The donor potential of twenty six donor bases in the Russian Federation: external audit (a pilot project)

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Abstract

Rationale: The imbalance between the need for donor organs and their current availability is a growing problem for all countries. An assessment of potential donor numbers is considered to be an important step towards better understanding of the problem as a whole at the national scale. This would help to build up a concept of a successful strategy to resolve this inequity.

Aim: To analyze the use of external audit of the efficacy of identification of potential organ donors with confirmed brain death.

Materials and methods: As a part of a pilot project aimed to increase the efficacy of donor bases of the Russian Federal Medical Biological Agency (FMBA), we retrospectively analyzed 5932 medical files of patients who died from 2014 to 2018 in the departments of resuscitation and intensive care units of 26 medical establishments serving as a donor bases in Moscow, Orenburg, Saratov, Abakan, Stavropol and FMBA of Russia. The probability of brain death was assessed with a special QAPDD (Quality Assurance Program in the Deceased Donation Process) technique focused on organ donation after brain death which is used for external audit in Spanish hospitals.

Results: Clinical manifestation of brain death were identified in 20.3% (95% confidence interval (CI) 18.4–22.4) of the patients aged 18 to 65 years with severe primary and secondary brain injury who died in the departments of resuscitation and had been maintained on mechanical ventilation at least 12 hours until their death was confirmed. The rate of potential donor identification with clinical manifestations of brain death in the donating in-patient departments was 12% (95% CI 10.5–13.7) of those who died with severe primary and secondary brain injury. The external audit performed in 26 donating in-patient departments, has shown that 41% (95% CI 35.8–46.4) of potential donors with brain death were not identified.

Conclusion: With the use of the QAPDD technique in our study, we found that 41% of potential donors were not identified in the Russian in-patient clinics participating in organ donation. Based on the information obtained during the audit of medical files in intensive care units, we can make realistic conclusions on the current system of organ donation, identify potential pitfalls in the identification procedures of potential donors, increase the efficacy of donation process, and to improve the system as a whole. The process could become effective only through the activities of specially trained donor hospital transplant coordinators.

About the authors

V. L. Vinogradov

State Research Center – Burnasyan Federal Medical Biophysical Center

Author for correspondence.
Email: v.l.vinogradov@gmail.com

Victor L. Vinogradov – MD, PhD, Anesthesiologist, Surgical Department for the Coordination of Donation of Organs and (or) Human Tissues; Professor, Department of Anesthesiology and Critical and Intensive Care, Institute of Postgraduate Professional Education

23 Marshala Novikova ul., Moscow, 123098

Tel.: +7 (916) 384 77 09

Россия

K. K. Gubarev

State Research Center – Burnasyan Federal Medical Biophysical Center

Email: fake@neicon.ru

Konstantin K. Gubarev – MD, PhD, Head of the Surgical Department for the Coordination of Donation of Organs and (or) Human Tissues

23 Marshala Novikova ul., Moscow, 123098

Россия

A. I. Zakhlevnyy

State Research Center – Burnasyan Federal Medical Biophysical Center

Email: fake@neicon.ru

Artur I. Zakhlevnyy – MD, Surgeon, Surgical Department for the Coordination of Donation of Organs and (or) Human Tissues

23 Marshala Novikova ul., Moscow, 123098

Россия

D. S. Svetlakova

State Research Center – Burnasyan Federal Medical Biophysical Center

Email: fake@neicon.ru

Daria S. Svetlakova – MD, Surgeon, Surgical Department for the Coordination of Donation of Organs and (or) Human Tissues

23 Marshala Novikova ul., Moscow, 123098

Россия

References

  1. Abouna GM. Organ shortage crisis: problems and possible solutions. Transplant Proc. 2008;40(1):34–8. doi: 10.1016/j.transproceed.2007.11.067.
  2. Garrison RN, Bentley FR, Raque GH, Polk HC Jr, Sladek LC, Evanisko MJ, Lucas BA. There is an answer to the shortage of organ donors. Surg Gynecol Obstet. 1991;173(5):391–6.
  3. Murphy PG, Smith M. Towards a framework for organ donation in the UK. Br J Anaesth. 2012;108 Suppl 1:i56–67. doi: 10.1093/bja/aer402.
  4. Mizraji R, Pérez S, Alvarez I. Brain death: epidemiology and quality control of solid organ donor generation. Transplant Proc. 2004;36(6):1641–4. doi: 10.1016/j.transproceed.2004.06.066.
  5. Филипцев ПЯ, Романовский ЮЯ, Ахметшин РБ. Анализ донорского потенциала отделения общей реанимации: проблемы и перспективы его использования. Вестник трансплантологии и искусственных органов. 2009;11(4):86–91. doi: 10.15825/1995-1191-2009-4-86-91.
  6. Багненко СФ, Полушин ЮС, Мойсюк ЯГ, Резник АО, Логинов ИВ, Погребниченко ИВ, Резник ОН. Анализ причин дефицита доноров органов и основные направления его преодоления. Трансплантология. 2011;(2–3):10–22. doi: 10.23873/2074-0506-2011-0-2-3-10-22.
  7. Domínguez-Gil B, Delmonico FL, Shaheen FA, Matesanz R, O'Connor K, Minina M, Muller E, Young K, Manyalich M, Chapman J, Kirste G, Al-Mousawi M, Coene L, García VD, Gautier S, Hasegawa T, Jha V, Kwek TK, Chen ZK, Loty B, Costa AN, Nathan HM, Ploeg R, Reznik O, Rosendale JD, Tibell A, Tsoulfas G, Vathsala A, Noël L. The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation. Transpl Int. 2011;24(4):373–8. doi: 10.1111/j.1432-2277.2011.01243.x.
  8. Israni AK, Zaun D, Rosendale JD, Schaffhausen C, Snyder JJ, Kasiske BL. OPTN/SRTR 2017 Annual Data Report: Deceased Organ Donation. Am J Transplant. 2019;19 Suppl 2:485–516. doi: 10.1111/ajt.15280.
  9. Rao PS, Ojo A. The alphabet soup of kidney transplantation: SCD, DCD, ECD–fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol. 2009;4(11):1827–31. doi: 10.2215/CJN.02270409.
  10. de la Rosa G, Domínguez-Gil B, Matesanz R, Ramón S, Alonso-Álvarez J, Araiz J, Choperena G, Cortés JL, Daga D, Elizalde J, Escudero D, Escudero E, Fernández-Renedo C, Frutos MA, Galán J, Getino MA, Guerrero F, Lara M, López-Sánchez L, Macías S, Martínez-Guillén J, Masnou N, Pedraza S, Pont T, Sánchez-Rodríguez A. Continuously evaluating performance in deceased donation: the Spanish quality assurance program. Am J Transplant. 2012;12(9):2507–13. doi: 10.1111/j.1600-6143.2012.04138.x.
  11. Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, Ledoux D, Lippert A, Maia P, Phelan D, Schobersberger W, Wennberg E, Woodcock T; Ethicus Study Group. End-of-life practices in European intensive care units: the Ethicus Study. JAMA. 2003;290(6):790–7. doi: 10.1001/jama.290.6.790.
  12. Dopki project. Guide of recommendations for Quality Assurance Programmesin the Deceased Donation Process [Internet]. 79 p. Accessed 28 July 2009. Available from: http://www.ont.es/publicaciones/Documents/DOPKI%20GUIA.pdf.
  13. Roels L, Smits J, Cohen B. Potential for deceased donation not optimally exploited: donor action data from six countries. Transplantation. 2012;94(11):1167–71. doi: 10.1097/TP.0b013e31826dde40.
  14. Escudero D, Valentín MO, Escalante JL, Sanmartín A, Perez-Basterrechea M, de Gea J, Martín M, Velasco J, Pont T, Masnou N, de la Calle B, Marcelo B, Lebrón M, Pérez JM, Burgos M, Gimeno R, Kot P, Yus S, Sancho I, Zabalegui A, Arroyo M, Miñambres E, Elizalde J, Montejo JC, Domínguez-Gil B, Matesanz R. Intensive care practices in brain death diagnosis and organ donation. Anaesthesia. 2015;70(10):1130–9. doi: 10.1111/anae.13065.
  15. Bodí MA, Pont T, Sandiumenge A, Oliver E, Gener J, Badía M, Mestre J, Muñoz E, Esquirol X, Llauradó M, Twose J, Quintana S. Brain death organ donation potential and life support therapy limitation in neurocritical patients. Med Intensiva. 2015;39(6):337–44. doi: 10.1016/j.medin.2014.07.010.
  16. Sandroni C, D'Arrigo S, Callaway CW, Cariou A, Dragancea I, Taccone FS, Antonelli M. The rate of brain death and organ donation in patients resuscitated from cardiac arrest: a systematic review and meta-analysis. Intensive Care Med. 2016;42(11):1661–71. doi: 10.1007/s00134-016-4549-3.
  17. Khatri R, Vellipuram AR, Maud A, Afzal MF, Qureshi MA, Qureshi IA, Piriyawat P, Cruz-Flores S, Rodriguez GJ. Frequency of brain death in acute cerebrovascular disease related mortality. Stroke. 2018;49 Suppl 1:ATP166. doi: 10.1161/str.49.suppl_1.TP166.
  18. Kirschen MP, Francoeur C, Murphy M, Traynor D, Zhang B, Mensinger JL, Ichord R, Topjian A, Berg RA, Nishisaki A, Morrison W. Epidemiology of Brain Death in Pediatric Intensive Care Units in the United States. JAMA Pediatr. 2019;173(5):469–76. doi: 10.1001/jamapediatrics.2019.0249.
  19. Hegarty M, O'Neill W, Colreavy F, Dwyer R, Cunningham P, Hanlon M. Potential organ donor audit in Ireland. Ir Med J. 2010;103(10): 294–6.
  20. Wesslau C, Grosse K, Krüger R, Kücük O, Mauer D, Nitschke FP, Norba D, Manecke A, Polster F, Gabel D. How large is the organ donor potential in Germany? Results of an analysis of data collected on deceased with primary and secondary brain damage in intensive care unit from 2002 to 2005. Transpl Int. 2007;20(2):147–55. doi: 10.1111/j.1432-2277.2006.00413.x.
  21. Procaccio F, Ricci A, Ghirardini A, Masiero L, Caprio M, Troni A, Caggiano M, Nanni Costa A. Deaths with acute cerebral lesions in ICU: does the number of potential organ donors depend on predictable factors? Minerva Anestesiol. 2015;81(6):636–44.
  22. Barber K, Falvey S, Hamilton C, Collett D, Rudge C. Potential for organ donation in the United Kingdom: audit of intensive care records. BMJ. 2006;332(7550):1124–7. doi: 10.1136/bmj.38804.658183.55.
  23. Sheehy E, Conrad SL, Brigham LE, Luskin R, Weber P, Eakin M, Schkade L, Hunsicker L. Estimating the number of potential organ donors in the United States. N Engl J Med. 2003;349(7):667–74. doi: 10.1056/NEJMsa021271.
  24. Procaccio F, Rizzato L, Ricci A, Venettoni S, Nanni Costa A. Do "silent" brain deaths affect potential organ donation? Transplant Proc. 2010;42(6):2190–1. doi: 10.1016/j.transproceed.2010.05.042.
  25. Opdam H. Organ and Tissue Donation in Victoria. Presentation to the Legal and Social Issues Standing Committee 2011 [Internet]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/SCLSI/Slides_8_Sep_2011/Vic_Parl_Inquiry_Opdam_8-9-2011.pdf.
  26. Виноградов ВЛ, Хубутия МШ, Губарев КК, Дулуб ВГ, Захлевный АИ, Светлакова ДС, Восканян СЭ, Самойлов АС. Характеристика посмертных органных доноров в НИИ СП им. Н.В. Склифосовского и донорских стационарах ФМБА России (2008–2017 гг.). Трансплантология. 2018;10(3):185–96. doi: 10.23873/2074-0506-2018-10-3-185-196.
  27. Tong YF, Koo J, Cheng B. Review of organ donation in Hong Kong: 1996–2009. Hong Kong Journal of Nephrology. 2010;12(2):62–73. doi: 10.1016/S1561-5413(10)60014-2.
  28. Memoria actividad de donación 2016. Organización Nacional deTrasplantes [Internet]. Available from: http://www.ont.es/infesp/Memorias/Memoria%20Donaci%C3%B3n%202016.pdf.
  29. Weiss JH, Keel I, Immer FF, Wiegand J, Haberthür C; Comité National du Don d'Organes (CNDO). Swiss Monitoring of Potential Organ Donors (SwissPOD): a prospective 12-month cohort study of all adult ICU deaths in Switzerland. Swiss Med Wkly. 2014;144:w14045. doi: 10.4414/smw.2014.14045.
  30. Cloutier R, Baran D, Morin JE, Dandavino R, Marleau D, Naud A, Gagnon R, Billard M. Brain death diagnoses and evaluation of the number of potential organ donors in Quebec hospitals. Can J Anaesth. 2006;53(7):716–21. doi: 10.1007/BF03021631.
  31. Guide to the quality and safety of organs for transplantation. 7 th edition, 2016. European Directorate for the Quality of Medicines & Health Care [Internet]. Available from: https://www.edqm.eu/en/news/new-release-7th-edition-guide-quality-and-safety-organs-transplantation.
  32. Israni AK, Zaun D, Rosendale JD, Schaffhausen C, Snyder JJ, Kasiske BL. OPTN/SRTR 2016 Annual Data Report: Deceased Organ Donation. Am J Transplant. 2018;18 Suppl 1:434–63. doi: 10.1111/ajt.14563.
  33. Alban RF, Gibbons BL, Bershad VL. Improving Donor Conversion Rates at a Level One Trauma Center: Impact of Best Practice Guidelines. Cureus. 2016;8(11):e891. doi: 10.7759/cureus.891.
  34. Jansen NE, Haase-Kromwijk BJ, van Leiden HA, Weimar W, Hoitsma AJ. A plea for uniform European definitions for organ donor potential and family refusal rates. Transpl Int. 2009;22(11):1064–72. doi: 10.1111/j.1432-2277.2009.00930.x.
  35. Luskin RS, Delmonico FL. Assessing organ donation from the dead should not be done by reporting a census of the living. Am J Transplant. 2003;3(10):1185–7. doi: 10.1046/j.1600-6143.2003.00241.x.

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Copyright (c) 2020 Vinogradov V.L., Gubarev K.K., Zakhlevnyy A.I., Svetlakova D.S.

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