How Large is the Potential of Brain Dead Donors and what Prevents Utilization? A Multicenter Retrospective Analysis at Seven University Hospitals in North Rhine-Westphalia

Englbrecht, Jan Sönke; Schrader, Daniel; Kraus, Holger; Schäfer, Melanie; Schedler, Dirk; Bach, Friedhelm; Soehle, Martin

doi:10.3389/ti.2023.11186

Cited by 6 publications

(10 citation statements)

References 39 publications

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“…Despite the presumed consent system in place in Colombia, there is a consensus among transplant groups regarding the critical importance of securing the family's agreement for the successful execution of the organ retrieval procedure. This consensus is founded on the principle that the organ donation process should not pose physical or emotional harm to the individuals involved (16,17).…”

Section: Discussionmentioning

confidence: 99%

Understanding the dynamics of deceased organ donation and utilization in Colombia

Cruz Mususú,

García-Lopez,

Lozano-Suarez

et al. 2024

Revista Panamericana De Salud Pública

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Objective. To obtain a comprehensive overview of organ donation, organ utilization, and discard in the entire donation process in Colombia. Methods. A retrospective study of 1 451 possible donors, distributed in three regions of Colombia, evaluated in 2022. The general characteristics, diagnosis, and causes of contraindication for potential donors were described. Results. Among the 1 451 possible donors, 441 (30.4%) fulfilled brain death criteria, constituting the potential donors pool. Families consented to organ donation in 141 medically suitable cases, while 60 instances utilized legal presumption, leading to 201 eligible donors (13.9%). Of those, 160 (11.0%) were actual donors (in whom operative incision was made with the intent of organ recovery or who had at least one organ recovered). Finally, we identified 147 utilized donors (10.1%) (from whom at least one organ was transplanted). Statistically significant differences were found between age, sex, diagnosis of brain death, and donor critical pathway between regions. A total of 411 organs were transplanted from 147 utilized donors, with kidneys being the most frequently procured and transplanted organs, accounting for 280 (68.1%) of the total. This was followed by 85 livers (20.7%), 31 hearts (7.5%), 14 lungs (3.4%), and 1 pancreas (0.2%). The discard rate of procured deceased donors was 8.1%. Conclusions. About one-tenth of donors are effectively used for transplantation purposes. Our findings highlight areas of success and challenges, providing a basis for future improvements in Colombia.

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Section: Discussionmentioning

confidence: 99%

Understanding the dynamics of deceased organ donation and utilization in Colombia

Cruz Mususú,

García-Lopez,

Lozano-Suarez

et al. 2024

Revista Panamericana De Salud Pública

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“…Braindeath cannot be diagnosed if brain stem reflexes are preserved, so that DBD was not possible in these cases. This group of pDBD could potentially become donors after cardiac death (DCD), when therapy is discontinued due to an unfavorable prognosis, but DCD is not possible in Germany due to legal regulations ( 22 ). It can be assumed, that a significant share of potential donations was thus lost because of these circumstances ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…Consent to donation was reduced during the first wave of the pandemic in some countries ( 13 ), probably due to uncertainty and reduced possibilities to discuss a donation with family members ( 9 , 12 ). Reliable data for consent rates in Germany during the pandemic are lacking ( 40 ), but traditionally, refused consent is a relevant reason against donation in Germany ( 22 , 46 ). In this cohort, refused consent was higher in 2021 than 2022.…”

Section: Discussionmentioning

confidence: 99%

“…Reduced ICU capacities during the pandemic may therefore play a rather minor role in the admission of potential DBD donors (pDBD). As information on the total number of pDBD in Germany is generally sparse ( 22 ), and available studies focused on the number of utilized DBD donors (uDBD) rather than pDBD ( 23 ), the impact of the pandemic-related healthcare restrictions on the number of pDBD remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Post-COVID-19 pandemic organ donation activities in Germany: a multicenter retrospective analysis

Englbrecht,

Schrader,

Alders

et al. 2024

Front. Public Health

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IntroductionThe 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.MethodsThe 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.ResultsThe 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.ConclusionThe 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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“…Up until 2020, only 174 of the 774 patients (22.5%) on the waitlist in Korea have received donor hearts [ 8 ]. The global acceptance rate of thoracic organs from brain-dead patients is approximately 23%, and the annual waiting list mortality rate for patients with critical heart and lung failure has consistently been between 10% and 20% [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Ex vivo lung perfusion and the Organ Care System: a review

Attawar,

et al. 2024

Clin Transplant Res

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With the increasing prevalence of heart failure and end-stage lung disease, there is a sustained interest in expanding the donor pool to alleviate the thoracic organ shortage crisis. Efforts to extend the standard donor criteria and to include donation after circulatory death have been made to increase the availability of suitable organs. Studies have demonstrated that outcomes with extended-criteria donors are comparable to those with standard-criteria donors. Another promising approach to augment the donor pool is the improvement of organ preservation techniques. Both ex vivo lung perfusion (EVLP) for the lungs and the Organ Care System (OCS, TransMedics) for the heart have shown encouraging results in preserving organs and extending ischemia time through the application of normothermic regional perfusion. EVLP has been effective in improving marginal or borderline lungs by preserving and reconditioning them. The use of OCS is associated with excellent short-term outcomes for cardiac allografts and has improved utilization rates of hearts from extended-criteria donors. While both EVLP and OCS have successfully transitioned from research to clinical practice, the costs associated with commercially available systems and consumables must be considered. The ex vivo perfusion platform, which includes both EVLP and OCS, holds the potential for diverse and innovative therapies, thereby transforming the landscape of thoracic organ transplantation.

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How Large is the Potential of Brain Dead Donors and what Prevents Utilization? A Multicenter Retrospective Analysis at Seven University Hospitals in North Rhine-Westphalia

Cited by 6 publications

References 39 publications

Understanding the dynamics of deceased organ donation and utilization in Colombia

Understanding the dynamics of deceased organ donation and utilization in Colombia

Post-COVID-19 pandemic organ donation activities in Germany: a multicenter retrospective analysis

Ex vivo lung perfusion and the Organ Care System: a review

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