or headache followed by rapidly progressive encephalopathy, often leading to death. The exact pathophysiology of AFCE is unknown, but many pathomechanisms have been proposed. We present a case of an 18-year-old female in excellent physical condition who presented with respiratory insufficiency after being recently diagnosed with influenza B infection. Three days later, she developed acute encephalopathy, leading to brain death. To our knowledge, this rare case of AFCE developing following influenza B infection is the first reported case outside the pediatric population.
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Affiliation(s)
- Luis E Santiago
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
| | - Ali Tariq Alvi
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
| | - Zahid Nadeem
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
| | - Ali Chaudhry
- Critical Care, HCA Florida Northwest Hospital, Margate, USA
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
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Bretagnol A, Barrier D, Brunet C, Lefebvre I, Messi L, Narcisse É, Vanacker L. [Diagnosis of encephalic death and donor resuscitation for harvesting purposes]. Soins 2023; 68:25-28. [PMID: 37657866 DOI: 10.1016/j.soin.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Encephalic death is a rare and unique pathophysiological process. Its diagnosis and management in the intensive care unit, which are well codified, determine the possibility and short- and long-term outcome of organ and tissue transplants.
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Affiliation(s)
- Anne Bretagnol
- Coordination hospitalière des prélèvements d'organes et de tissus, centre hospitalier universitaire d'Orléans, 14 avenue de l'Hôpital, 45067 Orléans, France.
| | - Damien Barrier
- Coordination hospitalière des prélèvements d'organes et de tissus, centre hospitalier universitaire d'Orléans, 14 avenue de l'Hôpital, 45067 Orléans, France
| | - Carine Brunet
- Coordination hospitalière des prélèvements d'organes et de tissus, centre hospitalier universitaire d'Orléans, 14 avenue de l'Hôpital, 45067 Orléans, France
| | - Isabelle Lefebvre
- Coordination hospitalière des prélèvements d'organes et de tissus, centre hospitalier universitaire d'Orléans, 14 avenue de l'Hôpital, 45067 Orléans, France
| | - Lydia Messi
- Coordination hospitalière des prélèvements d'organes et de tissus, centre hospitalier universitaire d'Orléans, 14 avenue de l'Hôpital, 45067 Orléans, France
| | - Éric Narcisse
- Coordination hospitalière des prélèvements d'organes et de tissus, centre hospitalier universitaire d'Orléans, 14 avenue de l'Hôpital, 45067 Orléans, France
| | - Ludivine Vanacker
- Coordination hospitalière des prélèvements d'organes et de tissus, centre hospitalier universitaire d'Orléans, 14 avenue de l'Hôpital, 45067 Orléans, France
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35
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Rayar M, Allain G, Kerforne T. [Surgical aspects of multi-organ harvesting for transplantation]. Soins 2023; 68:33-36. [PMID: 37657868 DOI: 10.1016/j.soin.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
The aim of multi-organ harvesting is to remove and condition organs so that they can be transplanted. It is an extremely well codified surgical procedure, performed in a precise order. It is unique in that it involves different teams, each with its own specialization.
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Affiliation(s)
- Michel Rayar
- Service de chirurgie hépatobiliaire et digestif, centre hospitalier universitaire de Rennes, site Pontchaillou, 2 rue Henri-le-Guilloux, 35000 Rennes, France; Institut NuMeCan, UMR 1241, Inserm, université de Rennes 1, campus santé, 2 avenue du Pr Léon-Bernard, 35000 Rennes, France.
| | - Géraldine Allain
- Service de chirurgie cardiothoracique et vasculaire, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France; Unité Irmetist, Inserm U1313, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 6 rue de la Milétrie, 86073 Poitiers, France
| | - Thomas Kerforne
- Unité Irmetist, Inserm U1313, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France; Université de Poitiers, 6 rue de la Milétrie, 86073 Poitiers, France; Service d'anesthésie-réanimation et médecine périopératoire, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France; Coordination hospitalière des prélèvements d'organes et de tissus, centre hospitalier universitaire de Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France
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Lalegani HA, Babaei S, Alimohammadi N, Yazdannik A, Sanei B, Ramezannezhad P. A Critical Ethnographic Study of Families of Brain-Dead Patients: Their Experiences and Attitudes to Organ Donation. Iran J Nurs Midwifery Res 2023; 28:536-543. [PMID: 37869701 PMCID: PMC10588912 DOI: 10.4103/ijnmr.ijnmr_267_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/04/2023] [Accepted: 03/15/2023] [Indexed: 10/24/2023]
Abstract
Background Despite the difficulty of making decisions providing facilitating mediators and removing barriers to making decisions about choosing the right path to donate the organs of brain-dead patients by families can assist in improving the services and help the lives of fellow human beings. This study aimed to explain the decision-making mediator for organ donation in families with brain-dead patients in a cultural context. Materials and Methods This qualitative study with a critical ethnographic approach was conducted based on Carspecken's stages from August 2021 to March 2022. In this regard, 22 participants were selected through the purposive sampling method and considering the inclusion and exclusion criteria. Sampling was continued until data saturation. After obtaining the required ethical approval, data collection was performed through observation, semi-structured interviews, and document review. All data were recorded and managed using MAXQDA 18 software. Results Based on the results, the main themes and subthemes of this study included "inefficient decision-making mediator" (the shadow of the socioeconomic situation on the medical status of organ recipients, as well as pessimistic influential individuals, social accountability, dialect difference, and ethnic beliefs) and "efficient decision-making mediator" (social learning, material, and spiritual motivation, mother role, and divine reward). Conclusions The results of this study, derived from a cultural context, can be applied to carrying out future applied and empirical research. Moreover, they can be used in the field of various nursing roles, especially management, care, and education.
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Affiliation(s)
- Hedayat Allah Lalegani
- phD of Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sima Babaei
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrollah Alimohammadi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmadreza Yazdannik
- Assistant Professor of Nursing, Department of Critical Care Nursing, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Shahrekord, Iran
| | - Behnam Sanei
- Associate Professor of Kidney Transplantation, Department of Surgery, School of Medicine, Acquired Immunodeficiency Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Shahrekord, Iran
| | - Pantea Ramezannezhad
- Assistant Professor of Forensic Medicine, Department of Emergency Medicine, School of Medicine, Kashani Hospital, Shahrekord University of Medical Sciences,Shahrekord, Iran
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37
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Baudoin K, Cariou I, Jehanno S. [Organizing and coordinating organ procurement]. Soins 2023; 68:21-24. [PMID: 37657865 DOI: 10.1016/j.soin.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
The task of organizing and coordinating organ and tissue donation projects for deceased patients in a state of encephalic death is a recent one. Now established, it is proving to be a decisive factor in the quality of the donation process and organ and tissue retrieval. It initiates, articulates and facilitates actions aimed at achieving transplants for patients on the waiting list.
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Affiliation(s)
- Karine Baudoin
- Unité fonctionnelle de coordination hospitalière de prélèvements d'organes et de tissus, centre hospitalier universitaire de Rennes, site Pontchaillou, 2 rue Henri-le-Guilloux, 35000 Rennes, France.
| | - Isabelle Cariou
- Unité fonctionnelle de coordination hospitalière de prélèvements d'organes et de tissus, centre hospitalier universitaire de Rennes, site Pontchaillou, 2 rue Henri-le-Guilloux, 35000 Rennes, France
| | - Sabrina Jehanno
- Unité fonctionnelle de coordination hospitalière de prélèvements d'organes et de tissus, centre hospitalier universitaire de Rennes, site Pontchaillou, 2 rue Henri-le-Guilloux, 35000 Rennes, France
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Ferrari F. [Ethical issues surrounding the donation process and support for loved ones]. Soins 2023; 68:37-40. [PMID: 37657869 DOI: 10.1016/j.soin.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
In France, since the 1970s and the so-called Cavaillet law, has the body of a deceased person been treated as a possible object of public health, and his or her organs as public property? It is first and foremost at the heart of intimate social relations and singular suffering.
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Affiliation(s)
- Frank Ferrari
- Hôpital Pitié-Salpêtrière, AP-HP, 47 boulevard de l'Hôpital, 75013 Paris, France.
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Durin L, Bianchi A, Kerbaul F. [Fundamentals of organ and tissue procurement]. Soins 2023; 68:10-15. [PMID: 37657863 DOI: 10.1016/j.soin.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Transplantation is the treatment of choice for the terminal evolution of many organ failures. This recent solution has been deployed in France, essentially from deceased donors, in a state of encephalic death or after circulatory arrest. The ethical issues raised by these practices are strictly regulated. The Agence de la biomédecine, in conjunction with healthcare professionals and supervisory authorities, is the public operator in charge of organizing and developing the procurement activities. The volume of activity, severely disrupted by the Covid-19 pandemic, is now back on the rise. The 2022-2026 transplant plan sets ambitious but realistic targets to meet the needs of waiting patients.
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Affiliation(s)
- Laurent Durin
- Direction du prélèvement et de la greffe d'organes et de tissus, Agence de la biomédecine, 1 avenue du Stade-de-France, 93200 Saint-Denis La Plaine, France.
| | - Anne Bianchi
- Direction du prélèvement et de la greffe d'organes et de tissus, Agence de la biomédecine, 1 avenue du Stade-de-France, 93200 Saint-Denis La Plaine, France
| | - François Kerbaul
- Direction du prélèvement et de la greffe d'organes et de tissus, Agence de la biomédecine, 1 avenue du Stade-de-France, 93200 Saint-Denis La Plaine, France
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40
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Maroudy D. [Legal provisions governing organ and tissue donation in France]. Soins 2023; 68:16-20. [PMID: 37657864 DOI: 10.1016/j.soin.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
As an expression of the general will, the law makes organ removal and transplantation a lawful activity. The legislator makes them conditional on the primacy of the person, the inviolability of the body and the need for consent.
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Affiliation(s)
- Daniel Maroudy
- c/o Soins, 65 avenue Camille-Desmoulins, 92442 Issy-les-Moulineaux, France.
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Paquette ED, Ross LF, Chavez J, Frader JE. Refusals of the Determination of Death by Neurologic Criteria: A Mixed Methods Study of Physician Perspectives on Refusals Cases. Pediatr Crit Care Med 2023; 24:628-635. [PMID: 37125806 PMCID: PMC10440233 DOI: 10.1097/pcc.0000000000003246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Refusals to allow examination for determination of death by neurologic criteria (DNC) challenge pediatric physicians and create distress for medical teams and families of patients suspected to meet criteria for DNC. The objective of this study was to inquire about and assess experiences with such refusals from the perspective of physicians. DESIGN We conducted a mixed-methods survey and interview-based study to understand physicians' experiences with refusals. SETTING An online survey was sent to pediatric intensivists and neurologists; phone interviews were conducted in a subset. PATIENTS/PARTICIPANTS The study included 80 physician survey respondents and 12 interview physician respondents. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Refusals occur for many reasons regarding patients with both acute and progressive brain injury. The most common reasons were consistent in surveys and interviews and include "waiting on a miracle," not wanting to give up, religious objections and disbelief in brain death. Time was an important mediator in many cases. Physicians described several approaches to managing refusals, highlighting the impact on medical teams, distraction from other patients, and need for resources to support physicians. CONCLUSIONS Refusals may have important sociodemographic associations that should be considered in managing complex cases. Physicians seek more guidance in law and policies to manage refusals.
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Affiliation(s)
- Erin D Paquette
- Division of Critical Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Pritzker School of Law, by courtesy, Chicago, IL
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL
- University of Chicago MacLean Center for Clinical Medical Ethics, Chicago, IL
- Division of Palliative Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Lainie F Ross
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL
- University of Chicago MacLean Center for Clinical Medical Ethics, Chicago, IL
| | - Jairo Chavez
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joel E Frader
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Palliative Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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de Luzan IF, Vormbrock M, Merkel A, Smith-Steinert R. Evidence-Based Practice Guidelines for Organ Procurement. AANA J 2023; 91:291-297. [PMID: 37527169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Organ procurement is a complex and unique procedure that warrants the creation of an evidence-based practice guideline. Anesthesia care of the donor may adversely impact the fate of organs once transplanted. The following article gives a brief review of the literature, and a guideline for providing anesthesia during an organ procurement which was created for a large, level-one, academic facility. Care of the organ donor during the preoperative phase is frequently discussed in the literature; however, there remains a need for further information on the care of the organ donor intraoperatively.
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Affiliation(s)
| | | | - Andrea Merkel
- at the University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Rachel Smith-Steinert
- is an Associate Professor of Clinical Nursing and Assistant Program Director of the Nurse Anesthesia Program at the University of Cincinnati, Cincinnati, Ohio and a CRNA at University of Cincinnati Medical Center, Cincinnati, Ohio.
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Casillas-Ramírez A, Micó-Carnero M, Sánchez-González A, Maroto-Serrat C, Trostchansky A, Peralta C. NO-IL-6/10-IL-1β axis: a new pathway in steatotic and non-steatotic liver grafts from brain-dead donor rats. Front Immunol 2023; 14:1178909. [PMID: 37593740 PMCID: PMC10427871 DOI: 10.3389/fimmu.2023.1178909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023] Open
Abstract
Introduction Brain death (BD) and steatosis are both risk factors for organ dysfunction or failure in liver transplantation (LT). Material and methods Here, we examine the role of interleukin 6 (IL- 6) and IL-10 in LT of both non-steatotic and steatotic liver recovered from donors after brain death (DBDs), as well as the molecular signaling pathways underlying the effects of such cytokines. Results BD reduced IL-6 levels only in nonsteatotic grafts, and diminished IL-10 levels only in steatotic ones. In both graft types, BD increased IL-1β, which was associated with hepatic inflammation and damage. IL-6 administration reduced IL-1β only in non-steatotic grafts and protected them against damage and inflammation. Concordantly, IL-1β inhibition via treatment with an IL-1 receptor antagonist caused the same benefits in non-steatotic grafts. Treatment with IL-10 decreased IL-1β only in steatotic grafts and reduced injury and inflammation specifically in this graft type. Blockading the IL-1β effects also reduced damage and inflammation in steatotic grafts. Also, blockade of IL-1β action diminished hepatic cAMP in both types of livers, and this was associated with a reduction in liver injury and inflammation, then pointing to IL-1β regulating cAMP generation under LT and BD conditions. Additionally, the involvement of nitric oxide (NO) in the effects of interleukins was evaluated. Pharmacological inhibition of NO in LT from DBDs prompted even more evident reductions of IL-6 or IL-10 in non-steatotic and steatotic grafts, respectively. This exacerbated the already high levels of IL-1β seen in LT from DBDs, causing worse damage and inflammation in both graft types. The administration of NO donors to non-steatotic grafts potentiated the beneficial effects of endogenous NO, since it increased IL-6 levels, and reduced IL-1β, inflammation, and damage. However, treatment with NO donors in steatotic grafts did not modify IL-10 or IL-1β levels, but induced more injurious effects tan the induction of BD alone, characterized by increased nitrotyrosine, lipid peroxidation, inflammation, and hepatic damage. Conclusion Our study thus highlights the specificity of new signaling pathways in LT from DBDs: NO-IL-6-IL-1β in non-steatotic livers and NO-IL-10-IL-1β in steatotic ones. This opens up new therapeutic targets that could be useful in clinical LT.
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Affiliation(s)
- Araní Casillas-Ramírez
- Department of Teaching and Research Sub-Direction, Hospital Regional de Alta Especialidad de Ciudad Victoria “Bicentenario 2010”, Ciudad Victoria, Mexico
- Facultad de Medicina e Ingeniería en Sistemas Computacionales de Matamoros, Universidad Autónoma de Tamaulipas, Matamoros, Mexico
| | - Marc Micó-Carnero
- Department of Liver, Digestive System and Metabolism, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Alfredo Sánchez-González
- Department of Teaching and Research Sub-Direction, Hospital Regional de Alta Especialidad de Ciudad Victoria “Bicentenario 2010”, Ciudad Victoria, Mexico
| | - Cristina Maroto-Serrat
- Department of Liver, Digestive System and Metabolism, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrés Trostchansky
- Departamento de Bioquímica and Centro de Investigaciones Biomédicas (CEINBIO), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Carmen Peralta
- Department of Liver, Digestive System and Metabolism, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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Yang W, Liu T, Zhan C, Jiang H, Zhang W, Yang Q, Zheng X. Burkholderia cepacia Induced Occipital Subcutaneous Abscess and Fracture in a Brain-Dead Woman. Infect Drug Resist 2023; 16:4535-4538. [PMID: 37457794 PMCID: PMC10349569 DOI: 10.2147/idr.s418967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
Burkholderia cepacia is an aerobic opportunistic Gram-negative pathogen that mainly infects immunodeficiency patients. However, soft tissue infections with fractures due to Burkholderia cepacia are rare with no cases reported. Here, we report a rare case of 3 years of brain death in a 43-year-old woman with Burkholderia cepacia resulting in an occipital subcutaneous abscess and fracture. Through the second-generation sequencing of the whole genome of this strain, it was found that there were no high virulence genes and virulence factors. The patient received targeted antibiotic therapy and showed improvement in clinical symptoms and radiological signs. Bone destruction because of Burkholderia cepacia is easily overlooked due to the lack of characteristic symptoms and limited clinical examination. This case reminds us that Burkholderia cepacia without major virulence factors could damage the bone in immune-compromised patients.
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Affiliation(s)
- Wu Yang
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China
| | - Tingting Liu
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China
| | - Chun Zhan
- Department of Critical Care Medicine, Hang Zhou Integrative Medicine Hospital, Hangzhou, Zhejiang, 310000, People’s Republic of China
| | - Hui Jiang
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China
| | - Wang Zhang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China
| | - Qing Yang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China
| | - Xia Zheng
- Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, People’s Republic of China
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Finneran M, Lewis A. Engagement of a State Medical Society to Promote Uniform Hospital Policies on Determination of Brain Death. Neurohospitalist 2023; 13:283-284. [PMID: 37441205 PMCID: PMC10334044 DOI: 10.1177/19418744231167500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
There is a need for the neuroscience community to advocate for uniformity in the determination of brain death/death by neurologic criteria (BD/DNC). Engagement with state medical societies is one example of this type of advocacy. After determining that her hospital policy on determination of BD/DNC was unclear and inconsistent with accepted standards, the principal author submitted a resolution to the Illinois State Medical Society (ISMS) in an attempt to encourage consistency in institutional policies on the determination of BD/DNC across the state. ISMS ultimately approved a resolution on this topic, but it has some shortcomings, so its impact is unclear. Nonetheless, other neuroscience clinicians are encouraged to engage with their state medical societies to advocate for uniformity in the determination of BD/DNC.
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Affiliation(s)
- Megan Finneran
- Neurological Surgery, Carle BroMenn Medical Center, Normal, IL, USA
| | - Ariane Lewis
- Departments of Neurology and Neurosurgery, NYU Langone Medical Center, New York, NY, USA
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Bacuşcă AE, Tinică G, Enache M, Ţărus A, Hanganu B, Gavriluţă C, Ioan BG. Organ transplantation in Romania: challenges and perspectives. Med Pharm Rep 2023; 96:289-297. [PMID: 37577014 PMCID: PMC10419689 DOI: 10.15386/mpr-2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/15/2022] [Indexed: 08/15/2023] Open
Abstract
Introduction The interest in the field of organ transplantation and the first attempts at making experimental transplant interventions in Romania date from the very beginning of the 20th century. Nevertheless, the evolution of the donating activity and of organ transplantation in Romania has been confronted with a certain inconsistency and a lack of resources necessary to the development of the system. Method The aim of this study is to analyze the dynamics of the transplantation activity in Romania between 2000 and 2020. The study was accomplished through the analysis of available data corresponding to the above-mentioned period, which were published in the database of the National Transplant Agency, Eurostat and the Global Observatory on Donation and Transplantation. The data were processed using the MedCalc Statistical Software, version 14.8.1 (MedCalc Software bvba, Ostend, Belgium; http://www.medcalc.org; 2014). Results The activity of donation and organ transplantation in Romania has been maintained at a low level, with a rate of 3.44 donators pmp and a transplantation rate of 12.55 pmp, as reported for the year 2020. Romania remains at a transplantation rate of under 6.6 pmp, despite the considerable increase in the number of patients on the waiting lists, a fact which describes the picture of a relatively weak system, incapable of providing surgical interventions to cover the minimum needs that emerge within a calendar year. Conclusions Our study points to the fact that the transplantation system in Romania is confronted with a major deadlock. Romania holds the last-but-one place in the ranking of countries in the European Union on transplant activity. The major impediment is the donation rate, which continues to be way below the European average, in a society where the awareness of the necessity to donate is very low, bureaucracy is cumbersome and there is a high degree of mistrust in the medical system, where the equipment is lacking and the infrastructure is incapable of providing services adapted to the modern standards.
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Affiliation(s)
- Alberto Emanuel Bacuşcă
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, Iasi, Romania
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Grigore Tinică
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, Iasi, Romania
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Mihai Enache
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, Iasi, Romania
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Andrei Ţărus
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, Iasi, Romania
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Bianca Hanganu
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | | | - Beatrice Gabriela Ioan
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Institute of Legal Medicine, Iasi, Romania
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Zhao DX, Caturegli G, Wilcox C, Stephens RS, Kim BS, Keller S, Geocadin RG, Suarez JI, Whitman GJR, Cho SM. Challenges in determining death by neurologic criteria in extracorporeal membrane oxygenation - A single center experience. Perfusion 2023:2676591231187548. [PMID: 37387124 PMCID: PMC10756925 DOI: 10.1177/02676591231187548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Apnea test (AT) in patients on extracorporeal membrane oxygenation (ECMO) support is challenging, leading to variation in determining death by neurologic criteria (DNC). We aim to describe the diagnostic criteria and barriers for DNC in adults on ECMO in a tertiary care center. METHODS A retrospective review of a prospective observational standardized neuromonitoring study was conducted in adult VA- and VV-ECMO patients at a tertiary center from June 2016 to March 2022. Brain death was defined according to the 2010 American Academy of Neurology guidelines and following the 2020 World Brain Death Project recommendations for performing AT in ECMO patients. RESULTS Eight (2.7%) ECMO patients (median age = 44 years, 75% male, 50% VA-ECMO) met criteria for DNC, six (75%) of whom were determined with AT. In the other two patients who did not undergo AT due to safety concerns, ancillary tests (transcranial doppler and electroencephalography) were consistent with DNC. An additional seven (2.3%) patients (median age = 55 years, 71% male, 86% VA-ECMO) were noted to have absent brainstem reflexes but failed to complete determination of DNC as they underwent withdrawal of life-sustaining treatment (WLST) before a full evaluation was completed. In these patients, AT was never performed, and ancillary tests were inconsistent with either neurological exam findings and/or neuroimaging supporting DNC, or with each other. CONCLUSION AT was used safely and successfully in 6 of the 8 ECMO patients diagnosed with DNC and was always consistent with the neurological exam and imaging findings, as opposed to ancillary tests alone.
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Affiliation(s)
- David X Zhao
- Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Giorgio Caturegli
- Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher Wilcox
- Cardiovascular Surgery Intensive Care Unit, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - R. Scott Stephens
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bo Soo Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Keller
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Romergryko G. Geocadin
- Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jose I. Suarez
- Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Glenn JR Whitman
- Cardiovascular Surgery Intensive Care Unit, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sung-Min Cho
- Division of Neurosciences Critical Care, Departments of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Eerola V, Sallinen V, Lempinen M, Helanterä I. Association of Procurement Time With Pancreas Transplant Outcomes in Brain-Dead Donors. Transpl Int 2023; 36:11332. [PMID: 37470064 PMCID: PMC10353260 DOI: 10.3389/ti.2023.11332] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023]
Abstract
A brain-death-induced cytokine storm damages organs in an organ donor. However, a longer time period between declaration of brain death and organ procurement (procurement interval) is associated with improved outcomes in kidney, liver, heart, and lung transplantation. The aim of this study was to find the optimal procurement interval for pancreas transplantation. Association of procurement interval with pancreas graft outcomes was analyzed using multivariable models adjusted for variables possibly affecting procurement interval and outcomes. Altogether 10,119 pancreas transplantations were included from the Scientific Registry of Transplant Recipients. The median follow-up was 3.2 (IQR 1.01-6.50) years. During the first year, 832 (9.0%) grafts were lost, including 555 (6.0%) within the first 30 days. Longer procurement interval was associated with increased death-censored graft survival in a multivariable model (HR 0.944 95% CI 0.917-0.972, per 10-h increase, p < 0.001). A decreasing hazard of graft loss was observed also with 1-year, but not with 30-day graft survival. During 1-year follow-up, 953 (12.1%) patients had an acute rejection, and longer procurement interval was also associated with less acute rejections (OR 0.937 95% CI 0.900-0.976, per 10-h increase, p = 0.002) in the multivariable model. In conclusion, longer procurement interval is associated with improved long-term outcomes in pancreas transplantation.
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Alshammari A, Brown M. Attitudes That Might Impact upon Donation after Brain Death in Intensive Care Unit Settings: A Systematic Review. Healthcare (Basel) 2023; 11:1857. [PMID: 37444690 DOI: 10.3390/healthcare11131857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Organ donation and transplantation can save or improve the quality of life of people worldwide. However, there are many challenges associated with organ donation, as the demand for organs greatly outstrips supply. Additionally, there are brain-dead patients who could be potential organ donors. It is thus important to determine the attitudes affecting organ donation and transplantation in intensive care unit settings. AIM this study aimed to identify attitudes that might affect organ donation and transplantation in intensive care unit settings. METHODOLOGY Five electronic databases (CINAHL, Medline, PsycINFO, Scopus, and EMBASE) were searched systematically. A systematic search strategy was formulated. The quality of each study was assessed using the MMAT quality appraisal tool. RESULTS A total of seven studies were included. The findings of this systematic review demonstrate that education, policy, and continuing professional development could help to address barriers to donation. CONCLUSIONS therefore, to influence organ donation and transplantation positively, the main themes evaluated in this systematic review provide an opportunity to influence organ donation and transplantation attitudes in intensive care unit settings.
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Affiliation(s)
- Areej Alshammari
- Northern Area Armed Forces Hospital, Hafar Albatin, King Khaild Military City 39748, Saudi Arabia
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Michael Brown
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL, UK
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Latifi M, Pourhosein E, Rahban H, Khajavi M, Dehghani S. The Impact of Heparin Therapy in Deceased Donors on Early Graft Survival for Kidney and Liver Recipients: A Clinical Trial Study. Front Biosci (Schol Ed) 2023; 15:7. [PMID: 37401509 DOI: 10.31083/j.fbs1502007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/19/2023] [Accepted: 06/08/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Significant hemodynamic, hormonal, and metabolic impairment of a brain-dead organ donor is often associated with the deterioration of graft viability. This study aimed to compare the effect of heparin therapy as a therapeutic dose after brain death confirmation on early graft survival in kidney and liver recipients. METHOD AND MATERIALS The deceased donors were sorted into two groups based on their D-dimer level. After confirming brain death, one group was given a heparin injection (case group), while the other group did not receive any heparin (control group). A total of 71 brain death donors and matched kidney and liver transplants were included in the case group. A total of 43 brain death donors and matched kidney and liver transplants were included in the control group. A total of 5000 units of heparin were administered every 6 hours to the deceased donor case group. RESULTS The mean age of the case and control groups were 36.27 ± 16.13 and 36.15 ± 18.45, respectively. An independent t test showed that there were no differences between the number of procured organs in both groups (p = 0.29). There was no significant difference between the graft survival rate and the doses of heparin injection to the liver recipients (p = 0.06). However, a significant difference was revealed between the graft survival rate and the dose of heparin injection (p = 0.004) in kidney recipients. CONCLUSIONS The data suggest that administering low therapeutic doses of heparin to donors before organ donation may potentially prevent thrombosis and provide a protective benefit. We showed that heparin therapy had no significant effect on the number of donated organs and graft survival.
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Affiliation(s)
- Marzieh Latifi
- Medical Ethics and Law Research Center, Shaheed Beheshti University of Medical Sciences, 1985717443 Tehran, Iran
| | - Elahe Pourhosein
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, 46911 Tehran, Iran
| | - Habib Rahban
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA 90210, USA
- Southern California Medical Education Consortium, Temecula Valley Hospital, Universal Health System, Temecula, CA 92592, USA
| | - Mohammadreza Khajavi
- Anesthesia, Critical Care and Pain Management Research Center, Tehran University of Medical Sciences, 1136746911 Tehran, Iran
| | - Sanaz Dehghani
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, 46911 Tehran, Iran
- Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, 1419733141 Tehran, Iran
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