甲基苯丙胺中毒脑死亡器官捐献1例报道

目的探讨甲基苯丙胺中毒脑死亡器官捐献供肾肾移植的效果。方法回顾性分析2015年10月1例甲基苯丙胺中毒脑死亡器官捐献供肾用于2例肾移植的临床资料。供者为女性,22岁,因甲基苯丙胺中毒导致脑死亡而捐献器官。受者均为女性,因慢性肾功能不全尿毒症接受肾移植。结果 2例受者术后4 d血清肌酐恢复正常,未发生急性排斥反应。术后1年随访血清肌酐及尿量均正常。结论甲基苯丙胺中毒脑死亡的患者可以作为器官捐献的供体来源。     

公民逝世后器官捐献供肾移植临床分析

目的探讨公民逝世后器官捐献供肾移植的近期临床效果。方法公民逝世后器官捐献供肾移植73例,供者43例,其中本院器官获取组织42例,外院器官获取组织分享1例。分析肾移植术后人/肾存活率和并发症的发生情况。结果 73例受者随访9~38个月,术后6个月、1年的人/肾存活率分别为97.3%/94.5%、94.5%/91.8%。10例(13.7%)受者发生移植肾功能恢复延迟,15例(20.5%)受者术后发生急性排斥反应,21例(28.8%)受者发生肺部感染。2例受者移植肾丢失,4例受者移植肾带功死亡。结论公民逝世后器官捐献供肾移植近期疗效较好,是解决供肾来源的有效途径。     

心脏死亡器官捐献供肾移植早期肾功能恢复情况的荟萃分析

目的 分析心脏死亡器官捐献(DCD)供肾移植后早期肾功能恢复情况.方法 通过Pubmed/Medline、Embase和Cochrane等数据库检索1950年至201 1年正式发表的DCD肾移植和脑死亡器官捐献(DBD)肾移植早期肾功能恢复情况的相关单中心的文献,进行荟萃分析.对移植物功能延迟恢复(DGF)和原发性肾脏无功能(PNF)的发生情况进行分析,计算比值比(OR)和95％可信区间(CI).结果 最终纳入9篇文献,包括DCD肾移植2049例和DBD肾移植5498例.DCD肾移植后DGF发生率为37.5％,DCD肾移植后DGF发生的OR为7.24(95％ CI为3.86～13.58);DCD肾移植后PNF发生率为18.2％,DCD肾移植后PNF发生的OR为4.97(95％ CI为3.77～6.55).DCD肾移植和DBD肾移植受者1、3、5和10年存活率的差异均无统计学意义,移植肾1、3、5和10年存活率的差异也均无统计学意义.结论 DCD肾移植后的DGF和PNF发生率较高,从而影响早期肾功能恢复.     

中国心死亡器官捐献与脑死亡器官捐献肾移植受者预后比较

自2007年《人体器官移植条例》颁布以来,中国器官捐献立法不断完善,临床实践也深入开展,公民器官捐献肾移植的数量明显增加。作为最主要的两种尸体器官捐献方式,心死亡器官捐献（donation after cardiac death,DCD）和脑死亡器官捐献（donation after brain death,DBD）肾移植受者的预后一直受到学界的关注。王长希等学者对2007--2012年中山大学附属第一医院和广州医学院附属第三医院器官移植中心实施的44例DCD肾移植和50例DBD肾移植受者的临床资料进行了分析,比较了两组受者的临床预后。     

心脏死亡供肾肾移植9例临床分析

目的 探讨心脏死亡无偿器官捐献肾脏移植治疗的经验及效果.方法 分析我院于2007年9月至2012年1月完成的9例心脏死亡无偿器官捐献肾移植的临床资料.根据＂脑死亡判定标准（成人）＂和＂脑死亡判定技术规范＂确诊为供体脑死亡,待心脏停止跳动后,按常规方法整块切取器官.其中7例接受4例院内脑死亡后心脏死亡（DCD）患者的无偿供肾,2例患者接受1例院外脑死亡后心脏死亡患者的无偿供肾.结果 所有患者手术顺利.4例受者术后第5天肾功能恢复正常.1例受者术后出现急性排斥反应,给予抗人胸腺细胞免疫球蛋白（ATG）冲击治疗并辅以血液透析.4例术后肾功能延迟恢复.所有受者随访3个月~5年.2例术后死于重症感染及进行性多灶性白质脑病,死亡时肌酐431.6μmol/L和105.3 μmol/L.结论 心脏死亡器官捐献是扩大器官来源的有效途径,近期移植效果可靠可以用于临床.     

脑死亡后器官捐献肾移植术后泌尿系感染危险因素的单中心临床研究

目的 探讨脑死亡后器官捐献肾移植术后受者发生泌尿系感染的独立危险因素，为受者泌尿道感染制定相应预防和控制措施提供理论依据。方法 回顾性分析2021年1月—2021年12月于北部战区总医院器官移植中心行同种异体的100例肾移植患者的临床资料，根据患者术后3个月内是否发生泌尿系感染分为感染组(26例)和非感染组(74例),采用单因素和多因素分析寻找脑死亡后器官捐献肾移植术后受者发生泌尿系感染的影响因素。结果 肾移植术后3个月内泌尿系感染的发生率为26%(26例)。单因素分析结果显示：性别、术后尿瘘、术后尿管留置时间及术后双J管留置时间是脑死亡后器官捐献肾移植术后受者泌尿系感染的影响因素(P<0.05);运用前进法逐步回归分析得出，术后双J管留置时间(OR=1.086,95%CI:1.003～1.177,P=0.042)及术后尿管留置时间(OR=4.687,95%CI:2.064～10.645,P<0.010)。是脑死亡后器官捐献肾移植术后受者出现泌尿系感染的独立危险因素(P<0.05)。结论 术后尿管留置及术后双J管留置时间长会增加脑死亡后器官捐献肾移植术后受者发生泌尿系...     

儿童器官捐献供肾肾移植疗效的临床研究

目的探讨儿童器官捐献供肾移植的近期临床疗效。方法回顾性分析2013年11月至2015年12月西安交通大学第一附属医院肾移植科完成的15例儿童器官捐献供者,供给28例肾移植受者(其中双肾移植2例)的供、受者临床资料。结果 28例受者手术均获成功。移植肾热缺血时间中位数为12.5 min(0~17.0 min),冷缺血时间中位数为4.3 h(1.5~7.7 h)。术后出现移植物功能延迟恢复(DGF)4例、透析1例、因肺部感染死亡2例、肾吻合口狭窄和供肾血栓形成后切除移植肾各1例。术后随访1~24个月,受者存活26例(93%),带肾存活受者24例(86%),其移植肾功能均正常。结论儿童器官捐献供者双肾整块移植及单肾移植早期临床疗效较好。     

29例脑死亡器官移植供体的维护体会

【摘要】 目的 探讨脑死亡器官移植供体在ICU的维护要点。方法〓回顾性分析我科2012年1月~2013年12月间完成的29例脑死亡供体器官捐献资料,分析脑死亡供体器官获取前情况,移植肾、移植肝受者情况及急性肾损伤(AKI)供肾的移植效果,总结脑死亡患者作为潜在供体的维护要点。结果〓维护脑死亡供体29例,共捐献肾脏40个、肝脏27个、心脏4个、角膜21对。6例(15%)移植肾受者发生移植物功能延迟恢复,1例(2.5%)发生急性排斥反应、1例(2.5%)发生髂内动脉假性动脉瘤出血切除移植肾,1例(2.5%)发生重症肺炎术后死亡;AKI供肾与非AKI供肾的受者在术后7天、2月肌酐恢复情况及不良事件发生率比较无明显差异;1例(4%)移植肝受者发生多脏器功能衰竭术后死亡。余受者随访至今均恢复顺利,器官功能良好。结论〓经过ICU内积极管理后的潜在器官移植供体能够获得较高质量的移植器官,有较好的移植效果。     

儿童器官捐献供体肝肾联合获取经验总结

目的探讨儿童器官捐献供体肝肾联合获取的临床经验。方法收集2011年10月至2016年12月佛山市第一人民医院6例儿童器官捐献供体肝肾联合获取的临床资料,总结其临床经验。结果根据国家卫生和计划生育委员会脑损伤质控评价中心制定的儿童脑死亡判定标准,6例儿童供体均在脑死亡状态下进行器官捐献肝肾联合获取,采用7号吸痰管髂外动脉插管或24 F导尿管髂总动脉插管、门静脉和腹主动脉灌注、胸主动脉阻断的肝肾联合灌注的改良方法。手术时间55~60 min,共成功获取6个供肝、12个供肾,所获取肝肾均成功应用于临床肝、肾移植,受者均未发生移植肝或移植肾原发性无功能。结论在儿童器官捐献供体中成功进行肝肾联合获取的关键在于及时进行脑死亡判定、严格谨慎的器官维护措施和肝肾联合获取技术的改良。     

不同免疫抑制方案对肾移植受者和移植肾存活的影响

目的回顾单中心近28年肾移植受者资料,分析探讨不同免疫抑制方案对移植受者和移植肾存活的影响。方法1977年10月至2004年12月,中国人民解放军总医院总共为1804例终末期肾病患者施行了2037例肾移植手术。根据临床资料和截止2005年底的随访结果,采用Kaplan-Meier方法计算人、肾存活率,并按照Terasaki公式计算移植物的半数生存期,分析各种免疫抑制方案对移植肾和移植受者存活的影响。结果以钙调素抑制剂（CNI）为基础的免疫抑制药物治疗显著提高了移植受者和移植肾的存活率,术后1、5、10和15年受者存活率分别为95．9％、89．1％、80．5％和73．0％;移植肾存活率分别为92．7％、80．4％、64．9％和54．1％。与无CNI类药物治疗相比,受者和移植肾的同期存活率差异具有统计学意义（均P〈0．0001）。在CNI为基础的三联药物治疗方案中,采用环孢素＋霉酚酸酯＋泼尼松方案者移植肾1、5、10年存活率高于采用环孢素＋硫唑嘌呤＋泼尼松方案者（1年94．3％比86．4％,5年90．9％比70．6％,10年71．3％比56．5％,均P〈0．0001）。结论以CNI为基础的三联药物治疗方案显著改善了肾移植受者和移植物的存活,特别是以他克莫司为基础的或包含霉酚酸酯的治疗方案对改善肾移植受者和移植物的存活具有重要作用。     

Successful organ donation from brain dead donors in a Chinese organ transplantation center

Solid organ transplantation is an effective treatment for patients with end-stage organ failure. Donation after brain death (DBD) is a means of addressing the inadequate supply of acceptable donor organs but has only gradually begun to be accepted in mainland China. A major barrier has been the absence of brain death and organ transplant legislation. This paper describes our initial experience with organ transplantation using organs from brain dead donors and discusses strategies for encouraging organ transplantation and brain death legislation in China. Six patients underwent renal transplantation and two patients underwent liver transplantation with organs procured from three brain dead donors at the Organ Transplantation Center, the 181st Hospital. All patients are alive with excellent graft function. DBD is an important means of increasing the number of organs available for transplantation and its widespread implementation in China should be encouraged. Brain death and organ transplantation legislation is necessary to ensure the rights and obligations of donors, recipients and medical institutions.     

Brain death caused by electric shock and organ donation in children

INTRODUCTION: There are still few publications about brain death caused by electric shock and the use of organs for donation in this situation. We sought to present our experience, with brain dead pediatric donors caused by electric shock. MATERIAL AND METHODS: Notification registers of potential donors were analyzed from 1998 to 2005. RESULTS: During this period, 2086 potential donors were secured, of whom 307 (14.7%) were less than 18 years old. Four pediatric potential donors (1.3%) suffered brain death due to anoxia by electric shock. Six kidneys, three livers, six corneas, and three heart valves were used for transplantation. The hearts and the lungs were not offered, because of a lack of compatible patients on the waiting list. The pediatric donors showed significant alterations of cardiac enzymes and two had altered liver enzymes. CONCLUSION: Brain death caused by electric shock is not a contraindication for organ donation. Follow-up of the recipients is necessary to determine if the transplants were successful.     

Induction of organ dysfunction and up-regulation of inflammatory markers in the liver and kidneys of hypotensive brain dead rats: a model to study marginal organ donors

BACKGROUND: Marginal donors exposed to the full array of effects induced by brain death are characterized by low success rates after transplantation. This study examined whether organs from marginal brain dead animals show any change in organ function or tissue activation making them eventually more susceptible for additional damage during preservation and transplantation. METHODS: To study this hypothesis we first focused on effects of brain death on donor organ quality by using a brain death model in the rat. After induction of brain death, Wistar rats were ventilated for 1 and 6 hr and then killed. Sham-operated rats served as controls. Organ function was studied using standard serum parameters. Tissue activation of liver and kidney was assessed by staining of immediate early gene products (IEG: FOS, JUN), and inflammatory markers; cell adhesion molecules (Intercellular adhesion molecule-1, vascular cell adhesion molecule-1), leukocyte infiltrates (CD45, T cell receptor, CD8, CD4), and MHC class II. RESULTS: During brain death progressive organ dysfunction was observed that coincided with a significant increase in activation of immediate early genes, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, CD45, and MHC class II versus nonbrain dead controls. In liver tissue also the markers for T cell receptor and CD8 significantly increased. CONCLUSIONS: These findings suggest that an immune activation with increased endothelial cell activation and immediate early gene expression occurs in marginal donors after brain death induction. We suggest that brain death should not longer be regarded as a given nondeleterious condition but as a dynamic process with potential detrimental effects on donor organs that could predispose grafts for increased alloreactivity after transplantation.     

Experience of heart transplantation from hemodynamically unstable brain-dead donors with extracorporeal support

Yang H‐Y, Lin C‐Y, Tsai Y‐T, Lee C‐Y, Tsai C‐S. Experience of heart transplantation from hemodynamically unstable brain‐dead donors with extracorporeal support. Abstract: The shortage of organ donors remains a major problem for transplantation worldwide. Potential donors after brain death may become hemodynamically unstable, despite maximal medical management, which ultimately leads to failure of organ procurement. We reviewed the medical records of five brain‐dead potential donors who presented with hemodynamic instability despite maximal medical management that were supported by extracorporeal circulation membrane oxygenation (ECMO). The outcomes of heart recipients were reviewed. The five donors under extracorporeal support finished a declaration of brain death without cardiac arrest. Donor organs, including three hearts, nine kidneys, and four livers, were harvested from the five donors under ECMO support. All three heart recipients recovered uneventfully after one yr of follow‐up. Our experience indicates that potential donors may experience central‐failure‐related hemodynamic instability after brain death, despite maximal medical support, which leads to a fatal result. Beyond medical management, prompt and early extracorporeal support for salvaging brain‐dead potential donors from cardiac death seems to be a practical strategy to increase the donor pool and preserve donor organs.     

Cardio‐pulmonary resuscitation of brain‐dead organ donors: a literature review and suggestions for practice

“Organ preserving cardiopulmonary resuscitation (OP‐CPR)” is defined as the use of CPR in cases of cardiac arrest to preserve organs for transplantation, rather than to revive the patient. Is it ethical to provide OP‐CPR in a brain‐dead organ donor to save organs that would otherwise be lost? To answer this question, we review the literature on brain‐dead organ donors, conduct an ethical analysis, and make recommendations. We conclude that OP‐CPR can benefit patients and families by fulfilling the wish to donate. However, it is an aggressive procedure that can cause physical damage to patients, and risks psychological harm to families and healthcare professionals. In a brain‐dead organ donor, OP‐CPR is acceptable without specific informed consent to OP‐CPR, although advance discussion with next of kin regarding this possibility is strongly advised. In a patient where brain death is yet to be determined, but there is known wish for organ donation, OP‐CPR would only be acceptable with a specific informed consent from the next of kin. When futility of treatment has not been established or it is as yet unknown if the patient wished to be an organ donor then OP‐CPR should be prohibited, in order to avoid any conflict of interest.     

Care of the brain-dead organ donor

Brain death commonly occurs after a devastating central nervous system (CNS) injury from head trauma or stroke. Severe brain injury and brain death create a variety of extra-cerebral organ manifestations including neuroendocrine hormone deficiencies, systemic inflammatory response syndrome (SIRS), neurogenic pulmonary oedema (NPE), myocardial stunning, as well as electrolyte and immunologic derangements. Spinal-mediated reflexes after brain death may be alarming to medical staff and families alike, and proper recognition and counselling to the family is necessary to prevent further emotional turmoil and doubt against the diagnosis of brain death. The challenge for the intensive care unit (ICU) physician is maintaining adequate organ perfusion and metabolism in brain-dead patients who eventually become organ donors. Due to the potential benefit from organ donation, maximal ICU management strategies should be employed to maintain viable organs until brain death is confirmed and the patient's wishes for organ donation can be expressed through family or documentation. Optimal ICU management of brain-dead patents who become organ donors increases the opportunity for organ transplantation and provides donation of organs previously not spared.     

A 10-year analysis of organ donation after cardiac death in the United States

BACKGROUND: The greatest challenge facing transplantation today is how to increase the number of organ donors. Patients with severe brain injury who are not brain-dead can donate organs after they are removed from a ventilator and allowed to die, termed donation after cardiac death (DCD). METHODS: We analyzed the database of all organs recovered from deceased donors in the United States from 1994 through 2003 to determine DCD trends in the United States. The database was obtained from the United Network for Organ Sharing (UNOS). RESULTS: There were 57,681 deceased donors reported from 1994 through 2003. Of these, 1,177 were donors without a heartbeat (DWHB), 55,206 were brain dead donors, and 1,298 were unspecified donors. At least one organ was transplanted from 1010 of the 1177 DWHB. Organ procurement organizations (OPOs) reported 0-212 DWHB accounting for up to 12.3 percent of deceased donors. There was a steady annual increase in the number of DWHB, but in 2003 there were still 19 of 59 OPOs that recovered no DWHB. A total of 2,231 organs were transplanted from the 1,177 DWHB donors, and another 665 organs were recovered for transplantation but not transplanted. The transplanted organs included 1,779 kidneys, 395 livers, 54 pancreata, 2 lungs, and 1 heart. Organs from DWHB can be successfully transplanted. CONCLUSIONS: Wider use of DWHB has the potential to greatly increase the number of organ transplants performed each year in the United States.     

Medical management to optimize donor organ potential: review of the literature

PURPOSE: Over the past two decades, the demand for donor organs continues to outpace the number of organs available for transplantation. Parallel with this has been a change in the demographics of organ donors with an increase in older donors and donors with marginal organs as a proportion of the total organ donor pool. Consequently, efforts have been made to improve the medical care delivered to potential organ donors to improve the conversion rate and graft survival of available organs. The purpose of this literature review is to provide updated recommendations for the contemporary management of organ donors after the neurological determination of death in order to maximize the probability of recipient graft survival. SOURCES: A comprehensive review of the literature obtained through searches of MEDLINE/PubMed, and personal reference files. PRINCIPAL FINDINGS: Contemporary management of the organ donor after neurological determination of death includes therapies to prevent the detrimental effects of the autonomic storm, the use of invasive hemodynamic monitoring and aggressive respiratory therapy including therapeutic bronchoscopy in marginal heart and lung donors, and the use of hormonal therapy including vasopressin, corticosteroids, triiodothyronine or thyroxine, and insulin for the pituitary failure and inflammation seen in brain dead organ donors. The importance of normalizing donor physiology to optimize all available organs is stressed. CONCLUSION: Aggressive hemodynamic and respiratory management of solid organ donors, coupled with the use of hormonal therapy improves the rate of conversion and graft survival in solid organ recipients.     

Use of grafts procured from organ transplant recipients

BACKGROUND: Massive intracerebral bleeding may cause brain stem death in transplant (Tx) recipients early or late postTx. We addressed the question as to whether Tx recipients may safely be used as organ donors. In particular, it is feared that exposure to immunosuppressive drugs may render those organs unsuitable for Tx. METHODS: We reviewed two case reports of liver grafts procured from Tx patients. In addition, we conducted a survey within United Kingdom Transplant Support Service Authority (UKTSSA) to delineate the UK experience in that area. RESULTS: Donor 1 was an 50-year-old heart Tx recipient who became brain stem dead due to cerebral bleeding 8 months postTx. His liver was used in an 55-year-old patient with PBC who is alive and well more than 22 months postTx. Donor 2 was a 22-year-old kidney Tx patient who developed cerebral bleeding 4 years postTx. His liver was used in a 65-year-old patient with PBC who is doing well more than 27 months postTx. During the study period of 1989-1995, 13 organs (9 kidneys, 3 hearts, 1 liver) were procured from 6 brain stem dead Tx patients (3 long, 2 heart, and 1 kidney Tx patients). Seven recipients are enjoying satisfactory graft function 1 to 7 years postTx; one kidney Tx recipient was relisted 4 years postTx due to chronic rejection; five functionning grafts were lost to patient death; primary nonfunction was seen in one heart Tx recipient. CONCLUSIONS: Tx patients can be successfully used as organ donors. In particular, chronic exposure to immunosuppression is not per se a contraindication to donation. Tx physicians confronted with the rare and tragic event of brain stem death in a Tx patient should not a priori exclude these patients from donation.