A Navarro

Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors.

Abstract Our aim was to analyze the short‐ and long‐term function of kidneys procured from non‐ heart‐beating donors (NHBD) by means of three techniques: in situ perfusion (ISP), total body cooling (TBC) and normothermic recirculation (NR). Fifty‐seven potential NHBD were included. Mean warm ischemia time was 68.9 ± 35.6 min. Forty‐four kidneys were obtained from donors perfused with ISP, 8 with TBC, and 8 with NR. Eighteen kidneys (32%) started functioning immediately, 29 (52 %) showed delayed graft function (DGF) and 9 (16%) showed primary non function (PNF). The actuarial graft survival rate was 76.4 % at 1 year and 56 % at 5 years. The patient survival rate was 89.3 % at 5 years. Incidence of DGF and PNF was significantly lower in kidneys perfused with NR than those with ISP or TBC (P < 0.01). Duration of DGF was shorter in kidneys obtained through TBC than in kidneys obtained with ISP (P < 0.05). In conclusion, NR reduces the incidence of DGF and may be considered the method of choice for kidney procurement from NHBD.

Persistence of intracranial diastolic flow in transcranial Doppler sonography exploration of patients in brain death.

OBJECTIVE The persistence of cerebral blood flow (CBF) in patients with whole brain death (BD) diagnosis is an unusual phenomenon. We describe patients with whole BD diagnosed despite persistence of intracranial blood flow on transcranial Doppler sonography (TDS). MATERIALS AND METHODS From January 2001 to December 2002, we reviewed the records of 11 patients. Etiology of BD was craniocephalic trauma in 2 cases, schemic cerebrovascular accident (CVA) in 4 cases, Hemorrhagic CVA in 3 cases, subaracnoid hemorrhage in 1 case, and acute hydrocephalus in 1 case. Six patients had a cerebral decompressive mechanism. In all patients, TDS was used to confirm BD after clinical diagnosis. Additionally, all patients underwent an electroencephalogram (EEG). In 3 patients cerebral angiography (CA) and in 2 others radionuclide angiography (RA) with Tc99m HMPAO were done. RESULTS All TDS studies showed persistent telediastolic positive flow in at least 1 artery. Because the TDS did not confirm the clinical diagnosis of BD, EEG tests were performed showing silence of bioelectrical activity. Those cases showed CA or RA results with a complete absence of CBF. CONCLUSION The TDS technique directly evaluates the intracranial but not the intracerebral circulation. For this reason, during the BD diagnosis for patients with previous decompressive techniques, it was possible to find persistence of intracranial telediastolic flow using TDS. In those cases, it is advisable to use other tests to confirm the clinical diagnosis of BD.

Cold chain monitoring during cold transportation of human corneas for transplantation.

BACKGROUND As recommended by international standards the cornea should be maintained in a specific temperature range (2 degrees -8 degrees C) to guarantee its viability. However, there is no standard packaging method to maintain these conditions during transport. Our packaging system is similar to those used by the main eye banks in Spain and elsewhere in Europe. The objective is to monitor the cold chain in the current packaging method to validate the maintenance of temperature within the adequate range for a minimum 24-hour period. METHODS The effects of the following variables were studied: number and freezing temperature of the cold packs; air volume in the packaging system; position of the cornea in the packaging system; and the wall section of the container. Exterior temperature was maintained constant at 20 degrees to 24 degrees C. The cold chain was monitored using a device that measures temperature continuously and for which a histogram of temperature variation can be downloaded to a computer for further analysis. RESULTS When the cold packs were frozen to -40 degrees C or the number of cold packs increased to four, the temperature decreased quickly to 0 degrees C and the transport period was not prolonged. The main objective was to improve isolation by reducing inner air volume, and maintaining the position of the cornea in the container. CONCLUSIONS The currently used cold packaging systems (not frozen, 4 degrees C) do not maintain the temperature within the accepted range for the required distribution period. The improved system maintains the cornea at between 2 degrees C and 6 degrees C for a minimum of 24 hours.

Importance of the transplant coordinator in tissue donor detection.

In 1996 we established an active system on tissue donors detection. First we defined coworker areas, which are the units from the hospital where, because of the pathology and critical situation of the patients, were possible units of potential donors. We set up two actions: assistance work to remind every day those in these areas the possibility of tissue donation and administration work analyzing every day deaths in these areas and knowing whether they were tissue donors. We defined some items for labeling the cause of no donation: no detection when there is no call from the coworker area; no coordinator localization; refusal because of age criteria or absolute contraindication for pathology, and family or judicial refusal.

The process of adult living liver donation

OBJECTIVE To evaluate both the opinion that living liver donors have of the process and the psychological, economic, and social consequences of donation. MATERIAL AND METHODS Six months after the donation, an anonymous survey was sent to 22 donors of the right liver lobe between March 2000 and December 2002. RESULTS 15 surveys were returned with all of the questions answered. Almost all the donors had no prior knowledge of living donation. When they were considered to be suitable donors, all of them felt happy, 21% were scared and 15% felt joy and insecurity. The information provided was well understood and accurately described the experiences of 93% of donors. All donors understood the vital risk, and 93% understood that transplantation is not always completely successful. All donors would repeat the experience. Mean hospital stay was 12.6 days. Mean convalescence was 50.6 days. Salaried donors were on sick leave for a mean of 96.4 days (21-150 days), causing financial problems in six cases (36%), due to no financial compensation and compulsory redundancy in one case. All donors had completely recovered at six months after donation. DISCUSSION Adult living donation of the right liver lobe is an accepted therapeutic alternative. In order to regulate medical and economic protection to avoid additional disturbances after donation, the public, patients, and physicians require more complete information about living donation.

Increasing Demand on Master Education for Transplantation

Introduction Transplant Procurement Management (TPM) and the University of Barcelona (UB) offers a Master in Donation and Transplantation since 2004. Until 2010, 3 Spanish, 3 English and 4 Italian editions were held. Since 2011 it has been in English. From 2011, it is a modular program that includes 5 modules: Donation, Transplantation, Management, Training for Trainers and Tissue Banking. The aim of the study is to analyze the total number of students and their profile, as well as the scores in the Transplantation module to evaluate improving measures. Materials and Methods Data including number and profile of the students (gender, nationality and background) and course evaluation scores are organized in 2 periods due to the introduction of the modularity in 2011 (2004-2010 & 2011-2016). For the scores, the first period evaluates the final grade and the second, the scores in the latest modules that has been introduced in the program, the Organ Transplantation module. Results and Discussion Number & profile: Ninety-six and 111 participants were registered in the master in the first and second period respectively. Most of them were women (2004-10: 56.25%; 2011-17:63.13%). The most common background was “medicine” during the first period (47.91%) and the second (57.66%), although background heterogeneity was lower. According to the specialization of the MD, Transplantation is the most frequent (64.93%), followed by Donation (32.46%) and others (2.59%). In the 2014-10 period, the nationalities according to the language were: 1 European for Italian edition, 14 from American countries in the Spanish edition, and 4 in the English edition, mostly from Asia (3). In the 2011-16 period, students were from 32 different countries, mostly European (46) and American (50). Scores: In 2005-2010 students were qualified on an on-site and online course on Donation & Transplantation, an internship and a Dissertation (FMD). The Master’s final grade was Pass/Fail. 100% of participants passed. In 2011-2016, students were evaluated through modules, as well as an internship and a FMD. From 2011-2014 there was no Transplantation module offered. In 2015 and 2016 Organ Transplantation module was introduced to the program according to the background of the participants and their needs, as it was the largest group among the specializations of MD. Results show that Donation has the lowest score (7.32/10) and Transplantation the highest (8.15/10). Training the trainers obtained an 8.20/10, Management an 8.17/10 and Tissue Banking an 7.54/10. Conclusion Considering that the main characteristics of the master are the students’ internationality and heterogeneity, the improving measures must focus on flexibility in the module selection and promoting online modality. Moreover, there is a direct impact in the increasing of the scores when the program is designed according to the needs and background of the participants.

Timing comparison of donation process after the new real decreto of transplantation in Spain.

IN SPAIN January 2001, a new Real Decreto regulates the Transplant Law of 1979. The main feature is a change in the brain death (BD) diagnosis, giving more strength to clinical evaluation and allowing the use of different BD diagnostic tools (electroencephalograph [EEG], cerebral blood flow studies [CBFS]) instead of two obligatory flat EEG separated by 6 hours as required by the Real Decreto of 1980. We compared the timing of the donation process between donor detection and organ extraction (OE) before and after the introduction of the new Real Order to establish if it is necessary to modify the logistic organisation of the process.