Potential brain death organ donors - challenges and prospects: a single center retrospective review.

Organ donation after brain death (BD) is a major source for obtaining transplantable organs for patients with end-stage organ disease (ESOD). This retrospective, descriptive study was carried out on all potential BD patients admitted in different intensive care units (ICUs) of the Hamad medical Corporation (HMC), Doha, Qatar during a period from January 2011 to April 2012. Our aim was to evaluate various demographic criteria and challenges of organ donation among potential BD organ donors and plan a strategy to improve the rate of organ donation in Qatar. Various aspects of BD patients in the ICUs and their possible effects on organ donation were studied. The time intervals analyzed to determine the possible causes of delay of organ retrieval were: time of diagnosing fixed dilated pupils in the ICU, to performing the first BD test, then to the second BD test, to family approach, to organ retrieval and/or circulatory death (CD) without organ retrieval. There were a total of 116 potential BD organ donors of whom 96 (82.75%) were males and 20 (17.25%) were females. Brain hemorrhage and head injury contributed to 37 (31.9%) and 32 (27.6%) BD cases, respectively. Time interval between diagnosing fixed dilated pupil and performing the first test of BD was delayed >24 h in 79% of the cases and between the first and second BD tests was >6 h in 70.8% of the cases. This delay is not compatible with the Hamad Medical Corporation (HMC) policy for BD diagnosis and resulted in a low number of organs retrieved. BD organ donation, a potential source for organs to save patients with ESOD has several pitfalls and every effort should be made to increase the awareness of the public as well as medical personnel to optimize donation efficacy.

Ileal-conduit following cystectomy, single-institution revision of indications and outcome.

OBJECTIVE: To revise indications, case fatality ratio, and postoperative early and late complications of ileal conduit as a method of urinary diversion. METHODS: This is a retrospective study in which 200 patients underwent an ileal conduit from August 1994 to December 2000 in Mansoura Urology and Nephrology Center, Mansoura, Egypt. Preoperative criteria of patient selection, peroperative findings, and postoperative follow-up data were reviewed. RESULTS: In 200 patients aged 29-75 years, with a mean age of 55.84 -/+ 8.91 years, the ileal conduit was chosen as a method of urinary diversion, due to one of the following patient or surgical factors; 50 (25%) cardiopulmonary co-morbidities, 27 (13.5%) liver cirrhosis, 20 (10%) impaired renal function, 18 (9%) poorly controlled diabetes mellitus, and 3 (1.5%) morbid obesity. Frozen section pathological examination showed carcinoma invasion of the urethra in 26 (13%), and prostate stroma in 16 (8%) male patients. Severe adhesions and difficult cystectomy were encountered in 25 (12.5%) patients. Tumor was found at or close to the bladder neck in 13 (6.5%) female patients, and 2 (1%) patients were found to have short mesentery. The mean follow up period was 90.02 -/+ 22.63 months. Fatality rate was 2%. Twenty-three (11.5%) patients had early complications, while 36 (23.7%) patients had late complications. CONCLUSION: Ileal conduit is still the best urinary diversion method in many patients who have bladder cancer with associated chronic medical disease or certain surgical factors that render other urinary diversion methods more difficult, carry more postoperative morbidity and mortality, or both.