Alicia Pérez‐Blanco

Organización Nacional de Trasplantes

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Beatriz Domínguez‐Gil

Organización Nacional de Trasplantes

Elisabeth Coll

Organización Nacional de Trasplantes

Eduardo Miñambres

Marqués de Valdecilla University Hospital

Manuela Camino

Hospital General Universitario Gregorio Marañón

Mario Royo-Villanova

Hospital Universitario Virgen de la Arrixaca

Marta López‐Fraga

Conseil de L'Europe

J.M. Pérez-Villares

Andalusian Health Service

Francisco González-Vílchez

Marqués de Valdecilla University Hospital

Manuel Gómez‐Bueno

Universitat de Barcelona

Iris P. Garrido

Hospital Universitario Virgen de la Arrixaca

Cooperative Institutions

Centro de Investigación Biomédica en Red

Centro de Investigación en Red en Enfermedades Cardiovasculares

Instituto de Salud Carlos III

Universitat de Barcelona

Organización Nacional de Trasplantes

International Society for Heart and Lung Transplantation

Hospital Universitario 12 De Octubre

Universidad Complutense de Madrid

Hospital Clínic de Barcelona

Hospital Universitario Virgen de la Arrixaca

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Family bereavement and organ donation in Spain: a mixed method, prospective cohort study protocol

BMJ Open (2023)

María Victoria Martínez‐López Elisabeth Coll Francisco Cruz‐Quintana Beatriz Domínguez‐Gil Ivar R. Hannikainen

Introduction There is a discrepancy in the literature as to whether authorising or refusing the recovery of organs for transplantation is of direct benefit to families in their subsequent grieving process. This study aims to explore the impact of the family interview to pose the option of posthumous donation and the decision to authorise or refuse organ recovery on the grieving process of potential donors’ relatives. Methods and analysis A protocol for mixed methods, prospective cohort longitudinal study is proposed. Researchers do not randomly assign participants to groups. Instead, participants are considered to belong to one of three groups based on factors related to their experiences at the hospital. In this regard, families in G1, G2 and G3 would be those who authorised organ donation, declined organ donation or were not asked about organ donation, respectively. Their grieving process is monitored at three points in time: 1 month after the patient’s death, when a semistructured interview focused on the lived experience during the donation process is carried out, 3 months and 9 months after the death. At the second and third time points, relatives’ grieving process is assessed using six psychometric tests: State-Trait Anxiety Inventory, Beck Depression Inventory-II, Inventory of Complicated Grief, The Impact of Event Scale: Revised, Posttraumatic Growth Inventory and Connor-Davidson Resilience Scale. Descriptive statistics (means, SDs and frequencies) are computed for each group and time point. Through a series of regression models, differences between groups in the evolution of bereavement are estimated. Additionally, qualitative analyses of the semistructured interviews are conducted using the ATLAS.ti software. Ethics and dissemination This study involves human participants and was approved by Comité Coordinador de Ética de la Investigación Biomédica de Andalucía (CCEIBA) ID:1052-N-21. The results will be disseminated at congresses and ordinary academic forums. Participants gave informed consent to participate in the study before taking part.

10.1136/bmjopen-2022-066286

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Citations (4)

Access of non‐residents to transplantation of deceased donor organs: practices and strategies in the European setting

Transplant International (2021)

Alicia Pérez‐Blanco Marta López‐Fraga John Forsythe Ana M. Pires Silva Massimo Cardillo

Vulnerability

10.1111/tri.14113

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Citations (6)

Eficiency of triiodothyronine treatment on organ donor hemodynamic management and adenine nucleotide concentration

Intensive Care Medicine (2005)

Alicia Pérez‐Blanco Juan Caturla-Such José Cánovas-Robles José Sánchez‐Payá

Adenine nucleotide

10.1007/s00134-005-2662-9

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Citations (51)

The international experience of in-situ recovery of the DCD heart: a multicentre retrospective observational study

EClinicalMedicine (2023)

John Louca Marco Öchsner Ashish S. Shah Jordan Hoffman Alexandra Debose-Scarlett

BackgroundHeart transplantation is an effective treatment offering the best recovery in both quality and quantity of life in those affected by refractory, severe heart failure. However, transplantation is limited by donor organ availability. The reintroduction of heart donation after the circulatory determination of death (DCD) in 2014 offered an uplift in transplant activity by 30%. Thoraco-abdominal normothermic regional perfusion (taNRP) enables in-situ reperfusion of the DCD heart. The objective of this paper is to assess the clinical outcomes of DCD donor hearts recovered and transplanted from donors undergoing taNRP.MethodThis was a multicentre retrospective observational study. Outcomes included functional warm ischaemic time, use of mechanical support immediately following transplantation, perioperative and long-term actuarial survival and incidence of acute rejection requiring treatment. 157 taNRP DCD heart transplants, performed between February 2, 2015, and July 29, 2022, have been included from 15 major transplant centres worldwide including the UK, Spain, the USA and Belgium. 673 donations after the neurological determination of death (DBD) heart transplantations from the same centres were used as a comparison group for survival.FindingstaNRP resulted in a 23% increase in heart transplantation activity. Survival was similar in the taNRP group when compared to DBD. 30-day survival was 96.8% ([92.5%–98.6%] 95% CI, n = 156), 1-year survival was 93.2% ([87.7%–96.3%] 95% CI, n = 72) and 5-year survival was 84.3% ([69.6%–92.2%] 95% CI, n = 13).InterpretationOur study suggests that taNRP provides a significant boost to heart transplantation activity. The survival rates of taNRP are comparable to those obtained for DBD transplantation in this study. The similar survival may in part be related to a short warm ischaemic time or through a possible selection bias of younger donors, this being an uncontrolled observational study. Therefore, our study suggests that taNRP offers an effective method of organ preservation and procurement. This early success of the technique warrants further investigation and use.FundingNone of the authors have a financial relationship with a commercial entity that has an interest in the subject.

10.1016/j.eclinm.2023.101887

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Citations (51)

Assessing Outcomes of Patients Subject to Intensive Care to Facilitate Organ Donation: A Spanish Multicenter Prospective Study

Transplant International (2024)

Alicia Pérez‐Blanco María Acevedo María Padilla Aroa Gómez L. Zapata

Intensive Care to facilitate Organ Donation (ICOD) consists of the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom curative treatment is deemed futile and death by neurological criteria (DNC) is foreseen, to incorporate organ donation into their end-of-life plans. In this study we evaluate the outcomes of patients subject to ICOD and identify radiological and clinical factors associated with progression to DNC. In this first prospective multicenter study we tested by multivariate regression the association of clinical and radiological severity features with progression to DNC. Of the 194 patients, 144 (74.2%) patients fulfilled DNC after a median of 25 h (95% IQR: 17–44) from ICOD onset. Two patients (1%) shifted from ICOD to curative treatment, both were alive at discharge. Factors associated with progression to DNC included: age below 70 years, clinical score consistent with severe brain injury, instability, intracranial hemorrhage, midline shift ≥5 mm and certain types of brain herniation. Overall 151 (77.8%) patients progressed to organ donation. Based on these results, we conclude that ICOD is a beneficial and efficient practice that can contribute to the pool of deceased donors.

10.3389/ti.2024.12791

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Citations (1)

Prevention of Trafficking in Organs, Tissues, and Cells

Transplantation (2024)

Dominique Martin Alexander Morgan Capron Riadh Fadhil John Forsythe Benita Padilla

Trafficking in human organs, cells, and tissues has long been a source of concern for health authorities and professionals, and several international ethical guidance documents and national laws have affirmed the prohibition of trade in these substances of human origin (SoHOs). However, despite considerable attention to the issue of organ trafficking, this remains a substantial and widespread problem internationally. In contrast, trafficking in cells, tissues, and medical products derived from SoHOs has received comparatively little attention, and the extent and nature of such trafficking remain largely unknown. Consequently, as part of the 2023 Global Summit on Convergence in Transplantation held in Santander, Spain, an ethics working group was assigned the task of formulating actionable recommendations to support the prevention of trafficking in all SoHOs. In reporting on this work, we review factors that may influence the persistent trafficking of SoHOs, explore the potential difficulties associated with the collection and reporting of data about suspected trafficking activities, and argue that more practical and consistent guidance, training, and regulatory frameworks are needed internationally to support effective reporting, sharing of data, and collaborative responses to suspected trafficking cases. We also discuss the importance of psychosocial evaluation of living donors as a strategy to detect and prevent organ trafficking and strive to advance the implementation of this well-established recommendation by outlining minimum standards for psychosocial evaluation of living donors.

Summit

10.1097/tp.0000000000005212

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Citations (2)

Uterus Transplantation as a Surgical Innovation

Journal of Bioethical Inquiry (2023)

Alicia Pérez‐Blanco José Seoane Teresa Pallàs Montserrat Nieto‐Moro Rocío Núñez Calonge

Uterus transplantation (UTx) research has been introduced in several countries, with trials in Sweden and the United States producing successful outcomes. The growing interest in developing UTx trials in other countries, such as Spain, the Netherlands, Japan, and Australia, raises important questions regarding the ethics of surgical innovation research in the field of UTx. This paper examines the current state of UTx in the context of the surgical innovation paradigm and IDEAL framework and discusses the ethical challenges faced by those considering the introduction of new trials. We argue that UTx remains an experimental procedure at a relatively early stage of the IDEAL framework, especially in the context of de novo trials, where protocols are likely to deviate from those used previously and where researchers are likely to have limited experience of UTx. We conclude that countries considering the introduction of UTx trials should build on the strengths of the reported outcomes to consolidate the evidence base and shed light on the uncertainties of the procedure. Authorities responsible for the ethical governance of UTx trials are advised to draw on the ethical framework used in the oversight of surgical innovation.

Medical law

10.1007/s11673-023-10272-5

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Citations (6)

ISHLT consensus statement on donor organ acceptability and management in pediatric heart transplantation

The Journal of Heart and Lung Transplantation (2020)

Richard Kirk Anne I. Dipchand Ryan R. Davies Oliver Miera Gretchen B. Chapman

Statement (logic)

Waiting list

Heart transplants

USable

10.1016/j.healun.2020.01.1345

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Citations (74)

Review of the allocation criteria for heart transplant in Spain in 2023. SEC-Heart Failure Association/ONT/SECCE consensus document

Revista Española de Cardiología (English Edition) (2023)

José González‐Costello Alicia Pérez‐Blanco Juan F. Delgado Francisco González-Vílchez Sònia Mirabet

Multidisciplinary team

10.1016/j.rec.2023.11.001

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Citations (1)

Maintaining the Permanence Principle of Death During Normothermic Regional Perfusion in Controlled Dcd: Results of a Prospective Clinical Study

Research Square (Research Square) (2023)

Mario Royo-Villanova Eduardo Miñambres José Moya Sánchez Eduardo Torres C F Manso

Abstract Purpose The use of normothermic regional perfusion (NRP) in donation after the circulatory determination of death (DCD) is limited by concerns associated with the reestablishment of circulation after death declaration. The aim of this study is to confirm that certain technical maneuvers applied during NRP preclude circulation to the brain. Methods A non-randomized trial was performed at two Spanish centers. Consecutive adult controlled DCD donors were included. In abdominal NRP (A-NRP), the thoracic aorta was blocked with an intra-aortic occlusion balloon. In thoraco-abdominal NRP (TA-NRP), the arch vessels were clamped and the cephalad ends vented to the atmosphere. Blood from the vented arch vessels drained to the thorax. The mean intracerebral arterial blood pressure (ICBP) was invasively measured at the circle of Willis. Results Ten cDCD donors subject to A-NRP (n = 8) and TA-NRP (n = 2) were included. Mean ICBP and mean blood pressure at the thoracic and the abdominal aorta during the circulatory arrest were 16.9 (SD:3.0), 17.2 (SD:3.0) and 17.6 (SD:4.4), respectively. When A-NRP was started, pressure at the abdominal aorta increased to 49.9 (SD:12.5) mmHg, while the ICBP remained unchanged. When TA-NRP was initiated, pressure at the thoracic aorta reached values of 70.5 (SD:17.7) mmHg, but the ICBP remained unmodified. Registered values of ICBP during NRP were 10 mmHg. Conclusion Appropriate technical measures applied during NRP preclude circulation to the brain in DCD procedures. This study can help to expand NRP, respecting the dead donor rule and increasing the number and quality of organs available for transplantation.

Abdominal aorta

Thoracic aorta

10.21203/rs.3.rs-2977641/v1

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Citations (1)