[Organ procurement in forensic deaths]. / Prélèvements d'organes et décès médico-légaux.

OBJECTIVE: There is a chronic shortage of transplants. There are many obstacles on organ procurement and some are related to forensics aspects of deaths. In these situations in France, the judge decides whether or not to perform the organ recovery. These refusals are about 40 donors per year, representing a loss of more than 120 potential transplants. STUDY DESIGN: Retrospective study of 9 years (2003-2011) aimed to study the expectations of judges in comparing them with forensics issues. PATIENTS AND METHODS: Sixty-two cases of organ recovery with judicial proceedings have been treated in collaboration between the Agency of Biomedicine (Northeast) and the Medico-Legal Institute of Lille (northern France). RESULTS: When there is a judicial opposition to an organ procurement, it is mostly upon criminal circumstances (57%). The main reason is the need to perform an autopsy (38%), raising fears of a loss of evidence because of resuscitation and surgery for the judges. However, autopsies rule out these problems if strict protocols are followed. CONCLUSIONS: In case of forensic death, French law provides that a forensic examination to take place prior to surgical procedures. The law also provides for collaboration between caregivers and medical examiners. Nevertheless, judicial oppositions persist and appear to belong to a lack of communication between actors (judges/medical examiners/organ procurement organization). Better collaboration through protocols must be thought to satisfy the demands of justice and public health.

Acute insulin response to arginine in deceased donors predicts the outcome of human islet isolation.

Despite a stringent donor selection, human islet isolation remains frustratingly unpredictable. In this study, we measured acute insulin response to arginine (AIRarg), an in vivo surrogate measure of islet mass, in 29 human deceased donors before organ donation, and correlated values with the outcome of islet isolation. Thirteen isolations (45%) met the threshold for clinical islet transplantation. Among all measured donor characteristics, the only discriminating variable between successful or unsuccessful isolations was donor AIRarg (p < 0.01). Using a threshold of 55 microIU/mL (ROC curve AUC: 72%), isolation was successful in 12/19 donors with high AIRarg and in 1/10 donors with low AIRarg (p < 0.001). The negative and positive predictive values were 90 and 63%, respectively. If used to select donors in the entire cohort, AIRarg would have increased our success rate by 40% and avoided 56% of unsuccessful isolations while missing only 8% of successful preparations. Our results suggest that donor AIRarg is markedly superior to body mass index (BMI) and other criteria currently used to predict isolation outcome. If routinely performed in deceased donors, this simple test could significantly reduce the failure rate of human islet isolation.