LO66: Solid organ donation from the emergency department: A death review
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Demographics
Organ procurement
Since Japan's organ transplantaion law went into effect in 1997, more than a dozen donations have been made from braindead donors. We discuss 2 problems with organ procurement in Japan, based on 14 cases, including our own, for which we obtained information on the donation time line. The first problem is the need to diagnose clinical brain death before Japanese criteria for brain death are met. The second problem is inputting data on newly available organs to the Japan Organ Transplantation Network computer system. An organ may be input for shipping only after brain death is diagnosed. Beause of these 2 problems, organ donations take much time and place a heavy burden on donor hospitals. The organ procurement procedure is strictly regulated by legal guidelines, and we propose that the procedure is redesigned within the existing legal framework.
Organ procurement
Brain dead
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To promote organ transplantation in Iran, organ procurement from deceased donors should be supported. For this policy, some organ procurement units have been established in university hospitals. Further researches in these activities are warranted to better elucidate the role of cadaveric organ transplantation in Iran.We retrospectively studied deceased organ donation from June 2005 through December 2007 in Organ Procurement Unit of Shariati Hospital in Tehran. We analyzed a total of 141 organs that were retrieved from 46 brain-dead organ donors.The median age of all donors was 29 years (min: six, max: 63). Two third of them were males. The average of harvested organs was 3.06 per donor and four organs per month. The main cause of brain death was head trauma (n=33, 72%). Organ yield per donor was correlated to the time of the organ procurement unit activity and increased during the three years (r=0.261, P=0.017). Other variables were not changed during this period. Donor characteristics such as age, sex, blood group, and causes of brain death impacted on the organ yield. This study showed that organ procurement units can improve organ yield and both experience and donor characteristics influence on the number of harvested organs.
Organ procurement
Brain dead
Cadaveric spasm
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The revised organ transplantation act will come into effect from July 2010 in Japan. Here, we discuss about problems related to the organ procurement system from the perspective of a donor hospital. Organ procurement poses a heavy burden on the donor hospital, and it is difficult to procure organs from a child. The procedure for organ donation, especially, organ donation upon the diagnosis of brain death, requires considerable time and involves many specialists. For example, the progression from the diagnosis of clinical brain death to the end of organ harvesting takes about more than 45 hours. To reduce the heavy burden on donor hospitals, some type of support system is required such as a system of providing economical assistance and specialists for the diagnosis of brain death. The shipping of organs from a child donor, the regulation of the criteria for the diagnosis children of brain death, and a framework of donor hospitals must be analyzed and standardized. Organ procurement is strictly regulated by legal guidelines; we propose that under the revised legal framework, the procedure of organ procurement be rapid.
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Abstract Many patients declared brain dead become organ and tissue donors. Donation can come through donation after cardiac death (DCD) or donation after brain death (DBD) protocols, and consent is obtained from family members by organ procurement officers. The care of the donor by the neurointensivist is transferred to organ procurement officers. This chapter discusses the essentials of care as well as procedures, but also details common dilemmas in the discussions with family members.
Organ procurement
Brain dead
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Organ procurement
Dissent
Tissue Donation
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In the 4 years since Japan's organ transplantation law went into effect, 22 organ procurements have taken place. To analyze problems in organ procurement from brain-dead donors, we reviewed the diagnosis of brain death and organ procurement in our 3 cases. 1) Although it signing and presentation of a donor card (“living will”) is generally regarded expression of definite intent of organ donation, this intent is not always fully discussed by family members. Procedures must proceed carefully until final decision-making for organ donation by family members. 2) To maximize respect for “living wills” in organ donation, we must reduce time taken for brain death diagnosis and organ procurement under legal guidelines and ensure organ viability. 3) The excellent results with organ transplantation surgery should be emphasized to improve organ transplantation awareness among potential donors.
Organ procurement
Brain dead
Presentation (obstetrics)
Organ dysfunction
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Organ procurement
Philosophy of technology
Solid organ
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The revised organ transplantation law has been gone into effect from July, 2010 in Japan. We discuss about the problems for organ procurement system from the point of a donor hospital. These problems are heavy burden for donor hospital and organ procurement from a donor of child. The criteria of brain death of child have to be established. And the donation of organ spends much time and requires many specialists. For example, it takes about more than 45 hours from the diagnosis of clinical brain death to the end of organ harvesting. To reduce a heavy burden for a donor hospital, supporting system have to be established for the donor hospital and the donor family. The organ procurement procedure is strictly regulated by the legal guidelines; we propose that the new framework is redesigned rapidly within the new law and the guidelines.
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Authoritative literature and clinically relevant data related to organ donation from a TBD family member lend support that organ donation is a multifaceted and challenging opportunity. These sources call forth multi-professional responsiveness in clinical practice, education, research, public policy, and ethics as advances in organ procurement and transplantation intensify. In turn, opportunities are rich for professionals to appreciate and to receive in new ways organ donation as a gift on behalf of society.
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Brain dead
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Despite the increasing numbers of patients in need of organ transplantation following the increasing prevalence of chronic diseases such as CRF, chronic liver disease, disparities between the supply and demand of transplantable organs are getting increasingly widened. After the "Organ transplatation act" is enacted in 2000, brain death organ is equitably allocated by KONOS and illegal organ bargains are nearly eradicated. But unfortunately, brain death organ donation is not sufficiently activated, because of immature organ donation culture, absence of notification of potential brain death and active organ procurement system, and inflexibe organ donation processes. Ministry of Health and Welfare had made the comprehensive activation plan to solve the organ shortage problems, to increase organ procurments and transplantations at Oct. 2005. The major measures are strengthening the PR and education about organ donation, introduction of notification of potential brain death, and establishment of active organ procurement system through organ procurement organizations, strengthening of national responsibility and support.
Organ procurement
Economic shortage
Christian ministry
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