Development of Korean Model for Independent Organ Procurement Organization / 대한이식학회지

PURPOSE: The aims of this project were to increase organ donation by developing potential brain dead donor actively and to provide basic data to settle up independent Organ Procurement Organization (OPO) in Korea. METHODS: Hospital based Organ Procurement Organization (HOPO) of Keimyung university worked as a regional OPO and all the reported potential brain dead patient were treated by OPO team during May through October, 2007. Every reported and confirmed brain dead patient was evaluated for their eligibility of organ donation and these organs were allocated by Korean Network for Organ Sharing (KONOS). In order to increase the development of organ donation, campaign was done for public and medical personnels. To estimate the capacity of brain death donor pool, medical records of the dead patients with brain injury were evaluated. Accommodations and educations to the care-giver to the potential donor, neurosurgeon, neurologist and emergency department physicians were also done. For standardization of potential donor care, frame a clinical pathway of the care of the potential donor from the data of computerized records. The cash flow of whole process from developing potential donor to final procurement of organs were calculated to provide minimum expenses for operating Independent OPO in our environment. RESULTS: Total 33 solid organs were procured from 11 brain dead donor during the experimental period. Twelve more organs were possible to donate but not procured because there were no matched recipient at that time. The reported number of potential donor was increased 2.5 times, compare to the same period of previous year (19 from 5 hospital in 2006 but 47 from 14 collaborating hospitals in 2007). Among 47 notified potential donor, only 11 were succeeded to procure. The reasons of failure for procurement in 36 patients were no familial consent in 12, poor patient condition to donate in 9, not in brain death criteria in 15. These results mean that we have at least 21 more potential donors if we can get familial consent and use marginal donor, and early notification. Mean medical expenses were 3 million won for individual expense beside insurance coverage and 5 million won for management expense of donor care from the detection to organ procurement. CONCLUSION: Our results showed the number of the potential donor and actual organ donation can be increased by continued active relationship with regional hospital and adequate care of the donor. The big gap between the profit from our donor care and calculated donor management expenses of IOPO can be progressively covered by increasing number of brain dead donor, increasing procurement rate and increasing organ fee paid by recipient. But for a certain periods, financial support is necessary to settle up IOPO. Our result can be used as a basic data for management plan of IOPO in the future.

Comparison of Tacrolimus Versus Cyclosporin on Cardiovascular Risk in Renal Allograft Recipient / 대한이식학회지

PURPOSE: Hyperlipidemia and diabetes mellitus are common metabolic disorders associated with transplantation and also are risk factors of cardiovascular disease which is leading cause of patient death in kidney transplant recipients. We compared blood lipid and glucose levels of patients receiving tacrolimus (Tac) with those of patients receiving cyclosporine (CyA). METHODS: Patients were grouped as Tac (n=124) or CyA (n=77). Minimal follow up duration was 18 months. Both groups have no difference in age, sex, HLA match, numbers of transplantation and proportion of the patients with pretransplant hypercholesterolemia (>220 mg/dL) or diabetes. Prevalence of hypercholesterolemia and diabetes in Tac and CyA groups were compared at posttransplant 1, 3, 6, and 12 months. RESULTS: Prevalence of diabetes in CyA versus Tac group were 18.9 vs. 13.8% (P=0.348), 8.6% vs. 18.8% (P=0.060), 5.9% vs. 18.6% (P=0.016), and 10.4% vs. 21.1% (P=0.067) at 1, 3, 6 and 12 months after transplantation respectively. Prevalence of hypercholesterolemia in CyA versus Tac group were 52.5% vs. 16.9% (P=0.000), 37.7% vs. 8.3% (P=0.000), 30.3% vs. 7.4% (P= 0.000) and 22.6% vs. 8.3% (P=0.001) at 1, 3, 6, and 12 months after transplantation. CONCLUSION: CyA group was more prone to develop hypercholesterolemia than Tac group, whereas incidence of diabetes in Tac group was not different from CyA group. In terms of cardiovascular risk, there was no significant difference between CyA treated group and Tac treated group in renal allograft recipients.

Significance of SPECT as a Confirming Test of the Brain Death / 대한이식학회지

In Korea, brain death was established by the law in year 2000 but organ procurements from brain dead donors have been performed before the law era under the social tacit approval. Contrary to expectations, organ transplantation from brain dead donor have been much decreased in the law era. Electroencephalogram (EEG) is mandatory to confirm brain death in Korea. However EEG has several shortcomings and EEG wave may persist several hours after declaration of brain death by other tests. PURPOSE: To evaluate the significance of EEG and single photon emission computerized tomography (SPECT) as a confirming test of the brain death. METHODS: Clinical records of 42 cadaveric donor and their kidney recipients were reviewed retrospectively. Flat EEG was declared by two board certified neurologist or neurosurgeon. Tc99m-ECD SPECT was done in recent 10 donors who didn't show flat EEG at 24 hours after declarartion of brain death on clinical examination. And compared interval from renal transplantation to the moment when serum creatinine level went down below 2.0 mg/dl. RESULTS: Among 42 donors, 3 went to cardiac arrest while waiting flat EEG. And one another donor also went to cardiac arrest just after taking flat EEG. All the ten donors who took brain SPECT showed absence of cerebral blood flow. After showing circulatory arrest to the brain on SPECT another 3 to 23 hours were needed to get the flat EEG. There was no difference in interval between EEG only group (9.8 days) and EEG plus SPECT group (9.2 days). But the interval was prolonged in cardiac arrest group up to 20 days. CONCLUSION: We could get the falt EEG 3 to 23 hours after circulatory arrest to the brain on SPECT scan. While waiting to get flat EEG three donors went to cardiac arrest and kidneys from these cardiac arrest donor showed delayed graft function in all cases. Brain SPECT should be used as a confirming test of brain death.