[Donor liver histology : Joint recommendations of the DGP, DTG and DSO]. / Histologische Diagnostik bei Spenderlebern : Gemeinsame Empfehlungen von DGP, DTG und DSO.

BACKGROUND: The indications, implementation and reporting of liver biopsies for deceased organ donation are not mandatory or regulated. Reliable data on outcome quality and prognostic relevance are therefore not available. Defined standards are thus required to enable meaningful studies and to ensure high data quality of a national transplantation registry. OBJECTIVE: Presentation of a synopsis of available studies and literature-based recommendations. RESULTS AND CONCLUSION: Against the background of an organ shortage and a growing number of older donors, pretransplantation liver histology is of significant relevance to guide clinical decision making. With the joint recommendations of the German Transplantation Society (DTG), the German Society of Pathology (DGP) and the German Organ Transplantation Foundation (DSO) standardized procedures are defined for the first time.

[Family approach--retrospective analysis of 6,617 donation requests]. / Gespräche mit Angehörigen zur Organspende. Retrospektive Analyse von 6,617 Gesprächen.

BACKGROUND: According to surveys the majority of the German population has a positive attitude towards organ donation. However, declarations of will concerning this matter are often missing in case of death. Thus, in nearly all cases consent must be obtained from the family of the deceased. Compared with refusal rates of other countries the refusal rate in Germany (approximately 40%) is rather high. The modification of the German Transplantation Legislation in November 2012 supports the voluntary documentation of everyone's decision with regard to organ donation. METHODS: Based on 6,617 documented donation requests collected between 2009 and 2011, factors were identified, which--besides personal attitude of morality--could influence the decision about donation. RESULTS: The decedent's will is often unknown (67.4%) and the family's decision is based on the suspected will of the patient. This resulted in 4097 (61.9%) consents and 2520 (38.1%) refusals. 4669 (70.6%) of these donation-requests were carried out by the physician in charge and 1948 (29.4%) with the assistance of a coordinator from the German foundation for organ transplantation (DSO). Predictive (p<0.001) for consent were the presence of a specially trained coordinator and the timing of the request for organ donation. CONCLUSION: There is a big discrepancy between the attitude displayed in surveys and the actual consent rate to organ donation. The major challenge is an improved caregiving for the donor family. Donation requests should be made preferably by trained physicians as well as coordinators. Waiting for the finalized certification of brain death may not be appropriate in all cases.

Detection of potential organ donors: 2-year analysis of deaths at a German university hospital.

OBJECTIVE: In 2006, inhouse coordinators were introduced in all hospitals with intensive care units in Baden-Württemberg to improve organ donation. At our university hospital with a neurosurgery and a transplantation unit, we analyzed whether brain death certification and donation requests were always initiated (if possible). MATERIALS AND METHODS: We retrospectively reviewed all 1312 hospital deaths from 2006-2007 by studying medical records and consulting with physicians. The possibility of organ donation was questioned. RESULTS: Donation was requested among 68/702 deaths due to cerebral complications. A request was impossible in 8 cases. Consent for donation was obtained in 29 cases, and it was realized in 24 cases. In 14 cases of resuscitation from shock or cardiac failure, therapy was not continued because of questionable hemodynamic stability. In 17 cases admitted to peripheral wards and 19 to intensive care units death due to cerebral complications occurred within 48 hours, but medical records were not relevant for exclusion criteria for organ donation. CONCLUSIONS: The detection of donors was not acceptable. In patients without a prognosis after resuscitation, further hemodynamic stabilization was frequently omitted, because organ donation had not been considered. In cases of donation requests the refusal rate was high. We initiated specific training.

Expanded criteria liver donors (ECD): effect of cumulative risks.

UNLABELLED: The use of ECD in liver donors increases the risk of primary non function (PNF). The German Medical Association (2004) defined an ECD, if one of the following conditions existed: high risk of disease transmission, hemodynamic deterioration, donor age > 65years, BMI > 30kg/m2, bilirubine > 51 mmol/l, ASAT or ALAT > 3*reference, sodium > 165 mmol/l, days on ICU > 7, steatosis > 40% or equivalent liver pathologies. The effect of ECD-criteria was assessed. METHODS: Out 422 consecutive donors (1992-2004) with 282 liver grafts were transplanted (LTX) the existing ECD criteria were cumulated per donor (sigmaECD), grouped and compared to the number of grafts used and the one year graft function rate (all grafts/censored for grafts lost due to PNF only). Discrimination was determined by Receiver-Operating-Characteristics (ROC). RESULTS: With increasing sigmaECD the rate of grafts procured declined (sigmaECD = 0: 95% [n = 162], sigmaECD = 1: 62% [n = 146], EECD = 2: 39% [n = 61], sigmaECD = 3: 32% [n = 38], sigmaECD > or = 4: 13% [n = 16], p < 0.0001). Similarly the one year graft function rate diminished (all grafts: sigmaECD = 0: 72%, sigmaECD = 1: 70%, sigmaECD = 2: 75%, sigmaECD = 3: 58%, sigmaECD > or = 4: 0%, p = 0.0801; censored for grafts lost due to PNF: sigmaECD = 0: 99%, sigmaECD = 1: 95%, sigmaECD = 2: 100%, sigmaECD= 3: 67%, sigmaECD > or = 4: 50%, p < 0.0001). The best cut off for prediction of grafts used was a sigmaECD of 0-1 vs. 2-5 (sensitivity 55%, specificity 87%). The one year graft function rate was adversely affected in sigmaECD above 3. All three grafts used for LTX with confirmed severe steatosis at donor operation (n = 3) did not function. CONCLUSION: Grafts from ECD can be used for LTX. Cumulated ECD was associated with an increased risk of PNF requiring retransplantation. Despite this fact not using donors with cumulated ECD will decrease the limited donor pool. Such livers should be ideally allocated regionally to avoid additional ischemic-reperfusion damage.

[Guidelines for electronic-data-processing-controlled serial diagnosis of donor blood samples]. / Leitlinien einer EDV-unterstützten Automatisierung der Seriendiagnostik von Spenderblutproben.

UNLABELLED: Increasing performance figures and the necessity to save expenses oblige transfusion services to automatize their donors' laboratory examination. Sufficient hard- and software for sample distribution and processing is now available. Following aspects should be regarded when switching to automatic serial screening: SAFETY: The identity of blood-donor, donation and laboratory result will be achieved by machine readable labeling and on-line communication between working-stations and central administration. Flexibility: Easy automatic selective laboratory screening will be possible using special barcodes including sample identification and working orders. A modular hardware concept with easily accessible programming control allows it to implement new devices or methods. Ergonomy: Automatic sample processing including selective screening and simultaneous operating robotic sample processors increase working quality, sample output and time benefits. Economy: Improved working conditions will result in saving reagents and compensating staff limitations.

[Automated serial diagnosis of donor blood samples. Combined pipette robot systems]. / Automatisierte Seriendiagnostik von Spenderblutproben. Kombinierte Pipettierrobotersysteme.

Combined robotic sample processors allow economic and ergonomic laboratory screening of blood donors without mismatching of samples. The modular configuration of the whole system serves as basis for easily achievable adaptation to future performance claims or installation at other institutions.

[Automated serial diagnosis of donor blood samples. Ergonomic and economic organization structure]. / Automatisierte Seriendiagnostik von Spenderblutproben. Ergonomische und ökonomische Organisationsstrukturen.

A comprehensive computer-aided administration-system for blood-donors is presented. Ciphered informations of barcode-labels allow the automatic and nevertheless selective pipetting of samples by pipetting-robots. Self-acting analysis-results are transferred to a host-computer in order to actualize a donor data-base.