A Colloquium on the Congress “A Gift for Life. Considerations on Organ Donation”

Costa, Alessandro Nanni; Castellví, JM; Spagnolo, Antonio G.; Comoretto, Nunziata; Laffitte, Jean; Gäbel, H; Delmonico, Francis L.; Muehlbacher, Ferdinand; Schaupp, Walter; Glazier, Alexandra K.; Garcı́a, Valter Duro; Abbud-Filho, Mário; Medina‐Pestana, José Osmar; Grainer, Mariangela Gritta; Donadio, P.P.; Guermani, A.; Bosco, Riccardo; Giordano, Francesco; Arroyabe, Blanca Martinez Lopez De; Brunetti, Marco; Manyalich, M.; Páez, Gloria; Valero, Ricard; Matesanz, Rafael; Coll, Elisabeth; Domínguez‐Gil, Beatriz; Mahíllo, Beatriz; Escobar, Eduardo Martín; Garrido, G.; Cantarovich, F

doi:10.1097/tp.0b013e3181b66576

Cited by 10 publications

(9 citation statements)

References 137 publications

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“…In contrast, it has been estimated that around one million people need a transplant nowadays (2). This organ shortage is one of the main obstacles for the full expansion of transplantation therapies.…”

Section: Introductionmentioning

confidence: 99%

“…Specifically focused on the process of donation after brain death (DBD), it was developed with three objectives: (1) to estimate the potential of deceased donation; (2) to evaluate performance in the process, analyzing the reasons for losing potential donors, as a tool to identify areas for improvement; and (3) to describe hospital factors with impact on the aforementioned areas.…”

Section: Introductionmentioning

confidence: 99%

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Continuously Evaluating Performance in Deceased Donation: The Spanish Quality Assurance Program

Rosa

Domínguez‐Gil

Matesanz

et al. 2012

American Journal of Transplantation

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The Spanish Quality Assurance Program applied to the process of donation after brain death entails an internal stage consisting of a continuous clinical chart review of deaths in critical care units (CCUs) performed by transplant coordinators and periodical external audits to selected centers. This paper describes the methodology and provides the most relevant results of this program, with information analyzed from 206,345 CCU deaths. According to the internal audit, 2.3% of hospital deaths and 12.4% of CCU deaths in Spain yield potential donors (clinical criteria consistent with brain death). Out of the potential donors, 54.6% become actual donors, 26% are lost due to medical unsuitability, 13.3% due to refusals to donation, 3.1% due to maintenance problems and 3% due to other reasons. Although the national pool of potential donors after brain death has progressively decreased from 65.2 per million population (pmp) in 2001 to 49 pmp in 2010, the number of actual donors after brain death has remained at about 30 pmp. External audits reveal that the number of actual donors could be 21.6% higher if all potential donors were identified and preventable losses avoided. We encourage other countries to develop similar comprehensive approaches to deceased donation performance.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Continuously Evaluating Performance in Deceased Donation: The Spanish Quality Assurance Program

Rosa

Domínguez‐Gil

Matesanz

et al. 2012

American Journal of Transplantation

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“…This paper aims to describe the quantitative phase of the aforementioned benchmarking project, i.e. the methodology applied to identify procurement hospitals with the best results in the donation after brain death process: (1) what indicators were used to evaluate the results and (2) how they were compared.…”

Section: Introductionmentioning

confidence: 99%

“…Although it is estimated that up to 1 million people need an organ transplant, only 100 000 procedures are performed yearly worldwide (1,2). Even in Spain, with the highest deceased donation rates ever described for a large country, organ availability is insufficient to cover the demand for transplantation.…”

Section: Introductionmentioning

confidence: 99%

Benchmarking in the Process of Donation After Brain Death: A Methodology to Identify Best Performer Hospitals

Matesanz

Coll

Domínguez‐Gil

et al. 2012

American Journal of Transplantation

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“…Some authors believe that severely brain-injured patients who are dependent on mechanical ventilation but do not meet criteria for brain death are good candidates for NHB organ donation and that terminal sedation is a component of the care given to these NHB donors [41]. French organ donation authorities consider that there can be a conflict of interest between treatment limitation and organ donation and have instituted a moratorium for organ harvesting from Maastricht III patients.…”

Section: Difficulties Concerns and Reservationsmentioning

confidence: 99%

The ethical and legal aspects of palliative sedation in severely brain-injured patients: a French perspective

Baumann

Claudot

Audibert

et al. 2011

Philos Ethics Humanit Med

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To fulfill their crucial duty of relieving suffering in their patients, physicians may have to administer palliative sedation when they implement treatment-limitation decisions such as the withdrawal of life-supporting interventions in patients with poor prognosis chronic severe brain injury. The issue of palliative sedation deserves particular attention in adults with serious brain injuries and in neonates with severe and irreversible brain lesions, who are unable to express pain or to state their wishes. In France, treatment limitation decisions for these patients are left to the physicians. Treatment-limitation decisions are made collegially, based on the presence of irreversible brain lesions responsible for chronic severe disorders of consciousness. Before these decisions are implemented, they are communicated to the relatives. Because the presence and severity of pain cannot be assessed in these patients, palliative analgesia and/or sedation should be administered. However, palliative sedation is a complex strategy that requires safeguards to prevent a drift toward hastening death or performing covert euthanasia. In addition to the law on patients' rights at the end of life passed in France on April 22, 2005, a recent revision of Article 37 of the French code of medical ethics both acknowledges that treatment-limitation decisions and palliative sedation may be required in patients with severe brain injuries and provides legal and ethical safeguards against a shift towards euthanasia. This legislation may hold value as a model for other countries where euthanasia is illegal and for countries such as Belgium and Netherlands where euthanasia is legal but not allowed in patients incapable of asking for euthanasia but in whom a treatment limitation decision has been made.

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A Colloquium on the Congress “A Gift for Life. Considerations on Organ Donation”

Cited by 10 publications

References 137 publications

Continuously Evaluating Performance in Deceased Donation: The Spanish Quality Assurance Program

Continuously Evaluating Performance in Deceased Donation: The Spanish Quality Assurance Program

Benchmarking in the Process of Donation After Brain Death: A Methodology to Identify Best Performer Hospitals

The ethical and legal aspects of palliative sedation in severely brain-injured patients: a French perspective

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