Changing Pattern of Organ Donation at a Single Center: Are Potential Brain Dead Donors Being Lost to Donation After Cardiac Death?

Saidi, Reza F.; Bradley, James W.; Greer, David M.; Luskin, Richard S.; OʼConnor, Kevin; Delmonico, Francis L.; Kennealey, Peter; Pathan, F.; Schuetz, Christian; Elias, Nahel; Ko, Dicken S.C.; Kawai, Tatsuo; Hertl, Martin; Cosimi, A. Benedict; Markmann, James F.

doi:10.1111/j.1600-6143.2010.03215.x

Cited by 50 publications

(46 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Most donors fall into the "marginal" category, which negatively affects islet yield and potency. The use of donors that have succumbed to cardiac death, more generally accepted in the Netherlands, have yielded successful outcomes in some centers, most notably the University of Pittsburgh (Markmann et al 2003;Saidi et al 2010). Living donors are used in many transplant programs including those performing liver and kidney graft transplants but have failed to gain popularity in islet transplantation, or indeed in segmental vascularized pancreas transplantation although technically possible (as shown by Sutherland and the Minnesota group).…”

Section: Pancreas Donor Access and Selectionmentioning

confidence: 99%

Update on Islet Transplantation

McCall

Shapiro²

2012

Cold Spring Harbor Perspectives in Medicine

192

147

View full text Add to dashboard Cite

Clinical islet transplantation has progressed considerably over the past 12 years, and .750 patients with type 1 diabetes have received islet transplants internationally over this time. Many countries are beginning to accept the transition from research to accepted and funded clinical care, especially for patients with brittle control that cannot be stabilized by more conventional means. Major challenges remain, including the need for more than one donor, and the requirement for potent, chronic immunosuppression. Combining immunological tolerance both to allo-and autoantigens, and a limitless expandable source of stem cell-or xenograft-derived insulin-secreting cells represent remaining hurdles in moving this effective treatment to a potential cure for all those with type 1 or 2 diabetes.

show abstract

Section: Pancreas Donor Access and Selectionmentioning

confidence: 99%

Update on Islet Transplantation

McCall

Shapiro²

2012

Cold Spring Harbor Perspectives in Medicine

192

147

View full text Add to dashboard Cite

show abstract

“…49 Our data support the declining rate of DNDD as DCDD is increasing, in agreement with several other recent reports. 50,51 However, when the question of altered medical decision-making was studied directly in children, the option of DCDD did not affect the number of patients who eventually donated organs after meeting neurologic criteria for death. 23 Clearly, the decline in DNDD donors has been affected by major medical advances, preventive health measures, and traffic safety improvements, resulting in fewer patients progressing to brain death.…”

Section: Figurementioning

confidence: 99%

Pediatric Organ Donation and Transplantation

et al. 2013

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: There is increasing unmet need for solid organ donation. Alternative donor sources, such as donation after circulatory determination of death (DCDD), are needed. The objective of this study was to examine the impact of DCDD on trends in pediatric organ donation and transplantation. METHODS: Data were obtained from the Organ Procurement and Transplantation Network for US organ recipients and donors from 2001 to 2010 stratified according to age, organ, and deceased donor type (DCDD or donation after neurologic determination of death). Additional data included transplant wait-list removals due to death. RESULTS: From 2001 to 2010, pediatric organ transplant recipients increased from 1170 to 1475. Organs from DCDD donors were transplanted into children infrequently but increased from 1 to 31. Pediatric donation after neurologic determination of death decreased by 13% whereas DCDD increased by 174% (50 to 137). Recipients of pediatric grafts decreased from 3042 to 2751. Adults receiving grafts from pediatric donors decreased from 2243 to 1780; children receiving pediatric grafts increased from 799 to 971. Transplant recipients receiving pediatric DCDD grafts were few but increased annually from 50 to 128 adults and 0 to 9 children. Pediatric candidates dying waiting for an organ decreased from 262 to 110. CONCLUSIONS: From 2001 to 2010, children received more solid organ transplants and fewer children died waiting. Organ recovery from pediatric and adult DCDD donors increased. The number of pediatric recipients of DCDD grafts remains small. Adults primarily receive the direct benefit from pediatric DCDD but other changes in organ allocation have directly benefited children.

show abstract

“…Recent publications point to a trend toward increased numbers of DCD donors. [14][15][16] Advances in the last decade in trauma care and neurosurgical and neuroradiological interventions immediately after brain injury may result in improved initial survival of patients. As a result, patients who are to become organ donors are increasingly not meeting brain death criteria.…”

mentioning

confidence: 99%

Early allograft dysfunction in liver transplantation using donation after cardiac death donors results in inferior survival

et al. 2014

View full text Add to dashboard Cite

Donation after cardiac death (DCD) liver allografts have been associated with increased morbidity from primary nonfunction, biliary complications, early allograft failure, cost, and mortality. Early allograft dysfunction (EAD) after liver transplantation has been found to be associated with inferior patient and graft survival. In a cohort of 205 consecutive liver-only transplant patients with allografts from DCD donors at a single center, the incidence of EAD was found to be 39.5%. The patient survival rates for those with no EAD and those with EAD at 1, 3, and 5 years were 97% and 89%, 79% and 79%, and 61% and 54%, respectively (P 5 0.009). Allograft survival rates for recipients with no EAD and those with EAD at 1, 3, and 5 years were 90% and 75%, 72% and 64%, and 53% and 43%, respectively (P 5 0.003). A multivariate analysis demonstrated a significant association between the development of EAD and the cold ischemia time [odds ratio (OR) 5 1.26, 95% confidence interval (CI) 5 1.01-1.56, P 5 0.037] and hepatocellular cancer as a secondary diagnosis in recipients (OR 5 2.26, 95% CI 5 1.11-4.58, P 5 0.025). There was no correlation between EAD and the development of ischemic cholangiopathy. In conclusion, EAD results in inferior patient and graft survival in recipients of DCD liver allografts. Understanding the events that cause EAD and developing preventive or early therapeutic approaches should be the focus of future investigations. Liver Transpl 20:1447-1453, 2014. V C 2014 AASLD.Received March 28, 2014; accepted August 7, 2014.The success of liver transplantation (LT) has expanded its therapeutic utility and necessitated the increased use of marginal donors to meet the growing demand. To understand the impact of these marginal organs, a clinical tool for identifying early allograft dysfunction (EAD) has been previously described by multiple groups. 1-4 A simple definition (characterized by high early aminotransferase levels, persistent cholestasis, and prolonged coagulopathy in the first week after LT) has previously been validated in a multicenter retrospective review of 297 LT recipients of liver allografts from both donation after brain death (DBD) and donation after cardiac death (DCD) donors. 5 This clinical tool has served as a marker for an increased risk of mortality, morbidity, allograft failure, and cost. 6 EAD has also become a target for therapeutic intervention to reduce morbidity and mortality in LT. [7][8][9] To date, there has been no published study delineating the incidence of and risk factors for EAD specifically in the recipients of liver allografts from DCD donors.Liver allografts from DCD donors are considered inferior because of an overall increased rate of allograft failure. [10][11][12] For this type of donor, the declaration of death is based on cardiopulmonary criteria

show abstract

Changing Pattern of Organ Donation at a Single Center: Are Potential Brain Dead Donors Being Lost to Donation After Cardiac Death?

Cited by 50 publications

References 16 publications

Update on Islet Transplantation

Update on Islet Transplantation

Pediatric Organ Donation and Transplantation

Early allograft dysfunction in liver transplantation using donation after cardiac death donors results in inferior survival

Contact Info

Product

Resources

About