In-House Coordinator Programs Improve Conversion Rates for Organ Donation

Salim, Ali; Berry, Cherisse; Ley, Eric J.; Schulman, Danielle; Desai, Chirag; Navarro, Sonia; Malinoski, Darren

doi:10.1097/ta.0b013e31820500e6

Cited by 34 publications

(34 citation statements)

References 14 publications

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“…This resulted in a 55% successful conversion of potential donors to voluntarily donate organs which is amongst the best in available literature. [1516]…”

Section: Discussionmentioning

confidence: 99%

Deceased donor renal transplantation at army hospital research and referral: Our experience

et al. 2013

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Context:In India, there are a large number of end-stage renal disease (ESRD) patients waiting for renal transplant. Deceased donor organ transplantation (DDOT) is the possible solution to bridge the disparity between organ supply and demand. The concept of expanded criteria donors (ECDs) was developed to combat the huge discrepancy between demand and organ availability. However, ECD kidneys have a higher propensity for delayed graft function (DGF), and therefore worse long-term survival. We present our experience of deceased donor renal transplantation.Aims:We report single centre experience on DDOT including ECDs vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr), rejection episodes, and delayed graft function in 44 DDOTMaterials and Methods:Between August 1998 and April 2011, 44 renal transplants from 35 deceased donors were performed, of which 37.2% were expanded criteria donors. Results were analyzed in terms of age of donor, terminal SCr, graft ischemia time, graft function, post-transplant complications, and graft and patient survival. All recipients received sequential triple drug immunosuppression and induction with rabbit antithymocyte globulin (rATG). The induction is commenced by giving first dose of rATG intraoperatively (dose 1.5 mg/kg) and subsequent rATG infusions were administered daily for a minimum of 5 and maximum of 7 doses depending on initial graft function.Results:We have been able to achieve a mean cold ischemia time of 6.25 ± 2.55 h due to the coordinated team efforts. Delayed graft function occurred in 34% patients and 31.8% had prolonged drainage. There were no urinary leaks. Seven (16%) patients had biopsy-proven rejection episodes, all of which were reversed with treatment. Two patients underwent graft nephrectomy. One of these was due to hyperacute rejection and another due to anastomotic hemorrhage. One-year graft survival was 92.4% and the patient survival was 83.8%.Conclusion:Deceased donor renal transplants have satisfactory graft function and patient survival despite the high incidence of delayed graft function. Retrieving kidneys from marginal donors can add to the donor pool.

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“…This resulted in a 55% successful conversion of potential donors to voluntarily donate organs which is amongst the best in available literature. [1516]…”

Section: Discussionmentioning

confidence: 99%

Deceased donor renal transplantation at army hospital research and referral: Our experience

et al. 2013

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“…4,29,30 These protocols included body temperature control, head elevation in bed, seizure prophylaxis, avoidance of jugular outflow obstruction, sedation, intubation, mechanical ventilation, and complete volume resuscitation to maintain a cerebral perfusion pressure (CPP) minimum of 60-70 mm Hg. Spaceoccupying lesions > 25 cm 3 were surgically removed. When intracranial pressure (ICP) exceeded 20 mm Hg, therapeutic interventions were initiated step by step: external ventricular drainage when possible, moderate hypocapnia (PaCO 2 : 30-35 mm Hg), deeper sedation and muscle relaxation, and relative hyperosmolar therapy with mannitol or hypertonic saline infusions.…”

Section: Methodsmentioning

confidence: 99%

“…Recent research has shown that the presence of an in-house transplant coordinator improves the donation process. 3 However, the comprehensive follow-up provided by this charge would be unlikely in donor hospitals, which depend upon a joint coordination office, or in large trauma centers with high volumes of neurocritical admissions. Therefore, the early detection of TBI patients at risk for BD is a priority for transplant teams seeking more efficient identification of potential donors.…”

mentioning

confidence: 99%

S100B Protein May Detect Brain Death Development after Severe Traumatic Brain Injury

Egea-Guerrero

Murillo-Cabezas

Gordillo-Escobar

et al. 2013

Journal of Neurotrauma

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Despite improvements in the process of organ donation and transplants, the number of organ donors is progressively declining in developed countries. Therefore, the early detection of patients at risk for brain death (BD) is a priority for transplant teams seeking more efficient identification of potential donors. In the extensive literature on S100B as a biomarker for traumatic brain injury (TBI), no evidence appears to exist on its prognostic capacity as a predictor of BD after severe TBI. The objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for BD after severe TBI. This prospective study included patients with severe TBI (Glasgow Coma Scale score [GCS] £ 8) admitted to our Neurocritical Care Unit over a 30 month period. We collected the following clinical variables: age, gender, GCS score, pupillary alterations at admission, hypotension and pre-hospital desaturation, CT scan results, isolated TBI or other related injuries, Injury Severity Score (ISS), serum S100B levels at admission and 24 h post-admission, and a final diagnosis regarding BD. Of the 140 patients studied, 11.4% developed BD and showed significantly higher S100B concentrations ( p < 0.001). Multivariate analysis showed that bilateral unresponsive mydriasis at admission and serum S100B at 24 h post-admission had odds ratios (ORs) of 21.35 ( p = 0.005) and 4.9 ( p = 0.010), respectively. The same analysis on patients with photomotor reflex in one pupil at admission left only the 24 h S100B sample in the model (OR = 15.5; p = 0.009). Receiver operating characteristics (ROC) curve analysis on this group showed the highest area under the curve (AUC) (0.86; p = 0.001) for 24 h S100B determinations. The cut off was set at 0.372 lg/L (85.7% sensitivity, 79.3% specificity, positive predictive value [PPV] = 18.7% and negative predictive value [NPV] = 98.9%). This study shows that pupillary responsiveness at admission, as well as 24 h serum S100B levels, could serve as screening tools for the early detection of patients at risk for BD after severe TBI.

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“…268 Programs that incorporate an in-house presence of the coordinator from the organ procurement agency can be effective in achieving these goals. 269 In addition, although the concept of brain death is widely accepted, policies and procedure to determine brain death are highly variable across states, and even across leading hospitals in the same region. 270 It is likely that the unification of criteria for brain death determination would have a positive impact on donation rates by avoiding unnecessary delays.…”

Section: Brain Death and Organ Donationmentioning

confidence: 99%

Palliative and End-of-Life Care in Stroke

Holloway¹,

Arnold²,

Creutzfeldt³

et al. 2014

Stroke

243

120

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Background and Purpose-The purpose of this statement is to delineate basic expectations regarding primary palliative care competencies and skills to be considered, learned, and practiced by providers and healthcare services across hospitals and community settings when caring for patients and families with stroke. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were chosen to reflect the diversity and expertise of professional roles in delivering optimal palliative care. Writing group members were assigned topics relevant to their areas of expertise, reviewed the appropriate literature, and drafted manuscript content and recommendations in accordance with the American Heart Association's framework for defining classes and level of evidence and recommendations. Results-The palliative care needs of patients with serious or life-threatening stroke and their families are enormous: complex decision making, aligning treatment with goals, and symptom control. Primary palliative care should be available to all patients with serious or life-threatening stroke and their families throughout the entire course of illness. To optimally deliver primary palliative care, stroke systems of care and provider teams should (1) promote and practice patient-and family-centered care; (2) effectively estimate prognosis; (3) develop appropriate goals of care; (4) be familiar with the evidence for common stroke decisions with end-of-life implications; (5) assess and effectively manage emerging stroke symptoms; (6) possess experience with palliative treatments at the end of life; (7) assist with care coordination, including referral to a palliative care specialist or hospice if necessary; (8) provide the patient and family the opportunity for personal growth and make bereavement resources available if death is anticipated; and (9) actively participate in continuous quality improvement and research. Conclusions-Addressing the palliative care needs of patients and families throughout the course of illness can complement

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In-House Coordinator Programs Improve Conversion Rates for Organ Donation

Abstract: The presence of an IHC program significantly improves conversion rates for organ donation as well as organ yield. An IHC program should be considered as a viable option to bridge the gap between organ supply and organ demand.

Cited by 34 publications

References 14 publications

Deceased donor renal transplantation at army hospital research and referral: Our experience

Deceased donor renal transplantation at army hospital research and referral: Our experience

S100B Protein May Detect Brain Death Development after Severe Traumatic Brain Injury

Palliative and End-of-Life Care in Stroke

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