Organ donation in France: legislation, epidemiology and ethical comments

Jousset, Nathalie; Gaudin, Arnaud; Mauillon, D.; Penneau, M.; Rougé-Maillart, Clotilde

doi:10.1258/rsmmsl.49.3.191

Cited by 13 publications

(5 citation statements)

References 20 publications

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“…In France, brain death is a clinical and legal diagnosis, as previously described [ 21 – 23 ]. In France, care can be continued pending brain death determination, but when a decision of withdrawal of life-sustaining therapy is made, patients are no longer suitable for a process of donation after brain death.…”

Section: Methodsmentioning

confidence: 99%

Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center

Renaudier

Binois²,

Charpentier³

et al. 2022

Ann. Intensive Care

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Background Organ shortage is a major public health issue, and patients who die after out-of-hospital cardiac arrest (OHCA) could be a valuable source of organs. Here, our objective was to identify factors associated with organ donation after brain death complicating OHCA, in unselected patients entered into a comprehensive real-life registry covering a well-defined geographic area. Methods We prospectively analyzed consecutive adults with OHCA who were successfully resuscitated, but died in intensive care units in the Paris region in 2011–2018. The primary outcome was organ donation after brain death. Independent risk factors were identified using logistic regression analysis. One-year graft survival was assessed using Cox and log-rank tests. Results Of the 3061 included patients, 136 (4.4%) became organ donors after brain death, i.e., 28% of the patients with brain death. An interaction between admission pH and post-resuscitation shock was identified. By multivariate analysis, in patients with post-resuscitation shock, factors associated with organ donation were neurological cause of OHCA (odds ratio [OR], 14.5 [7.6–27.4], P < 0.001), higher pH (OR/0.1 increase, 1.3 [1.1–1.6], P < 0.001); older age was negatively associated with donation (OR/10-year increase, 0.7 [0.6–0.8], P < 0.001). In patients without post-resuscitation shock, the factor associated with donation was neurological cause of OHCA (OR, 6.9 [3.0–15.9], P < 0.001); higher pH (OR/0.1 increase, 0.8 [0.7–1.0], P = 0.04) and OHCA at home (OR, 0.4 [0.2–0.7], P = 0.006) were negatively associated with organ donation. One-year graft survival did not differ according to Utstein characteristics of the donor. Conclusions 4% of patients who died in ICU after OHCA led to organ donation. Patients with OHCA constitute a valuable source of donated organs, and special attention should be paid to young patients with OHCA of neurological cause.

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Section: Methodsmentioning

confidence: 99%

Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center

Renaudier

Binois²,

Charpentier³

et al. 2022

Ann. Intensive Care

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“…As recommended, the clinical diagnosis of BD was made in the absence of confounding factors (e.g., residual sedation) [16]. Ancillary tests (e.g., computed tomography angiograph or electroencephalogram) were used to confirm BD when the apnea test could not be performed and/or, according to French law, when organ donation was considered [17].…”

Section: Methodsmentioning

confidence: 99%

Risk factors for progression toward brain death after out-of-hospital cardiac arrest

Cour

Turc

Madelaine

et al. 2019

Ann. Intensive Care

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Background Successfully resuscitated out-of-hospital cardiac arrest (OHCA) may lead to brain death (BD) and good-quality transplantable organs. We aimed to determine risk factors for evolution toward BD after OHCA. We analyzed adult patients admitted to an intensive care unit (ICU) who survived at least 24 h after an OHCA between 2005 and 2015. BD was defined according to international guidelines. Multivariate logistic regression was used to identify potential risk factors for BD available 24 h after OHCA. Results A total of 214 patients were included (median age 68 years; sex ratio 1.25; non-shockable OHCA: 88%). Among these, 42 (19.6%) developed BD, while 22 (10.3%) were alive at 1 year with a good neurological outcome. Independent risk factors for BD were age (OR per year 0.95; 95% CI [0.92–0.98]), female gender (OR 2.34; 95% CI [1.02–5.35]), neurological cause of OHCA (OR 14.72; 95% CI [3.03–71.37]), duration of the low-flow period > 16 min (OR 2.94, 95% CI [1.21–7.16]) and need of vasoactive drugs at 24 h (OR 6.20, 95% CI [2.41–15.93]). Conclusions The study identified, in a population of OHCA with predominantly non-shockable initial rhythms, five simple risk factors independently associated with progression toward BD.

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“…Organ harvesting from a cadaveric individual is authorized if the individual did not make known his refusal during his or her lifetime. However, the consent of the family is always necessary to collect organs from a cadaveric individual (Jousset, Gaudin, Mauillon, Penneau, & Rougé-Maillart, 2009). Abadie and Gay (2004) reported that about 30% of the families that are approached by the medical team to request donation refuse it.…”

Section: Religious Primingmentioning

confidence: 99%

The Positive Effect of the Mere Presence of a Religious Symbol on Compliance With an Organ Donation Request

Guéguen

Bougeard-Delfosse

Jacob

2015

Social Marketing Quarterly

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Identifying low-cost, effective methods to influence behavior is of keen interest to social marketers and others striving to bring about social change. Research on material primes (an object or a word present in the individual’s environment) has received little interest from scientists. This field study conducted in France examined whether the presence of a religious symbol could influence the number of individuals who accepted an organ donation card. The study, conducted with 200 males and 200 females, examined the effect of the presence versus the absence of a Christian cross worn by a solicitor on participant’s compliance to an organ donation request. The findings showed that participants exposed to a Christian cross worn by a solicitor complied more favorably with the request addressed by the solicitor. This effect was found among both male and female participants. The presence of the Christian cross could have acted as a prime that led in turn to the activation of further concepts associated with religion such as compassion, support or solidarity, which in turn led participants to accept the organ donation solicitation more favorably.

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Organ donation in France: legislation, epidemiology and ethical comments

Cited by 13 publications

References 20 publications

Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center

Organ donation after out-of-hospital cardiac arrest: a population-based study of data from the Paris Sudden Death Expertise Center

Risk factors for progression toward brain death after out-of-hospital cardiac arrest

The Positive Effect of the Mere Presence of a Religious Symbol on Compliance With an Organ Donation Request

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