Derivation of the Uncontrolled Donation after Circulatory Determination of Death

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03582.x/abstract

Derivation of the Uncontrolled Donation after Circulatory Determination of Death Protocol for New York City
S. P. Wall1,2, B. J. Kaufman3,4, A. J. Gilbert5, Y. Yushkov6, M. Goldstein6,7, J. E. Rivera6, D. O’Hara6, H. Lerner6, M. Sabeta6, M. Torres6, C. L. Smith6, Z. Hedrington6, F. Selck8, K. G. Munjal4,9, M. Machado1, S. Montella1,2, M. Pressman1, L. W. Teperman5, N. N. Dubler10,11, L. R. Goldfrank1,2,*, for the NYC UDCDD Study Group
Article first published online: 28 JUN 2011

DOI: 10.1111/j.1600-6143.2011.03582.x

American Journal of Transplantation
Volume 11, Issue 7, pages 1417–1426, July 2011

Abstract

Evidence from Europe suggests establishing out-of-hospital, uncontrolled donation after circulatory determination of death (UDCDD) protocols has potential to substantially increase organ availability. The study objective was to derive an out-of-hospital UDCDD protocol that would be acceptable to New York City (NYC) residents. Participatory action research and the SEED-SCALE process for social change guided protocol development in NYC from July 2007 to September 2010. A coalition of government officials, subject experts and communities necessary to achieve support was formed. Authorized NY State and NYC government officials and their legal representatives collaboratively investigated how the program could be implemented under current law and regulations. Community stakeholders (secular and religious organizations) were engaged in town hall style meetings. Ethnographic data (meeting minutes, field notes, quantitative surveys) were collected and posted in a collaborative internet environment. Data were analyzed using an iterative coding scheme to discern themes, theoretical constructs and a summary narrative to guide protocol development. A clinically appropriate, ethically sound UDCDD protocol for out-of-hospital settings has been derived. This program is likely to be accepted by NYC residents since the protocol was derived through partnership with government officials, subject experts and community participants.

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03562.x/abstract

Kidney Transplantation from Donors after Cardiac Death: Uncontrolled versus Controlled Donation
E. R. P. Hoogland1,*, M.G.J. Snoeijs1, B. Winkens2, M. H. L. Christaans3, L. W. E. van Heurn1
Article first published online: 10 JUN 2011

DOI: 10.1111/j.1600-6143.2011.03562.x

American Journal of Transplantation
Volume 11, Issue 7, pages 1427–1434, July 2011

Abstract

Kidney donation after cardiac death has been popularized over the last decade. The majority of these kidneys are from controlled donors. The number of organs for transplantation can be further increased by uncontrolled donors after cardiac death. The outcome of uncontrolled compared to controlled donor kidney transplantation is relatively unknown. We compared the long-term outcome of kidney transplantation from uncontrolled (n = 128) and controlled (n = 208) donor kidneys procured in the Maastricht region from January 1, 1981 until January 1, 2008, and transplanted in the Eurotransplant region. The incidence of primary nonfunction and delayed graft function in both uncontrolled and controlled donor kidneys is relatively high (22% vs. 21%, and 61% vs. 56%, p = 0.43, respectively). Ten-year graft and recipient survival are similar in both groups (50% vs. 46%, p = 0.74 and 61% vs. 60%, p = 0.76, respectively). Estimated glomerular filtration rates 1 year after transplantation are 40 ± 16 versus 42 ± 19 mL/min/1.73 m2, p = 0.55, with a yearly decline thereafter of 0.67 ± 3 versus 0.70 ± 7 mL/min/1.73 m2/year, p = 0.97. The outcome of kidney transplantation from uncontrolled and controlled donors after cardiac death is equivalent. This justifies the expansion of the donor pool with uncontrolled donors to reduce the still growing waiting list for renal transplantation, and may stimulate the implementation of uncontrolled kidney donation programs.