Organ donation in the ICU - a survey on next of kin response in two Swiss academic centres.

AIM OF THE STUDY: In the Swiss population, attitudes to organ donation are mostly positive. However, a high refusal rate by the next of kin may be observed. We aimed to investigate potential underlying reasons. METHODS: In two independent Swiss tertiary care academic centres 167 next of kin were confronted with potential organ donation, over a period of 18 to 24 months. Of these, 147 could be contacted and were asked ≥6 months later to participate in a post-hoc survey (72-item questionnaire). Aspects related to conversations, time and care in the intensive care unit (ICU), underlying concepts for organ donation, impact on mourning, and other potential influencing factors were addressed. RESULTS: The overall return rate was 66%. Seventy four of 77 (96%) next of kin stated that the request for organ donation was appropriate and they agreed to address the issue. Personal attitudes of next of kin regarding organ donation correlated with the decision for or against organ donation (p <0.0001). Thirteen percent (8/62) reported that conversations with ICU physicians changed their decision. In 56% (18/32) of reports when organ donation was refused, the next of kin stated that presence of a documented will might have changed their decisions. Mourning was reported to be impaired by the request for organ donation in 8% (6/71), facilitated in 14% (10/71) and not affected in 77% (55/71) of cases. Twenty-seven percent (16/59) indicated that an opt-out policy for organ donation would subjectively have facilitated their decision and 81% (34/42) of consenting next of kin stated that an objection law should be put into place (p <0.0001). CONCLUSIONS: In this observational study, the majority of the next of kin stated that addressing organ donation did not affect mourning. Presence of a presumed will could likely facilitate grief and provide comfort for affected families. (Trial registration: ClinicalTrials.gov. Identifier: NCT03612024. Date of registration: 24 July 2018.).

In the eye of the hurricane: the Swiss COVID-19 pandemic stepwise shutdown approach in organ donation and transplantation.

The Swiss stepwise shutdown approach in organ donation and transplantation helped to maintain a limited national organ procurement and vital organ transplant activity, avoiding a complete nationwide shutdown of organ donation and transplant activity. .

Rare Case of Transcutaneous Oxygen Desaturation in a Cancer Patient: A Case Report and Diagnostic Approach for a Recurrent Problem.

We present a case of a 73-year-old cancer patient with low transcutaneous oxygen saturation who was transferred to the intensive care unit after deployment of the rapid response team. Differential diagnosis remained broad until methemoglobinemia (MetHb) was detected.MetHb was induced by administration of rasburicase, which was given to prevent tumor lysis syndrome. In a follow-up examination, glucose-6-phosphate dehydrogenase deficiency was found to be the cause of MetHb after rasburicase exposure.Diagnosis was made by either measuring arterial MetHb or CO oximeter. Treatment options involve transfusion and methylene blue, if glucose-6-phosphate dehydrogenase deficiency is not present.

Deceased organ donation activity and efficiency in Switzerland between 2008 and 2017: achievements and future challenges.

BACKGROUND: Various actions have been taken during the last decade to increase the number of organs from deceased donors available for transplantation in Switzerland. This study provides an overview on key figures of the Swiss deceased organ donation and transplant activity between 2008 and 2017. In addition, it puts the evolution of the Swiss donation program's efficiency in relation to the situation in the neighboring countries. METHODS: This study is an analysis of prospective registry data, covering the period from 1 January 2008 to 31 December 2017. It includes all actual deceased organ donors (ADD) in Switzerland. Donor data were extracted from the Swiss Organ Allocation System. The "donor conversion index" (DCI) methodology and data was used for the comparison of donation program efficiency in Switzerland, Germany, Austria, Italy and France. RESULTS: During the study period there were 1116 ADD in Switzerland. The number of ADD per year increased from 91 in 2008 to 145 in 2017 (+ 59%). The reintroduction of the donation after cardiocirculatory death (DCD) program in 2011 resulted in the growth of annual percentages of DCD donors, reaching a maximum of 27% in 2017. The total number of organs transplanted from ADD was 3763 (3.4 ± 1.5 transplants per donor on average). Of these, 48% were kidneys (n = 1814), 24% livers (n = 903), 12% lungs (n = 445), 9% hearts (n = 352) and 7% pancreata or pancreatic islets (n = 249). The donation program efficiency assessment showed an increase of the Swiss DCI from 1.6% in 2008 to 2.7% in 2017 (+ 69%). The most prominent efficiency growth was observed between 2012 and 2017. Even though Swiss donation efficiency increased during the study period, it remained below the DCI of the French and Austrian donation programs. CONCLUSION: Swiss donation activity and efficiency grew during the last decade. The increased donation efficiency suggests that measures implemented so far were effective. The lower efficiency of the Swiss donation program, compared to the French and Austrian programs, may likely be explained by the lower consent rate in Switzerland. This issue should be addressed in order to achieve the goal of more organs available for transplantation.

Unusual cause of myocardial infarction and congestive heart failure in a patient with prosthetic valve endocarditis.

In a patient with staphylococcus lugdunensis prosthetic aortic valve endocarditis and coronary septic embolism accompanied by antero-lateral myocardial infarction, embolic material was successfully aspirated from the bifurcation of the left anterior descending coronary artery and the first diagonal branch. A good angiographic result was documented six months thereafter when the patient presented with a second complication, pulsatile compression of the left main coronary artery by an abscess cavity originating between the aortic and mitral annulus, leading to congestive heart failure. The patient underwent successful surgical replacement of the aortic valve prosthesis with concomitant patch reconstruction of the annulus as well as tricuspid annuloplasty.