Quality control standard and evaluation of lung transplantation / 中国胸心血管外科临床杂志

@#The quality control of lung transplantation involves many aspects, such as team building, selection of recipients, preoperative diagnosis and evaluation of recipients, maintenance of brain-dead donors, evaluation and acquisition of donors, surgical operation, postoperative management and postoperative follow-up. Precision management is the core concept of operation quality control. Only by normalizing the operation quality control of lung transplantation to provide basic guarantee for multi-team cooperation and development of lung transplantation management in the future, building a complete lung transplantation database to excavate data resources and improve the quality of transplanta-tion, and comprehensively building a Chinese lung transplantation quality control system with multi-team participation and cooperation, can we improve the overall level of surgical diagnosis and treatment of lung transplantation in China.

Causes of Failure during the Management Process from Identification of Brain-Dead Potential Organ Donors to Actual Donation in Korea: a 5-Year Data Analysis (2012–2016)

BACKGROUND: This retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years. METHODS: Data of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family. RESULTS: From January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non-brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead. CONCLUSION: The rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.

Influencing Factors Affecting Successful Organ Donation and Families' Consent to Donate after Drain Death / 대한이식학회지

BACKGROUND: This study was conducted to identify the factors influencing successful organ donation and families' consent to donate after brain death. METHODS: Medical records and data regarding organ donation counseling with the families of 107 brain-dead potential donors between September 2012 and March 2016 at a single tertiary medical center were retrospectively reviewed. RESULTS: The final consent rate was 57.9% (62/107), and successful donation was performed in 40.2% (43/107) of cases. Univariate and multivariate analyses revealed that the independent factors associated with successful organ donation were age <60 years (odds ratio [OR], 3.384; 95% confidence interval [CI], 1.350 to 8.484; P=0.009), systolic blood pressure ≥90 mmHg (OR, 6.261; 95% CI, 1.418 to 27.653; P=0.015), and serum sodium level ≥150 mEq (OR, 4.215; 95% CI, 1.655 to 10.733; P=0.003). Family's consent to donate was significantly associated with head trauma (OR, 3.538; 95% CI, 1.104 to 11.334; P=0.033) and serum sodium level ≥150 mEq (OR, 3.392; 95% CI, 1.404 to 8.194; P=0.007). CONCLUSIONS: Successful organ donation was associated with patient age, systolic blood pressure and serum sodium level. Family's consent to donate was associated with head trauma and serum sodium level.

Successful Management of Potential Non-Heart-Beating Donor with Extracorporeal Membrane Oxygenation: A Case Report / 대한구급학회지

Hemodynamics of a brain-dead donor can change rapidly during management. It frequently leads to loss of the donor or deterioration of organ functions. Various efforts have been made not to lose potential donors. Extracorporeal membrane oxygenation (ECMO) and non-heart-beating donation (NHBD) are good examples of such efforts. A 47 year-old woman with a history of hypertension, diabetes mellitus and atrial fibrillation was diagnosed with cerebral infarction and hemorrhage. Cardiopulmonary resuscitation was performed three times before transfer to our hospital. Her family agreed to organ donation. ECMO was applied due to her unstable vital signs, which made the first declaration of brain death possible. However, considering the deteriorating vital signs and expected cardiac arrest, it was decided to switch to NHBD under the family's consent. All life-support devices including ECMO were turned off in the operation room. After cardiac death was declared, the harvesting of liver and kidneys was performed with perfusion through an ECMO catheter. The liver and kidneys were successfully transplanted to three recipients.

Successful Brain Dead Donor Management with CRRT: A Case Report / 대한구급학회지

Brain death results in adverse pathophysiologic effects in many brain-dead donors with cardiovascular instability. We experienced a brain-dead donor with continuous renal replacement therapy (CRRT) who was in a severe metabolic, electrolyte derangement and poor pulmonary function. The thirty-nine-year-old male patient with subarachnoid hemorrhage and intraventricular hemorrhage was admitted into the intensive care unit (ICU). After sudden cardiac arrest, he went into a coma state and was referred to as a potential organ donor. When he was transferred, his vital sign was unstable even under the high dose of inotropics and vasopressors. Even with aggressive treatment, the level of blood sugar was 454 mg/dl, serum K+ 7.1 mEq/L, lactate 5.33 mmol/L and PaO2/FiO2 60.3. We decided to start CRRT with the mode of continuous venovenous hemodiafiltration (CVVHDF). After 12 hours of CRRT, vital sign was maintained well without vasopressors, and blood sugar, serum potassium and lactate levels returned to 195 of PaO2/FiO2. Therefore, he was able to donate his two kidneys and his liver.

Establishment of Active Identification and Management System for Potential Brain Dead Donors in Life-link Center / 대한이식학회지

BACKGROUND: The purpose of this study was to promote organ donation by active identification and proper management of brain-dead donor with collaborating network system and to assume operating expenses in the setting of independent organ procurement organization (IOPO) in Korea. METHODS: Seoul National University Hospital and Gachon University Gill Hospital worked together as regional OPO during 8 months from April to December 2008. RESULTS: We constructed cooperative network system with five base-hospitals by MOU (memorandum of understanding). We visited 138 hospitals 223 times and built up brain-dead organ donation. Among total 265 dead patients in intensive care unit (ICU), 95 (36%) patients were considered as potential organ donors, but only 14 (14.7%) donated their organs actually. During the previous 8 months, there were 67 contacts for potential donor evaluation and total 100 solid organs were actually procured from 31 brain-dead donors except 4 cases. We also established and applied a flow chart and critical pathway of potential brain-dead donor. It was worthy of notice to manage 3 brain-dead donors and successfully procured their organs without donor transportation to HOPO. Apart from operating and depreciation expenses, we could estimate the expenses loss of mean 850,000 won per organ in the current system. CONCLUSIONS: Our results showed hope for success of IOPO in Korea which would be founded in the near future. Besides persistent active relationship with regional hospitals, a certain degree of financial support or other means such as increase of organ fee and medical insurance coverage should be considered.

Hormonal Changes of the Brain-Dead Organ Donors: A 3-Year Experience / 대한구급학회지

BACKGROUND: Success of transplantation is critically dependent upon the quality of the donor organ and optimal management. Recently, hormonal replacement therapy has been reported to result in rapid recovery of cardiac function and enable significantly more organs to be transplanted, while some other studies show conflicting results. The aim of this study is to comprehensively evaluate changes in basal circulating hormonal levels of the brain-dead organ donors. METHODS: We reviewed the records of all brain-dead patients between January, 2004, and June, 2007. Hemodynamic variables, plasma hormone levels were recorded at following time points: admission to the ICU (T1, baseline), 30 minutes (min) after first apnea test (T2), 30 min after second apnea test (T3), before operation for harvesting (T4). Hormonal measurements included cortisol, adrenocorticotrophic hormone, triiodothyronine (T(3)), thyroxine, free thyroxine, thyroid-stimulating hormone, growth hormone, and testosterone. RESULTS: Nineteen patients were included in this study. Comparisons of hemodynamic parameters and hormonal levels to baseline values revealed no significant changes throughout the study period. When the patients were divided into 2 groups according to the requirement of norepinephrine (either>0.05 or 0.05microgram/kg/min of norepinephrine had T(3) level below the normal range at significantly more time points of measurement (7 vs. 0). CONCLUSION: In this comprehensive assessment of hormonal levels in brain-dead organ donors, we could not observe any significant changes during the ICU stay. Replacement therapy of T(3) may be considered in patients requiring >0.05microgram/kg/min of norepinephrine.

Improvement of Hypoxemia by Repetitive Alveolar Recruitments in Brain-dead Donor: A case report / 대한마취과학회지

Brain-dead potential donors manifest devastating physiological changes associated with pulmonary edema, profound hemodynamic and metabolic abnormalities. These derangements may be more significant after apnea tests which result in severe hypoxemia and cardiovascular complications. De-recruitment can occur following apnea tests in the brain-dead donor whose ventilator support has been maintained with high positive end-expiratory pressure (PEEP), and recruitment maneuvers are intended to open collapsed lung units. We report a brain-dead potential donor with severe hypoxemia and hemodynamic instability after apnea tests, which improved after multiple alveolar recruitments with adequate vasoactive drugs. Multiple high-pressure recruitment maneuvers will be helpful for expansion of lung collapse with improvement of severe hypoxemia after de-recruitment which could be developed with apnea tests in brain-dead organ donor.

Nurse's Knowledge and Attitudes on Organ Donation in Brain Death / 대한이식학회지

PURPOSE: This study attempted as investigations of nurse's knowledge and attitudes on organ donation in brain death, to find the method solving of the problems. METHODS: A survey questionnaire was used and received responses from nurses (n=180) of university hospital and general hospital in B city. The data were analyzed using SPSS/PC program on real numbers, percentage, frequency, mean, standard deviation and t-test. RESULTS: Organs invaded by cancer cell or infected by microorganism are not able to donate' obtained to highest score (94.9%) in knowledge measurement on organ donation in brain death. According to nurse's knowledge and positive attitudes, there were statistical differences in ''Knowing the Korean government permit the organ transplantation from brain death donors' (P=0.014), and ''Best organs to donate are aged 20 years of young people in brain dead state from head injury' (P=0.005). There was statistical difference between knowledge and negative attitude in 'Unknowing the Korean government permit the organ transplantation from brain death donors' (P=0.050). CONCLUSIONS: This study might help the nurses who are concerning organ sharing and make effective interventions and educations to facilitate the decision making process for organ donation in brain dead donors or families.

Analysis for Influencing Factor of the Organ Procurement Rate in Brain Dead Donors / 대한이식학회지

PURPOSE: The number of patients waiting for organ transplantation continues to grow as technical and pharmacological advances increase the success rate of transplantation procedures, while organs are donated by few of the thousands of potential donors who die every year. The organ transplantation continues to be the best treatment for many end-stage diseases of the heart, liver, kidneys, and other organs. Many organ procurement failures have been attributed to a failure to identify patients with nonsurvivable central nervous system injury or disease as potential organ donors or failure to maintain a hemodynamic stability or failure to request consent for donation from next to kin. This study has been done for investigating the factors that influence the organ procurement rate in brain dead donors. METHODS: Of the 259 brain dead donors in the Asan Medical Center, from January 1991 to April 2003, 189 brain dead donors donated solid organs excluding conea. We retrospectively reviewed the medical records and the data of the transplantation center. A hemodynamic stability is defined as systolic blood pressure more than 90~100 mmHg with the use of low-dose vasopressor (dopamine less than 10microgram/ kg/min). RESULTS: From January 1991 to April 2003, the procurement rates of liver, heart, kidney and pancreas were 39% (n=75), 40% (n=76), 97% (n=184) and 17% (n=33), respectively. The procurement rates according to age were 26% in 50 years (n=11). The major. causes of death among potential organ donors were traffic accident (59%) and cerebrovascular events (33%). In traffic accident, the procurement rates of liver, heart, kidney and pancreas were 42% (n=47), 37% (n=41), 98% (n=109) and 16% (n=18), and in cerebrovascular events, 33% (n=21), 38% (n=24), 97% (n=61) and 19% (n=12). Multiple organs were donated in the hemodynamically stable donors. CONCLUSION: Aggressive resuscitation and hemodynamically stabilization of all brain dead donors are important factors that may increase procurement rates.