Clinical features analysis of 75 deceased donors maintained in ICU

doi:10.21203/rs.3.rs-3348302/v1

Download PDF

Research Article

Clinical features analysis of 75 deceased donors maintained in ICU

https://doi.org/10.21203/rs.3.rs-3348302/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Objective

To summarize and analyze the integrated management program of 75 deceased donors maintained in ICU of our hospital, so as to promote the development of organ transplantation.

Methods

The data deceased donors maintained in ICU of our hospital from June 2020 to January 2022 were collected. The basic data, laboratory examination results, disease distribution and maintenance measures were retrospectively studied.

Results

75 patients were included, with a sex ratio (M/F) of 90.67% vs 9.33%, a median age of 55, a median ICU length of 4 days. Donors with higher APACHE II scores tended to enter the donation process faster (P=0.001). The primary disease of donors was mainly cerebral hemorrhage (53, 70.67%). 53 pathogens were detected in 58 patients (infection rate: 77.33%), mainly bacteria (42, 79.25%, Gram-negative mainly), Klebsiella pneumoniae, Acinetobacter baumannii and Escherichia coli were the most detected. 96.00% (72/75) donors successfully completed donation, mainly donation after cardiac death (65, 86.67%). 229 large organs and tissues were obtained from 72 donors, with an acquisition ratio of 1:3.14. The acquisition ratio of donors of different ages was statistically different (P<0.001). The overall organ utilization rate was 96.51% (221/229), and the kidney utilization rate in our hospital was 95.14% (137/144).

Conclusion

ICU plays an irreplaceable role in organ transplantation. ICU staffs familiarize the integrated management program of deceased donors, which is helpful to promote the development of organ transplantation.

Donation after citizen's death in China

deceased donors

organ transplantation

ICU

organ maintenance

donation conversion rate

Organ transplantation is an effective treatment for end-stage organ failure. Despite the impact of COVID-19, the global organ transplantation is still developing rapidly. In 2021, 144,302 organ transplants were completed worldwide (11.3% increase over 2020). In 2021, China has completed 19,386 organ transplants, ranking as one of the world's four major organ transplant countries with the United States (42,217), Brazil (7,088) and Spain (4,781). Organ transplants in these four countries accounts for more than 50% of the world[1]. Despite the rapid development of global organ transplantation, it can only meet about 10% of the demand, while only 1/30 of the demand in China has been met[2]. Deceased donor is the main source of transplantable organs in China. In 2021, the number of deceased donors in China is 5,272 (only 1.00% increase over 2020). The organ donors per million population (PMP) is only 3.63 in China, which is lower than global average (6.37), far lower than the United States (41.64), Brazil (13.72) and Spain (40.79)[1]. There is a huge space for development of deceased donor in China. There are two ways for deceased donor to donate in China: ①registration before death; ②application for donation after death. Most deceased donor need to be maintained in the intensive care unit (ICU) before organ acquisition surgery. ICU patients are also important sources of deceased donor, and ICU staff have participated in organ donation process in different extent. In order to better manage deceased donors maintained in ICU and promote the development of organ transplantation, we collected the data of deceased donors maintained in ICU of our hospital from June 2020 to January 2022, and retrospectively studied the basic data, laboratory examination results, disease distribution and maintenance measures.

2.1 Study population

The clinical data of deceased donors who were maintained in ICU of our hospital from June 2020 to January 2022 were collected. The organ donation conforms to the organ donation process and norms of donation after citizen's death in China (2019 edition)[3]. The study was conducted in accordance with the declaration of Helsinki and national and institutional standards. The study was approved by the Ethics Committee of Renmin Hospital of Wuhan University (WDRY2023-K124). This study is a retrospective observational study. The researchers only collected patient data in the electronic medical record system, and did not involve human samples. The patients included in this study were deceased donors, who could not obtain their written informed consent. According to the above situation, the Ethics Committee of Renmin Hospital of Wuhan University allowed us to carry out this study without obtaining the written informed consent of the patients according to the relevant laws and regulations. We give each patient a fixed number to protect the patient's privacy.

2.2 Study content

The medical records of deceased donors were collected retrospectively, and the basic data, medical history, laboratory examination results, maintenance measures and completion of organ donation were extracted. Each patient is given a unique number to protect privacy.

2.3 Statistical analysis

Excel 2019 was used to collect data, and SPSS 26.0 was used for data processing. Normal data were expressed as mean ± standard deviation (‾x ± s), non-normal measurement data were expressed as median (interquartile range) [M(P₂₅,P₇₅)], and count data were expressed as frequency (percentage) [n(%)]. The normal data were analyzed by variance analysis and t test for heterogeneity analysis, the non-normal measurement data were analyzed by non-parametric test, and the count data were analyzed by χ² test. P<0.05 was considered statistically significant.

3.1 Basic data and laboratory examination results

3.1.1 Basic data

75 patients were included in this study, including 68 males (90.67%) and 7 females (9.33%), with a median age of 55 (46,62). The median time of ICU length was 4 (2,6) days. The median Glasgow coma score was 3 (3,5), and the median acute physiology and chronic health (APACHE II) score was 19 (16,22). 29 (38.67%) patients with APACHE II score greater than 20, patients with higher APACHE II score tended to enter the donation process faster (P = 0.001). Most patients had low mean arterial pressure (MAP, 91.56 ± 21.27 mmHg) and fast pulse rate (103.80 ± 23.42 times/min) when entering ICU (Table 1). All patients had brain dysfunction, 69 (92.00%) had coagulation dysfunction, 60 (80.00%) had cardiac dysfunction, 33 (44.00%) had renal dysfunction, and 30 (40.00%) had liver dysfunction. There was no statistical difference in gender, age and other basic data between donation after cardiac death (DCD) and donation after brain death (DBD) donors.

Table 1

Basic data of deceased donors
Basic data	Deceased donors	Donation after cardiac death	Donation after brain death	P value
Sex = male	68(90.67%)	59(90.80%)	6(85.70%)	0.668
Age (years)	55.0(46.0,62.0)	55.0(46.0,61.5)	54.0(45.0,58.0)	0.555
Body temperature (℃)	36.7(36.4,37.0)	36.7(36.45,37.2)	36.9(36.0,37.0)	0.909
Respiratory rate (times/min)	15(15,18)	16(15,18)	15(15,15)	0.138
Pulse rate (times/min)	103.80 ± 23. 42	102.94 ± 23.29	111.14 ± 28.69	0.389
Mean arterial pressure (mmHg)	91.56 ± 21.27	91.52 ± 20.48	86.14 ± 25.43	0.521
ICU length (days)	4(2,6)	4(2,6)	3(2,4)	0.147
Glasgow Coma Scale	3(3,5)	3 (3,5)	3(3,3)	0.142
APACHE II	19.0(16.0,22.0)	19.0(16.0,21.5)	21.0(19.0,23.0)	0.145
Mechanical ventilation duration (h)	77(45,118)	81(50, 119.5)	60(38,84)	0.143
Large organ and tissue donation (number)	3.18 ± 0.57	3.22 ± 0.57	2.86 ± 0.38	0.111
Data were expressed as‾x ± s, M(P₂₅,P₇₅) or n(%). The ICU length was the time from admission to organ procurement surgery. APACHE II = Acute Physiology and Chronic Health Evaluation II.

3.1.2 Laboratory examination results

Most patients had abnormal coagulation function, such as high D-dimer and fibrinogen degradation products (median 5.46 mg/L and 15.84 mg/L, respectively). Liver enzymes, bilirubin, creatinine, N-terminal pro-brain natriuretic peptide and hypersensitive cardiac troponin I were also abnormal (Table 2). Central nervous system specific protein s100 was detected in 9 patients, with a median of 619.00 (200.00,10,136.5) pg/ml. Blood ammonia was detected in 31 patients with a median of 40.00 (34.00,63.00) µmol/L. There was no statistical difference in laboratory examination results between DCD and DBD donors.

Table 2

Partial laboratory examination results of deceased donors
laboratory examination	Deceased donors	Donation after cardiac death	Donation after brain death	P value
Glucose(mmol/L)	7.28 (6.11,11.11)	7.28(6.15,11.31)	6.58(5.95,8.94)	0.419
Prothrombin Time Activity (%)	79.81 ± 25.34	81.17 ± 26.59	75.14 ± 13.03	0.557
Activated Partial Thromboplastin Time (s)	27.10 (24.60,30.10)	26.90(24.55,30.00)	28.80(24.60,32.60)	0.408
D-Dimer(mg/L)	5.46 (1.64,13.21)	5.03(1.51,12.22)	8.40(3.27,13.21)	0.669
Fibrinogen degradation products (mg/L)	15.84 (5.57,42.66)	15.70(4.88,38.00)	26.33(8.15,43.90)	0.549
Alanine Aminotransferase (U/L)	38.00 (20.00,76.00)	40.00(20.50,76.50)	23.00(14.00,64.00)	0.262
Aspartate Aminotransferase (U/L)	43.00 (25.00,67.00)	43.00(25.00,68.50)	33.00(21.00,63.00)	0.500
Albumin(g/L)	35.49 ± 5.20	35.81 ± 5.18	33.32 ± 5.02	0.229
Total Bilirubin (µmol/L)	13.94 (9.03,23.25)	14.34(9.35,23.73)	10.33(6.23,44.98)	0.655
Direct Bilirubin (µmol/L)	5.60 (3.20,9.50)	5.60(3.30,9.30)	4.20(2.80,20.20)	0.955
Urea(mmol/L)	7.03 (4.83,11.37)	6.18(4.73,10.55)	9.77(3.37,15.34)	0.300
Creatinine(µmol/L)	77.00 (55.00,122.00)	76.00(54.50,107.50)	141.00(50.00,174.00)	0.165
Glomerular Filtration Rate (ml/min)	94.37 (61.41,112.45)	95.76(68.55,113.46)	48.31(35.17,124.71)	0.199
N-terminal pro Brain Natriuretic Peptide (pg/ml)	239.00 (108.00,1130.00)	212.00(99.00,1023.00)	676.00(50.00,2919.00)	0.332
Hypersensitive Cardiac Troponin I (ng/ml)	0.082 (0.008,0.400)	0.068(0.006,0.368)	0.115(0.076,1.240)	0.174
Data were expressed as‾x ± s or M(P₂₅,P₇₅).

3.1.3 Organ donation

72 of 75 (96.00%) patients completed the final donation, 65 (86.67% ) were DCD, 7 ( 9.33% ) were DBD, and 3 (4.00%) did not complete the final donation (#40 and #70 with severe sepsis; #73 with severe organ dysfunction). 229 large organs and tissues were obtained from 72 patients, with an acquisition ratio of 1:3.14 and a utilization rate of 96.51% (221/229). The most donated organ was kidney (144,62.88%), followed by liver. In this study, all donated kidneys were allocated to our hospital, and the utilization rate was 95.14% (137/144). Bilateral kidneys of most patients (67,89.33%) were used, 3 (4.00%) gave up the left kidney and 2 (2.67%) gave up bilateral kidneys. The organ acquisition ratio was statistically different in different age groups donors (F = 9.528, P < 0.001). The organ acquisition ratio of patients aged 18–34 was the highest, and that of patients over 50 was the lowest (Table 3).

Table 3

Organ donation of deceased donors
Items	Number of large organ and tissue donated(‾x ± s)	P value
Sex		0.377
Male	3.20 ± 0.59
Female	3.00 ± 0.00^a
Age (years)^b		<0.001
18 ~ 34	4.00 ± 1.23
35 ~ 49	3.32 ± 0.57
≥ 50	3.02 ± 0.34
Acute Physiology and Chronic Health Score II		0.245
≤ 20	3.24 ± 0.60
>20	3.08 ± 0.49
a: In this study, there were few female patients and all of them donated 3 organs, so the standard deviation was 0;b: There were no patients < 18 in this study, so they were not listed.

3.2 Disease distribution

105 diseases were diagnosed in 75 patients. The primary disease of patients was mainly cerebral hemorrhage (53,70.67%), followed by pulmonary infection (47,62.67%) and hypertension (41%, 54.67%) (Fig. 1). The past medical history was mainly hypertension (33,44.00%), followed by cerebral hemorrhage (16,44.00%). Patients with a history of cerebral hemorrhage were more likely to suffer from cerebral hemorrhage again (P<0.001). Whether there was cerebral hemorrhage did not affect the ICU length and organ acquisition ratio (P>0.05).

3.3 Infections

All patients received infection screening after entering ICU, including culture, nanopore targeted sequencing, T-SPOT, PCR, and G/GM experiments. 58 (77.33%) patients had infection, including 39 (52.00%) of bloodstream infection, 37 (49.33%) of pulmonary infection and 2 (2.67%) of urinary tract infection. Half of the patients had multiple site infections (37,49.33%). 53 pathogens were detected in 75 patients, including 42 (79.25%) bacteria, 7 (13.21%) fungi and 4 others. Among the detected bacteria, 27 (64.29%) were Gram-negative bacteria, 1 (2.38%) was acid-fast staining positive bacteria (Mycobacterium tuberculosis), and 1 was methicillin-resistant Staphylococcus. Klebsiella pneumoniae (17,22.67%), Acinetobacter baumannii (14,18.67%) and Escherichia coli (12,16.00%) were the most common bacteria, followed by Staphylococcus aureus, Pseudomonas aeruginosa and Streptococcus pneumoniae. 7 fungi were detected, mainly Candida (including Candida albicans, Candida parapsilosis and Candida tropicalis), and 4 (5.33%) of Omerkoda were also detected. 4 viruses and spirochetes were detected, mainly hepatitis B virus (6,8.00%), followed by BK polyomavirus (3,4.00%), human cytomegalovirus and syphilis spirochete (Fig. 2). T-SPOT was positive in 15 (20.00%) patients.

3.4 Maintenance measures

All patients were treated with anti-infection, mechanical ventilation, sedation and analgesia after admission to ICU (Fig. 3A). The median time of mechanical ventilation was 77.00 (45.00,118.00) h. 8 antimicrobial agents were used, teicoplanin (74,98.67%) and meropenem (67,89.33%) were the most commonly used, followed by polymyxin B sulfate (23,30.67%). Voriconazole was the most commonly used antifungal drug (68,90.67%). Two patients were treated with isoniazid and rifampicin for anti-tuberculosis treatment (Fig. 3B). ICU doctors attach great importance to the maintenance of patients' organs. 72 (96.00%) patients received organ protection treatment, with the most application of gastric protection (51,68.00%), followed by liver protection (31,41.33%) (Fig. 3C). Other maintenance measures included maintaining water and electrolyte balance (63,84.00%), nutritional support (54,72.00%), blood transfusion (42,56.00%) and maintaining acid-base balance (42,56.00%) (Fig. 3A). 8 (10.67%) patients received extracorporeal membrane oxygenation (ECMO), with an average ECMO time of 28.00 ± 23.47 h. ICU doctors attach great importance to maintaining the stability of hemodynamics, and maintain the MAP and urine volume of patients in a stable state through various measures such as rehydration and vasoactive drugs (Fig. 3D).

According to the data of the Chinese Human Organ Donation Management Center, as of February 24, 2023, China has registered 6,071,357 voluntary donors, with 44,076 donations and 133,694 organs donated. China has strong vitality and great potential in organ transplantation. Nowadays, deceased donor is the main source of transplantable organs in China. ICU plays an irreplaceable role in maintenance of organ function and early detection and evaluation of potential donors, and there is still huge room for development of transplantable organs in China. Therefore, it is of great significance to systematically summarize and analyze the clinical characteristics and organ maintenance of deceased donors maintained in ICU of our hospital to further improve the conversion rate of donation and the development of transplantation.

75 patients were included in this study, of which men were far more than women (90.67% vs 9.33%). This may be related to the high proportion of men in outdoor work, vulnerability to traffic accidents and other trauma, and also related to bad living habits such as smoking and drinking. The median age of the patients in this study was 55 (46,62) years old. Studies have shown that donor age affects the efficiency of donation. Donors older than 50 have lower organ utilization and lower survival rate of transplanted organs[4, 5]. This may be because elderly donors may be accompanied by cardiovascular and cerebrovascular diseases. The degree of glomerulosclerosis and tubulointerstitial fibrosis, renal function compensatory ability are also related to age[6]. However, other studies have shown that elderly donors still have survival benefits after kidney transplantation[7]. The results of this study show that the donation conversion rate of young patients is higher than older patients, so ICU doctors need to maintain older donors more deeply.

In this study, deceased donors were critically ill when admitted to ICU. The median APACHE II score was 19 (16,22), and the median Glasgow coma score was 3 (3,5). After active maintenance, 72 (96.00%) patients successfully completed organ donation. At present, China implements three types of criteria for determining the deceased donors: Chinese type I (C-I, international standardized DBD), Chinese type II (C-II, international standardized DCD) and Chinese type III (C-III, Chinese transitional DBCD)[3]. According to GODT, deceased donors in China is mainly based on DBD (62.31%)[1]. In this study, 86.67% of the patients were DCD. The possible reasons are as follows: (1)The data in this study are only from our hospital, which is inconsistent with the national level; (2)Compared with developed countries and the eastern region of China, Wuhan, as a city in central China, the economic level affects the family members' understanding of different donation methods; (3)Chinese citizens are more receptive to the concept of cardiopulmonary death, the concept of brain death has not been generally accepted, and brain death has not been confirmed by legislation in China. However, DBD can not only greatly improve the utilization rate of donated organs, but also avoid the waste of medical resources caused by transitional medical treatment. Therefore, it is necessary to further popularize the concept of brain death in our hospital and promote relevant legislation.

The disease distribution of deceased donors has obvious characteristics. The primary disease is mainly cerebral hemorrhage (53,70.67%), followed by pulmonary infection (47,62.67%), which may be related to aspiration and mechanical ventilation. Critical patients themselves are also risk factors for pulmonary infection. In this study, the patients were mainly infected with bacteria, and the most detected bacteria were Klebsiella pneumoniae, Acinetobacter baumannii and Escherichia coli, while the fungi were less, which was consistent with the related research[8]. In this study, the infection rate was 77.33%, which was consistent with the increasing trend of infection rate of deceased donors reported in recent years[9, 10]. Donor infection can affect organ utilization, transplant success rate and recipient survival rate[11]. However, prophylactic use of antibiotics can make liver and kidney safely transplanted to recipients, so donors with systemic infection may not be a contraindication for organ transplantation. Renal insufficiency in deceased donors may affect the utilization of donated kidneys, but studies have shown that kidneys with acute kidney injury can still achieve good results if used properly during transplantation[12]. Compared with the high risk of death during the waiting period for transplantation, recipients receiving kidneys from donors with acute kidney injury have survival benefits[13]. In this study, 5 patients had renal insufficiency. After active maintenance, the renal function of 3 patients was significantly improved compared with that at admission to ICU and the kidney was successfully donated (2 patients had both kidneys used and 1 patient had right kidney used ). 1 (1.33%) patient were diagnosed with disseminated intravascular coagulation (DIC), and 10 (13.33%) patients also had abnormal coagulation function. Studies have shown that recipients are prone to glomerular microthrombus when receiving organs from donors with DIC, which can increase rejection after renal transplantation[14]. This shows that in ICU management, it is also very important to adjust the coagulation function to prevent the occurrence of DIC.

In this study, deceased donors received many organ maintenance measures, including mechanical ventilation, sedation, analgesia, organ protection and nutritional support. The stability of hemodynamics in deceased donors is very important to maintain the perfusion of important organs. The duration of hypotension is an important factor affecting the function and survival of transplanted kidney. Hypotension-related organ damage will increase the risk of delayed organ function in transplanted kidney[15]. Studies have shown that donor hemodynamics can more accurately reflect the status of transplanted organs after renal transplantation than peripheral blood oxygen saturation[16]. Donor management guidelines emphasize the early management of hypotension. Maintaining MAP > 60 mmHg and urine volume > 1ml/kg/h is beneficial to the protection of kidneys and other organs. In this study, the MAP and urine volume of deceased donors were always maintained at an appropriate level to maintain the perfusion of vital organs. Compared with DBD, DCD has a longer warm ischemia time, which can affect the prognosis of recipients and the survival rate of grafts. Studies have shown that ECMO can provide perfusion for donor organs, reduce warm ischemia time to reduce organ damage[17, 18] and reduce delayed graft function recovery. In this study, 8 patients received ECMO treatment and successfully completed the donation. The application of ECMO may expand the potential organ pool for DCD[19].

In summary, the donation conversion rate and utilization rate of deceased donors in our hospital are high, and the organ maintenance effect is good. Organ donation and transplantation require the efforts and cooperation of the government, medical institutions and the public, and the popularization of the concept of brain death in the region. ICU doctors and nurses have a deeper understanding of the organ donation process, organ donor characteristics and basic management measures, which helps to effectively identify more potential donors, improve donation conversion rate and utilization rate. The results of this study provide data support for solving the above problems.

ICU: Intensive care unit; APACHE II: Acute physiology and chronic health; DCD: Donation after cardiac death; DBD: Donation after brain death; ECMO: Extracorporeal membrane oxygenation

Ethics approval and consent to participate

The study was conducted in accordance with the declaration of Helsinki and national and institutional standards. The study was approved by the Ethics Committee of Renmin Hospital of Wuhan University (WDRY2023-K124). This study is a retrospective observational study. The researchers only collected patient data in the electronic medical record system, and did not involve human samples. The patients included in this study were deceased donors, who could not obtain their written informed consent. According to the above situation, the Ethics Committee of Renmin Hospital of Wuhan University allowed us to carry out this study without obtaining the written informed consent of the patients according to the relevant laws and regulations.

Consent for publication

Not applicable.

Availability of data and materials

The data in this study can be provided after approval by the corresponding author.

Competing interests

All authors declare that they have no affiliation with this article.

Funding

This study did not receive funding.

Authors’ contribution

Zhiyuan YAO: Responsible for data collection, data statistics, data analysis and paper writing. Yu LIU, Liying ZHAN, Tao QIU, Guang LI, Zhongbao CHEN, Xiaoyu FANG, Zhou LIU, Wei WU, Zhaomin LIAO: Responsible for data collection. Wenfang XIA: Responsible for data collection and research guidance.

Acknowledgments

The authors would like to express their profound gratitude to the organ donors.

Home. GODT. https://www.transplant-observatory.org/. Accessed 24 Feb 2023.
Wang Y, Lei T, Wei L, Du S, Girani L, Deng S. Xenotransplantation in China: Present status. Ann Ny Acad Sci. 2019;26.
Huang J, Millis JM, Mao Y, Millis MA, Sang X, Zhong S. Voluntary organ donation system adapted to Chinese cultural values and social reality. Liver Transpl. 2015;21:419–22.
Aida N, Ito T, Kurihara K, Naka Mieno M, Nakagawa Y, Kenmochi T. Analysis of risk factors for donation after circulatory death kidney transplantation in Japan. Clin Exp Nephrol. 2022;26:86–94.
Choi AY, Jawitz OK, Raman V, Mulvihill MS, Halpern SE, Barac YD, et al. Predictors of nonuse of donation after circulatory death lung allografts. The Journal of Thoracic and Cardiovascular Surgery. 2021;161:458-466.e3.
Tanrısev M, Hoşcoşkun C, Aşçı G, Sözbilen M, Fırat Ö, Ertilav M, et al. Long-term outcome of kidney transplantation from elderly living and expanded criteria deceased donors. Ren Fail. 2015;37:249–53.
Yu S, Long JJ, Yu Y, Bowring MG, Motter JD, Ishaque T, et al. Survival benefit of accepting kidneys from older donation after cardiac death donors. Am J Transplant. 2021;21:1138–46.
Burrage MK, Cheshire C, Hey CY, Azam S, Watson WD, Bhagra S, et al. Comparing Cardiac Mechanics and Myocardial Fibrosis in DBD and DCD Heart Transplant Recipients. J Card Fail. 2022;:S1071916422012246.
Yuan X, Chen C, Zhou J, Han M, Wang X, Wang C, et al. Organ Donation and Transplantation From Donors With Systemic Infection: A Single-Center Experience. Transplantation Proceedings. 2016;48:2454–7.
Ye Q-F, Zhou W, Wan Q-Q. Donor-derived infections among Chinese donation after cardiac death liver recipients. World J Gastroenterol. 2017;23:5809.
Wan Q, Liu H, Ye S, Ye Q. Confirmed Transmission of Bacterial or Fungal Infection to Kidney Transplant Recipients from Donated After Cardiac Death (DCD) Donors in China: A Single-Center Analysis. Med Sci Monitor. 2017;23:3770–9.
Jadlowiec CC, Heilman RL, Smith ML, Khamash HA, Huskey JL, Harbell J, et al. Transplanting kidneys from donation after cardiac death donors with acute kidney injury. Am J Transplant. 2020;20:864–9.
Lia D, Singer P, Nair V, Yang J, Teperman L, Grodstein E. DCD Renal Transplantation From Donors With Acute Kidney Injury. Transplantation. 2021;105:886–90.
Xu L, Yin W, Li G, Fang J, Zhang L, Liu L, et al. Effect of disseminated intravascular coagulation on donation after citizens’ death donor kidneys. Translational Andrology and Urology. 2021;10:1273–8.
Morrissey PE. Organ donation and imminent death: pro position. Curr Opin Organ Tran. 2017;22:179–83.
Peters-Sengers H, Houtzager JHE, Heemskerk MBA, Idu MM, Minnee RC, Klaasen RW, et al. DCD donor hemodynamics as predictor of outcome after kidney transplantation. Am J Transplant. 2018;18:1966–76.
Kłosiewicz T, Puślecki M, Zieliński M, Mandecki M, Ligowski M, Stefaniak S, et al. The role of extracorporeal membrane oxygenation in patients after irreversible cardiac arrest as potential organ donors. Polish Journal of Cardio-Thoracic Surgery. 2017;4:253–7.
Gregorini M, Ticozzelli E, Abelli M, Grignano MA, Pattonieri EF, Giacomoni A, et al. Kidney Transplants From Donors on Extracorporeal Membrane Oxygenation Prior to Death Are Associated With Better Long-Term Renal Function Compared to Donors After Circulatory Death. Transpl Int. 2022;35:10179.
Puślecki M, Ligowski M, Stefaniak S, Dąbrowski M, Zieliński M, Pawlak A, et al. “Extracorporeal Membrane Oxygenation for Greater Poland” Program: How to Save Lives and Develop Organ Donation? Transplant Proc. 2018;50:1957–61.

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

Clinical features analysis of 75 deceased donors maintained in ICU

Status:

Version 1

Abstract

Figures

1 Introduction

2 Materials and Methods

2.1 Study population

2.2 Study content

2.3 Statistical analysis

3 Results

3.1 Basic data and laboratory examination results

3.1.1 Basic data

3.1.2 Laboratory examination results

3.1.3 Organ donation

3.2 Disease distribution

3.3 Infections

3.4 Maintenance measures

4 Discussions and conclusions

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1