First Organ Donation after Circulatory Death Following Withdrawal of Life-sustaining Treatment in Korea: a Case Report

Jeong, Eunsil; Baik, Seung Min; Park, Hoonsung; Oh, Jaesook; Lee, Yongmin; Lee, Jae Myeong

doi:10.3346/jkms.2021.36.e171

Cited by 8 publications

(4 citation statements)

References 8 publications

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“…In South Korea, organ donation after circulatory death following the withdrawal of LST, but not considered to be brain dead, is not permitted. However, there have been recent efforts to implement the possibility of organ donation after circulatory death, specifically following the withdrawal of LST 17,34) . There is a need to discuss organ donation in patients with circulatory death after LST withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021

Kim¹,

Jang²,

Kim³

et al. 2024

J Korean Neurosurg Soc

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Objective : The Act on Life-Sustaining Treatment (LST) decisions for end-of-life patients has been effective since February 2018. An increasing number of patients and their families want to withhold or withdraw from LST when medical futility is expected. This study aimed to investigate the status of the Act on LST decisions for patients with acute cerebrovascular disease at a single hospital.Methods : Between January 2017 and December 2021, 227 patients with acute cerebrovascular diseases, including hemorrhagic stroke (n=184) and ischemic stroke (n=43), died at the hospital. The study period was divided into the periods before and after the Act.Results : The duration of hospitalization decreased after the Act was implemented compared to before (15.9±16.1 vs. 11.2±18.6 days, p=0.127). The rate of obtaining consent for the LST plan tended to increase after the Act (139/183 [76.0%] vs. 27/44 [61.4%], p=0.077). Notably, none of the patients made an LST decision independently. Ventilator withdrawal was more frequently performed after the Act than before (52/183 [28.4%] vs. 0/44 [0%], p<0.001). Conversely, the rate of organ donation decreased after the Act was implemented (5/183 [2.7%] vs. 6/44 [13.6%], p=0.008). Refusal to undergo surgery was more common after the Act was implemented than before (87/149 [58.4%] vs. 15/41 [36.6%], p=0.021) among the 190 patients who required surgery.Conclusion : After the Act on LST decisions was implemented, the rate of LST withdrawal increased in patients with acute cerebrovascular disease. However, the decision to withdraw LST was made by the patient’s family rather than the patient themselves. After the execution of the Act, we also observed an increased rate of refusal to undergo surgery and a decreased rate of organ donation. The Act on LST decisions may reduce unnecessary treatments that prolong end-of-life processes without a curative effect. However, the widespread application of this law may also reduce beneficial treatments and contribute to a decline in organ donation.

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Section: Discussionmentioning

confidence: 99%

Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021

Kim¹,

Jang²,

Kim³

et al. 2024

J Korean Neurosurg Soc

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“…Our case report showed that the kidney from a hypoxic donor with a prolonged CIT (compared to the average in Korea) could be transplanted safely by using HMP. Interest in DCD and ECD transplantation has also been rising in Korea since the first DCD KT in 2020 [ 13 , 14 ]. We believe that expanded use of machine perfusion will be needed, not only on Jeju Island, but nationwide in the transplantation of kidneys vulnerable to ischemic damage.…”

Section: Discussionmentioning

confidence: 99%

The first use of hypothermic machine perfusion in Korea to recover a procured kidney graft and prevent prolonged cold ischemic time: a case report

Shin

Park

et al. 2023

Korean J Transplant

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To overcome the shortage of donor grafts in kidney transplantation (KT), the use of marginal grafts has evolved. However, prolonged cold ischemic time (CIT) is especially critical when using marginal grafts. Recently, hypothermic machine perfusion (HMP) has been used to overcome the negative effects of prolonged CIT, and we report the first use of HMP in Korea. The donor was a 58-year-old man with severe hypoxia (PaO 2 <60 mmHg, FiO 2 100%) for 9 hours prior to procurement. The patient’s kidneys were the only organs accepted for transplantation, and both kidneys were assigned to Jeju National University Hospital. After procurement, the right kidney was preserved using HMP immediately, and the left kidney was directly transplanted into a patient with a CIT of 2 hours 31 minutes. The second operation was performed following the first, using the right kidney graft that had been preserved by HMP for 10 hours and 30 minutes. Although postoperative graft function gradually recovered in both patients, the serum creatinine level decreased faster in the HMP patient. Neither patient showed signs of delayed graft function, and both were discharged without significant complications. The short-term outcomes in this transplantation of mate kidney grafts demonstrated that graft function can be safely preserved using HMP, and that HMP is beneficial in overcoming the negative effects of prolonged CIT.

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“…Therefore, the physicians in charge of post-CA care do not encourage WLST, and it is restrictively performed in patients with brain death who are denied organ donation by the caregiver or family. In addition, Korea accepts a highly strict qualification for brain death, such as a flat activity (< 2 µV) in an electroencephalogram (EEG) for 30 min 15 .…”

Section: Methodsmentioning

confidence: 99%

Combination strategy for prognostication in patients undergoing post-resuscitation care after cardiac arrest

Park,

Kim,

You

et al. 2023

Sci Rep

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This study investigated the prognostic performance of combination strategies using a multimodal approach in patients treated after cardiac arrest. Prospectively collected registry data were used for this retrospective analysis. Poor outcome was defined as a cerebral performance category of 3–5 at 6 months. Predictors of poor outcome were absence of ocular reflexes (PR/CR) without confounding factors, a highly malignant pattern on the most recent electroencephalography, defined as suppressed background with or without periodic discharges and burst-suppression, high neuron-specific enolase (NSE) after 48 h, and diffuse injury on imaging studies (computed tomography or diffusion-weighted imaging [DWI]) at 72–96 h. The prognostic performances for poor outcomes were analyzed for sensitivity and specificity. A total of 130 patients were included in the analysis. Of these, 68 (52.3%) patients had poor outcomes. The best prognostic performance was observed with the combination of absent PR/CR, high NSE, and diffuse injury on DWI [91.2%, 95% confidence interval (CI) 80.7–97.1], whereas the combination strategy of all available predictors did not improve prognostic performance (87.8%, 95% CI 73.8–95.9). Combining three of the predictors may improve prognostic performance and be more efficient than adding all tests indiscriminately, given limited medical resources.

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First Organ Donation after Circulatory Death Following Withdrawal of Life-sustaining Treatment in Korea: a Case Report

Cited by 8 publications

References 8 publications

Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021

Recent Trends in the Withdrawal of Life-Sustaining Treatment in Patients with Acute Cerebrovascular Disease : 2017–2021

The first use of hypothermic machine perfusion in Korea to recover a procured kidney graft and prevent prolonged cold ischemic time: a case report

Combination strategy for prognostication in patients undergoing post-resuscitation care after cardiac arrest

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