Prélèvements sur « donneurs décédés après arrêt cardiaque » : l’expérience du Samu de la Seine-Saint-Denis

The use of non-heart-beating donors (NHBD) could help shorten the list of patients who are waiting for a kidney transplant. The aim of this study was to evaluate efficiency of prehospital management of non-heart-beating donors in Seine-Saint-Denis area. We performed a retrospective cohort study of non-heart-beating donor managed by prehospital medical team of Samu 93 from February 2007 to January 2008. There were 28 non-heart-beating donors included consecutively. Twenty-five NHBD (89%) were canuled by Gillot probe within 150 min from patient collapse. Fourteen NHBD were harvested and 17 kidneys were transplanted. Six-month survival rate for NHBD grafts was 94%. In the same time, eight brain dead donors were managed by Samu 93 and were harvested leading to transplant 16 kidneys. Finally, 50% of overall kidney transplant activity in Seine-Saint-Denis was provided by NHBD grafts.     

Prélèvements d’organes et décès médico-légaux

Objective

There is a chronic shortage of transplants. There are many obstacles on organ procurement and some are related to forensics aspects of deaths. In these situations in France, the judge decides whether or not to perform the organ recovery. These refusals are about 40 donors per year, representing a loss of more than 120 potential transplants.

Study design

Retrospective study of 9 years (2003–2011) aimed to study the expectations of judges in comparing them with forensics issues.

Patients and methods

Sixty-two cases of organ recovery with judicial proceedings have been treated in collaboration between the Agency of Biomedicine (Northeast) and the Medico-Legal Institute of Lille (northern France).

Results

When there is a judicial opposition to an organ procurement, it is mostly upon criminal circumstances (57%). The main reason is the need to perform an autopsy (38%), raising fears of a loss of evidence because of resuscitation and surgery for the judges. However, autopsies rule out these problems if strict protocols are followed.

Conclusions

In case of forensic death, French law provides that a forensic examination to take place prior to surgical procedures. The law also provides for collaboration between caregivers and medical examiners. Nevertheless, judicial oppositions persist and appear to belong to a lack of communication between actors (judges/medical examiners/organ procurement organization). Better collaboration through protocols must be thought to satisfy the demands of justice and public health.     

Traitement des métastases cérébrales par radiochirurgie stéréotaxique : étude de 33 cas liés à un accident de « surexposition »

The consequences of a dosimetric radiosurgery accident are not the same as a conventional radiotherapy accident. The objective of this study was to estimate the clinical and radiological outcome of patients treated by radiosurgery for metastasis during the period of the overexposure accident that occurred in the Toulouse Radiosurgery Unit. Between April 2006 and March 2007, 33 patients with 57 metastases were treated in the Toulouse Radiosurgery Unit (Novalis^®, BrainLab). An initial error in the estimation of the scatter factors led to an overexposure to radiation. The median age was 55 years [range, 35-85]. Twenty-one patients (64%) harbored a single metastasis. The primary tumor location was lung (16 cases), kidney (nine cases), breast (four cases), and others (four cases). The mean tumoral volume was 3.2 cm³ [0.04-14.07]. The mean prescribed dose at the isocenter was 20 Gy [range, 10-23], the mean delivered dose was 31.5 Gy [range, 13-52], and the mean overdose was 61.2% [range, 5.6-226.8]. In order to evaluate the consequences of the overdose, three parameters were analyzed: a risk index using dose and volume, the volume of parenchyma that received more than 12 Gy, and the mean dose in a sphere of 20 cm³ surrounding the target volume. Median actuarial survival was 14.1 months, the survival rate was 79.4 % at six months, 59.1% at 12 months, and 27.2% at 24 months. The rate of tumor control was 80.7%. No morbidity was observed. There was no correlation between death and the parameters studied. The survival rates and times observed in our study of the patients treated for brain metastases by radiosurgery and overexposed were among the good results of the international literature. Deaths were not related to the overdose and no side effect was noted. This dosimetric accident has not had worse consequences in this population.