organ donation

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Introduction

Transplantable organs:

* kidneys in greatest demand (76%), followed by liver (17%)

* kidneys most suitable organ for transplantation from brain dead potential donors[10]

Other harvestable tissues:

Epidemiology

Contraindications

contraindications to organ donation or tissue harvesting

* prophylaxis with direct-acting antivirals may enable safe kidney transplantation from hepatitis C-infected deceased donors to uninfected patients[5]

Procedure

  • 5-minute observation period prior to proceeding with organ donation after circulatory determination of death*

* after planned withdrawal of life-sustaining measures, the longest duration after pulselessness before resumption of cardiac activity was 4 minutes 20 seconds[8]

  • dead donor rule[9]
    • brain death must be documented prior to the removal of organs
    • the act of organ procurement & donation must not cause the donor's death

Complications

Notes

The correct time to approach family members is after they have viewed the patient's body. The family should be given time for bereavement & to accept their loved one's death.

Steps to tank to ensure donation:

Identification of unsurvivable out-of-hospital cardiac arrest (criteria) for potential organ donation[4]

More general terms

More specific terms

Additional terms

References

  1. 1.0 1.1 Stevens LM et al, Glass RM (ed) Organ Donation JAMA patient page 2007, 299:244
  2. 2.0 2.1 Segev DL et al Perioperative Mortality and Long-term Survival Following Live Kidney Donation JAMA. 2010;303(10):959-966. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20215610 <Internet> http://jama.ama-assn.org/cgi/content/short/303/10/959
  3. 3.0 3.1 Ibrahim HN et al Long-Term Consequences of Kidney Donation N Eng J Med 2009 360:459-469 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19179315 <Internet> http://content.nejm.org/cgi/content/short/360/5/459
  4. 4.0 4.1 Jabre P, Bougouin W, Dumas F et al Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation. Ann Intern Med. Published online 13 September 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27618681 <Internet> http://annals.org/article.aspx?articleid=2552075
  5. 5.0 5.1 Durand CM, Bowring MG, Brown DM et al Direct-Acting Antiviral Prophylaxis in Kidney Transplantation From Hepatitis C Virus-Infected Donors to Noninfected Recipients: An Open-Label Nonrandomized Trial. Ann Intern Med. 2018. March 6. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29507971 <Internet> http://annals.org/aim/article-abstract/2674335/direct-acting-antiviral-prophylaxis-kidney-transplantation-from-hepatitis-c-virus
  6. Tullius SG, Rabb H. Improving the Supply and Quality of Deceased-Donor Organs for Transplantation. N Engl J Med 2018; 378:1920-1929. May 17, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29768153 https://www.nejm.org/doi/full/10.1056/NEJMra1507080
  7. Rosenbaum L Altruism in Extremis - The Evolving Ethics of Organ Donation. N Engl J Med 2020;382:493-496. Feb 6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32023370 https://www.nejm.org/doi/full/10.1056/NEJMp2000048
  8. 8.0 8.1 Dhanani S, Hornby L, van Beinum A et al. Resumption of cardiac activity after withdrawal of life-sustaining measures. N Engl J Med 2021 Jan 28; 384:345 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33503343 https://www.nejm.org/doi/10.1056/NEJMoa2022713
  9. 9.0 9.1 Sade RM Consequences of the Dead Donor Rule Ann Thorac Surg 2014 Apr;97(4):1131-2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24694402 PMCID: PMC4100619 Free PMC article
  10. 10.0 10.1 10.2 Kneisel K The Lazarus Syndrome in Extremis? A bizarre case of autoresuscitation during donor organ procurement MedPage Today June 14, 2021 https://www.medpagetoday.com/casestudies/emergencymedicine/93094
  11. FaceBook Organ Donation Site Sharing for Organ Donor Status https://www.facebook.com/help/?page=368924819806375
    Richtel M and Sack K Facebook Is Urging Members to Add Organ Donor Status New York Times, May 1, 2012 http://www.nytimes.com/2012/05/01/technology/facebook-urges-members-to-add-organ-donor-status.html
    .gov organ donation sites http://www.organdonor.gov/ http://www.nlm.nih.gov/medlineplus/organdonation.html
    Transplant Recipients International http://www.trioweb.org
    United Network for Organ Sharing (UNOS) http://www.unos.org
    Donate Life America http://www.donatelife.net
    National institute on Aging Organ Donation: https://www.nia.nih.gov/health/topics/organ-donation