RESUMO
OBJECTIVES: to analyze the trends and factors associated with family refusal of skin donation for transplantation. METHODS: this cross-sectional study was conducted in the State of São Paulo, with family authorization terms collected from 2001 to 2020. The variables analyzed included year, age, gender, cause of death, and type of institution. Data were analyzed using linear and multiple logistic regression, with the Odds Ratio estimated at p<0.05 for statistical significance. RESULTS: 1,355 individuals refused skin donation. The trend of refusals decreased between 2001 and 2009 in the age groups of 0-11 years and 12-19 years, but increased in the group aged ≥60 years. This trend continued to decrease in the 0-11 years group from 2010 to 2020, and increased in the 20-40 years group. Males and the age groups of 20-40 years, 41-59 years, and ≥60 years exhibited 27%, 34%, 47%, and 53% lower chances of refusal, respectively. CONCLUSIONS: there is an urgent need for measures to mitigate the high number of refusals associated with skin donation.
Assuntos
Família , Obtenção de Tecidos e Órgãos , Humanos , Estudos Transversais , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Brasil , Adolescente , Criança , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/tendências , Obtenção de Tecidos e Órgãos/métodos , Família/psicologia , Pré-Escolar , Lactente , Doadores de Tecidos/psicologia , Doadores de Tecidos/estatística & dados numéricos , Transplante de Pele/estatística & dados numéricos , Transplante de Pele/tendências , Transplante de Pele/métodos , Transplante de Pele/psicologia , Idoso , Modelos LogísticosRESUMO
BACKGROUND: Thoracoabdominal normothermic regional perfusion (TA-NRP) has emerged as a powerful technique for optimizing organ procurement from donation after circulatory death donors. Despite its rapid adoption, standardized guidelines for TA-NRP implementation are lacking, prompting the need for consensus recommendations to ensure safe and effective utilization of this technique. METHODS: A working group composed of members from The American Society of Transplant Surgeons, The International Society of Heart and Lung Transplantation, The Society of Thoracic Surgeons, and The American Association for Thoracic Surgery was convened to develop technical guidelines for TA-NRP. The group systematically reviewed existing literature, consensus statements, and expert opinions to identify key areas requiring standardization, including predonation evaluation, intraoperative management, postdonation procedures, and future research directions. RESULTS: The working group formulated recommendations encompassing donor evaluation and selection criteria, premortem testing and therapeutic interventions, communication protocols, and procedural guidelines for TA-NRP implementation. These recommendations aim to facilitate coordination among transplant teams, minimize variability in practice, and promote transparency and accountability throughout the TA-NRP process. CONCLUSIONS: The consensus guidelines presented herein serve as a comprehensive framework for the successful and ethical implementation of TA-NRP programs in organ procurement from donation after circulatory death donors. By providing standardized recommendations and addressing areas of uncertainty, these guidelines aim to enhance the quality, safety, and efficiency of TA-NRP procedures, ultimately contributing to improved outcomes for transplant recipients.
Assuntos
Consenso , Preservação de Órgãos , Perfusão , Humanos , Perfusão/normas , Perfusão/métodos , Preservação de Órgãos/normas , Preservação de Órgãos/métodos , Doadores de Tecidos/provisão & distribuição , Transplante de Órgãos/normas , Transplante de Órgãos/métodos , Seleção do Doador/normas , Obtenção de Tecidos e Órgãos/normas , Obtenção de Tecidos e Órgãos/métodosRESUMO
Introdução: O processo de doação de órgãos e tecidos é definido por ações a fim de transformar um Potencial Doador (PD) em doador efetivo e inicia-se com o diagnóstico de morte encefálica. Objetivo: Analisar o perfil clínico e sociodemográfico dos potenciais doadores de órgãos, como também os fatores que influenciam na doação de órgãos. Métodos: Trata-se de uma pesquisa quantitativa, transversal, retrospectiva e analítica realizada através da coleta de dados de 455 prontuários de pacientes com diagnóstico de Morte Encefálica, de uma Região do Nordeste brasileiro, utilizando formulário estruturado. Posteriormente realizaram-se análises descritivas e nas associações entre as variáveis independentes e dependente, utilizou-se o teste qui-quadrado de Pearson Resultados: As faixas etárias de maior incidência foram entre 21 a 40 anos e 41 a 60 anos, com 33,8% cada, prevalecendo o sexo masculino (64,1%). Em relação à causa da morte, predominou o Trauma Cranioencefálico com 36,5%. Foram entrevistados 83,3% dos familiares e desses, 53,5% autorizaram a doação. Quanto à relação das respostas das entrevistas com os familiares e o sexo dos PD o sexo masculino se destacou com 59,01% das entrevistas positivas, quanto a entrevista e faixa etária, não foram encontradas diferenças significativas. Correlacionando o resultado das entrevistas familiares e a causa da morte, 40,63% destas tinham como causa o trauma cranioencefálico, e desse total, 63,63% tiveram a doação autorizada. Conclusão: A maioria dos doadores efetivos foram jovens e do sexo masculino, com prevalência do trauma craneoencefálico como causa da morte encefálica e da aceitação familiar para a doação.
Introducción: El proceso de donación de órganos y tejidos se define por las acciones encaminadas a transformar a una persona donante potencial (DP) en donante efectiva. Este proceso comienza con el diagnóstico de muerte encefálica. Objetivo: Analizar el perfil clínico y sociodemográfico de potenciales donantes de órganos, así como los factores que influyen en la donación de órganos. Métodos: Se trata de una investigación cuantitativa, transversal, retrospectiva y analítica realizada a partir de la recopilación de datos de 455 prontuarios de pacientes con diagnóstico de muerte encefálica, en una región del Nordeste de Brasil, utilizando un formulario estructurado. Posteriormente, se realizaron análisis descriptivos y, en las asociaciones entre las variables independiente y dependiente, se utilizó la prueba chi-cuadrado de Pearson Resultados: Los grupos de edad con mayor incidencia fueron de 21 a 40 años y de 41 a 60 años, con un 33.8 % cada uno, con predominio del sexo masculino (64.1 %). En cuanto a la causa de muerte, predominó el trauma craneoencefálico con un 36.5 %. Se entrevistó al 83.3 % de familiares y, de este grupo, el 53.5 % autorizó la donación. En cuanto a la relación entre las respuestas de las entrevistas a familiares y el sexo del TP, se destacó el sexo masculino con un 59.01 % de las entrevistas positivas; en cuanto a la entrevista y grupo de edad no se encontraron diferencias significativas. Correlacionando los resultados de las entrevistas familiares y la causa de muerte, el 40.63 % fue por trauma craneoencefálico y, de ese total, el 63.63 % tenía autorizada la donación. Conclusión: Los donantes más efectivos fueron jóvenes y varones, con predominio del traumatismo craneoencefálico como causa de muerte encefálica y aceptación familiar de la donación.
Introduction: The process of organ and tissue donation is defined by actions to transform a Potential Donor (PD) into an effective donor and begins with the diagnosis of brain death. Objective: To analyze the clinical and sociodemographic profile of potential organ donors, as well as the factors that influence organ donation. Methods: This is a quantitative, cross-sectional, retrospective, and analytical research carried out in a region of Northeast Brazil by collecting data from 455 medical records of patients with brain death, who were diagnosed using a structured form. Subsequently, descriptive analyzes were carried out and for the associations between the independent and dependent variables, the Pearson's chi-square test was used. Results: The age groups with the highest incidence were between 21 to 40 years old and 41 to 60 years old, with a 33.8 % each, with a predominance of males (64.1%). Regarding the cause of death, traumatic brain injury was the most common with a 36.5% of the sample. From the 83.3% of the family members that were interviewed, 53.5% of them authorized the donation. Male potential donors constituted the 59.01% of the authorized donations (positive interviews). There was no relationship between the interview results and the age group of the PD. When correlating the results of family interviews and the cause of death, 40.63% of them were caused by traumatic brain injury and, out of this total, 63.63% had the donation authorized. Conclusion: The most effective donors were young and male whose cause of brain death was traumatic brain injury and whose families allowed the donation.
Assuntos
Humanos , Transplante , Obtenção de Tecidos e Órgãos/métodos , Doadores de Tecidos/estatística & dados numéricos , BrasilRESUMO
BACKGROUND: Living donor liver transplantation (LDLT) continues to be the primary modality of liver transplantation in Asia, but it accounts for about 5% of all liver transplantations in the US. ABO incompatibility is the primary reason motivated donors are declined. Although kidney paired exchanges are common, liver paired exchange (LPE) is still evolving in the US. STUDY DESIGN: This is a retrospective review (between January 1, 2019, and July 31, 2021) of our initial experience with LPE. RESULTS: A total of 10 LPEs (20 LDLTs) were performed during the study period. Seven LPEs were initiated by a nondirected O donor. The other 3 pair sets involved 1 ABO compatible and 1 ABO incompatible pair. Transplantations in a pair set were completed within a mean of 4.8 (range 1-14) days of each other. All 20 donors are doing well with no major complications at 12.7 (range 1-20) months. Seventeen of 20 recipients are alive and have good allograft function. One recipient died in the early postoperative period. Two late deaths of patients with functioning allografts were due to COVID-19 (at 8 months) and peritoneal carcinomatosis and gram-negative sepsis (at 9 months). CONCLUSIONS: LPE is feasible in a high-volume LDLT center and is a useful option to increase LDLT by overcoming ABO incompatibility. Nondirected donors can be utilized to initiate an LPE.
Assuntos
Transplante de Fígado/estatística & dados numéricos , Doadores Vivos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/métodos , Sistema ABO de Grupos Sanguíneos , Adolescente , Adulto , Idoso , Incompatibilidade de Grupos Sanguíneos , COVID-19/mortalidade , Causas de Morte , Feminino , Humanos , Rim , Doadores Vivos/provisão & distribuição , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Transplantados/estatística & dados numéricos , Adulto JovemRESUMO
INTRODUCTION: Several clinical studies have demonstrated the safety, feasibility, and efficacy of machine perfusion in liver transplantation, although its economic outcomes are still underexplored. This review aimed to examine the costs related to machine perfusion and its associated outcomes. METHODS: Expert opinion of several groups representing different machine perfusion modalities. Critical analysis of the published literature reporting the economic outcomes of the most used techniques of machine perfusion in liver transplantation (normothermic and hypothermic ex situ machine perfusion and in situ normothermic regional perfusion). RESULTS: Machine perfusion costs include disposable components of the perfusion device, perfusate components, personnel and facility fees, and depreciation of the perfusion device or device lease fee. The limited current literature suggests that although this upfront cost varies between perfusion modalities, its use is highly likely to be cost-effective. Optimization of the donor liver utilization rate, local conditions of transplant programs (long waiting list times and higher MELD scores), a decreased rate of complications, changes in logistics, and length of hospital stay are potential cost savings points that must highlight the expected benefits of this intervention. An additional unaccounted factor is that machine perfusion optimizing donor organ utilization allows patients to be transplanted earlier, avoiding clinical deterioration while on the waiting list and the costs associated with hospital admissions and other required procedures. CONCLUSION: So far, the clinical benefits have guided machine perfusion implementation in liver transplantation. Albeit there is data suggesting the economic benefit of the technique, further investigation of its costs to healthcare systems and society and associated outcomes is needed.
Assuntos
Transplante de Fígado/economia , Perfusão/economia , Análise Custo-Benefício , Humanos , Transplante de Fígado/métodos , Perfusão/métodos , Obtenção de Tecidos e Órgãos/economia , Obtenção de Tecidos e Órgãos/métodosRESUMO
El donar oÌrganos, se considera un acto voluntario, altruista y gratuito, por el cual una persona o el representante de su familia deciden "donar" sus oÌrganos, para que sean extraiÌdos del cuerpo e implantados en otra persona que lo necesite. Sin embargo, existen varios factores que afectan de manera negativa o positiva al momento de tomar una decisioÌn frente a la donacioÌn de oÌrganos, teniendo un rol fundamental la estrategia de difusioÌn utilizada para difundir informacioÌn a la comunidad respecto a la donacioÌn de oÌrganos. El objetivo de esta revisioÌn de literatura, fue conocer las estrategias utilizadas en programas y/o intervenciones en Salud sobre la donacioÌn de oÌrganos. Se realizoÌ una RevisioÌn bibliograÌfica Narrativa utilizando las bases de datos PubMed y Google AcadeÌmico, siendo seleccionados los artiÌculos para anaÌlisis de acuerdo al cumplimiento de criterio de inclusioÌn y exclusioÌn en los uÌltimos 5 anÌos. El 44% de los programas de donacioÌn de oÌrganos utilizoÌ la paÌgina Web como estrategia de difusioÌn, el 39% utilizoÌ educacioÌn en aulas y el 33% utilizoÌ videos educativos, capacitacioÌn de personal de salud y uso de folletos. Las estrategias implementadas para la difusioÌn de informacioÌn maÌs usadas y efectivas son la educacioÌn en aulas y el uso de Web.
Organ donation is considered a voluntary, altruistic, and free act by which a person or the representative of the family decided to "donate" their organs to be removed from the body and implanted in another person in need. However, there are several factors that negatively or positively affect the decision to donate organs. This literature review's objective was to know the strategies used in health programs and organ donation interventions. A Narrative Literature Review was carried out using PubMed and Google Scholar databases, selecting articles for analysis according to the fulfillment of inclusion and exclusion criteria in the last 5 years. The most used strategies were the use of web pages (44%) and the implementation of face-to-face education (39%). 44% of the organ donation programs used the Web page as a dissemination strategy, 39% used classroom education, and 33% used educational videos, training of health personnel, use of brochures. The most used and effective methods were classroom education and the use of the Web.
Assuntos
Humanos , Obtenção de Tecidos e Órgãos/métodos , Disseminação de Informação/métodos , Estratégias de Saúde , Participação SocialRESUMO
BACKGROUND: Donors with drowning or asphyxiation (DA) as a mechanism of death (MOD) are considered high risk in pediatric lung transplantation. We sought to evaluate whether recipients of DA donors had negatively impacted outcomes. METHODS: Pediatric recipients recorded in the United Network for Organ Sharing registry between 2000 and 2019 were included. Primary stratification was donor MOD. Propensity matching with a 1:1 ratio was performed to balance the DA and non-DA MOD donor cohorts. Cox multivariable regression was used to determine the risk-adjusted impact of donor MOD. A subanalysis of the effect of lung allocation score was also evaluated. RESULTS: A total of 1016 patients underwent bilateral lung transplantation during the study period, including 888 (85.6%) from non-DA donors and 128 (14.4%) from DA donors. Survival at 90 days, 1 year, and 2 years were similar in the matched and unmatched cohorts regardless of the donor MOD. Moreover, separate risk-adjusted analysis of drowning and asphyxiated donors was similar to other MOD donors at 30 days, 1 year, and 5 years. Similar survival findings persisted regardless of pretransplant lung allocation score. Although the rates of posttransplant stroke (1.0% versus 3.1%, P = 0.04) and the length of hospital stay (19 versus 22 d, P = 0.004) were elevated in the unmatched DA MOD recipients, these differences were mitigated after propensity matching. CONCLUSIONS: This study evaluated the impact of DA MOD donors in pediatric lung transplant recipients and found similar rates of complications and survival in a propensity-matched cohort. These data collectively support the consideration of DA MOD donors for use in pediatric lung transplantation.
Assuntos
Asfixia , Afogamento , Transplante de Pulmão , Sistema de Registros , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Transplantados , Fatores Etários , Criança , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: The quality of clinical care of brain-dead potential organ donors may help reduce donor losses caused by irreversible or unreversed cardiac arrest and increase the number of organs donated. We sought to determine whether an evidence-based, goal-directed checklist for donor management in intensive care units (ICUs) can reduce donor losses to cardiac arrest. METHODS/DESIGN: The DONORS study is a multicentre, cluster-randomised controlled trial with a 1:1 allocation ratio designed to compare an intervention group (goal-directed checklist for brain-dead potential organ donor management) with a control group (standard ICU care). The primary outcome is loss of potential donors due to cardiac arrest. Secondary outcomes are the number of actual organ donors and the number of solid organs recovered per actual donor. Exploratory outcomes include the achievement of relevant clinical goals during the management of brain-dead potential organ donors. The present statistical analysis plan (SAP) describes all primary statistical procedures that will be used to evaluate the results and perform exploratory and sensitivity analyses of the trial. DISCUSSION: The SAP of the DONORS study aims to describe its analytic procedures, enhancing the transparency of the study. At the moment of SAP subsmission, 63 institutions have been randomised and were enrolling study participants. Thus, the analyses reported herein have been defined before the end of the study recruitment and database locking. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03179020. Registered on 7 June 2017.
Assuntos
Lista de Checagem/métodos , Interpretação Estatística de Dados , Obtenção de Tecidos e Órgãos/métodos , Obtenção de Tecidos e Órgãos/organização & administração , Morte Encefálica/diagnóstico , Brasil , Medicina Baseada em Evidências , Humanos , Unidades de Terapia Intensiva , Estudos Multicêntricos como Assunto , Avaliação de Resultados em Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Little has changed in donor management and liver utilization rates in Brazil over the last decade. With a growing demand for liver donations, organ waste is an important obstacle toward better patient care. The study of discarded donors helps to shed light on the possibilities of increasing organ usage, including by using extended criteria donors. METHODS: We retrospectively analyzed all discarded liver donors in a high-volume Brazilian transplant center from January 2015 to December 2018. Pertinent clinical and laboratorial data were collected from the donors' electronic health records. RESULTS: In our study period, there were 248 liver harvests, of which 67 (27.0%) were discarded. Most discarded donors were male (65.7%). More than three-quarters of donors were Caucasian (79.1%). Median donor body mass index was 26.27 kg/m2, and most discarded donors presented no comorbidities. Donor liver injury tests were abnormal in 56 (83.5%) out of 67 discarded donors. Forty-three (64.1%) donors presented elevated transaminases. Alanine aminotransferase levels were elevated in 35 (52.2%) discarded donors, with a median value of 38 U/L. Half of all discarded livers were due to graft-related issues. Twenty-eight organs (41.79%) presented external pathologic alterations. Organ refusal due to donor clinical and laboratorial condition was reported in 24 cases. CONCLUSION: It is clear there is a considerable issue of organ waste in Brazil, with the subjective judgment of graft quality and inadequate interpretation of donor's laboratorial exams leading to excessive denial of organs that could be fitted into extended criteria for donation.