Causes of Failure during the Management Process from Identification of Brain-Dead Potential Organ Donors to Actual Donation in Korea: a 5-Year Data Analysis (2012–2016)

김미임,오재숙,조원현,김동식,정철웅,유영동,권준교,이재명 대한의학회 2018 Journal of Korean medical science Vol.33 No.50

Background: This retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years. Methods: Data of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family. Results: From January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non- brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead. Conclusion: The rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.

지속적 신대체 요법을 이용한 성공적인 뇌사 장기 공여자의 관리 -증례 보고-

임상현,이영주,조한범,이재명,이인경 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.4

Brain death results in adverse pathophysiologic effects in many brain-dead donors with cardiovascular instability. We experienced a brain-dead donor with continuous renal replacement therapy (CRRT) who was in a severe metabolic, electrolyte derangement and poor pulmonary function. The thirty-nine-year-old male patient with subarachnoid hemorrhage and intraventricular hemorrhage was admitted into the intensive care unit (ICU). After sudden cardiac arrest, he went into a coma state and was referred to as a potential organ donor. When he was transferred, his vital sign was unstable even under the high dose of inotropics and vasopressors. Even with aggressive treatment, the level of blood sugar was 454 mg/dl, serum K+ 7.1 mEq/L, lactate 5.33 mmol/L and PaO2/FiO2 60.3. We decided to start CRRT with the mode of continuous venovenous hemodiafiltration (CVVHDF). After 12 hours of CRRT, vital sign was maintained well without vasopressors, and blood sugar, serum potassium and lactate levels returned to 195 of PaO2/FiO2. Therefore, he was able to donate his two kidneys and his liver.

Hormonal Changes of the Brain-Dead Organ Donors: A 3-Year Experience

최용선,나성원,강승연,고신옥 대한중환자의학회 2008 Acute and Critical Care Vol.23 No.1

Background: Success of transplantation is critically dependent upon the quality of the donor organ and optimal management. Recently, hormonal replacement therapy has been reported to result in rapid recovery of cardiac function and enable significantly more organs to be transplanted, while some other studies show conflicting results. The aim of this study is to comprehensively evaluate changes in basal circulating hormonal levels of the brain-dead organ donors. Methods: We reviewed the records of all brain-dead patients between January, 2004, and June, 2007. Hemodynamic variables, plasma hormone levels were recorded at following time points: admission to the ICU (T1, baseline), 30 minutes (min) after first apnea test (T2), 30 min after second apnea test (T3), before operation for harvesting (T4). Hormonal measurements included cortisol, adrenocorticotrophic hormone, triiodothyronine (T3), thyroxine, free thyroxine, thyroid-stimulating hormone, growth hormone, and testosterone. Results: Nineteen patients were included in this study. Comparisons of hemodynamic parameters and hormonal levels to baseline values revealed no significant changes throughout the study period. When the patients were divided into 2 groups according to the requirement of norepinephrine (either>0.05 or ≤0.05μg/kg/min), patients requiring >0.05μg/kg/min of norepinephrine had T3 level below the normal range at significantly more time points of measurement (7 vs. 0). Conclusions: In this comprehensive assessment of hormonal levels in brain-dead organ donors, we could not observe any significant changes during the ICU stay. Replacement therapy of T3 may be considered in patients requiring >0.05μg/kg/min of norepinephrine.

Contrast-enhanced ultrasonography-based renal blood perfusion in brain-dead donors predicts early graft function

Weiming He,Yuguang Xu,Chaoyang Gong,Xiaozhen Liu,Yuqiang Wu,Xi Xie,Jiazhen Chen,Yi Yu,Zhiyong Guo,Qiang Sun 대한초음파의학회 2023 ULTRASONOGRAPHY Vol.42 No.4

Purpose: The aim of this study was to quantify renal microcirculatory perfusion in braindead donors using contrast-enhanced ultrasonography (CEUS), and to establish an accurate, noninvasive, and convenient index for predicting delayed graft function (DGF) post-transplantation. Methods: In total, 90 brain-dead donor kidneys (training group, n=60; validation group, n=30) examined between August 2020 and November 2022 were recruited in this prospective study. CEUS was performed on the kidneys of brain-dead donors 24 hours before organ procurement and time-intensity curves were constructed. The main measures were arrival time, time to peak, and peak intensity of the kidney segmental arteries, cortex, and medulla. Recipients were divided into DGF and non-DGF groups according to early post-transplant graft function. The area under the receiver operating characteristic curve (AUC) was used to assess diagnostic performance. Results: The arrival time of the kidney segmental artery and cortex and the time interval between the time to peak of the segmental artery and cortex were identified as independent factors associated with DGF by multivariate stepwise regression analysis. A new index for the joint prediction model of three variables, the contrast-enhanced ultrasonography/Kidney Donor Profile index (CEUS-KDPI), was developed. CEUS-KDPI showed high accuracy for predicting DGF (training group: AUC, 0.91; sensitivity, 90.5%; specificity, 92.3%; validation group: AUC, 0.84; sensitivity, 75.0%; specificity, 92.3%). Conclusion: CEUS-KDPI accurately predicted DGF after kidney transplantation. CEUS may be a potential noninvasive tool for bedside examinations before organ procurement and may be used to predict early renal function after kidney transplants kidneys from donors after brain death.

우리나라 장기이식의 현황과 법률문제

문성제 ( Moon Seong-jea ) 한국외국어대학교 법학연구소 2006 외법논집 Vol.24 No.-

Organ transplantation, the finest example of modem medicine, is based on respect for human life in that it can deliver patients from malignant diseases incurable in past. Since the first successful operation in 1969 as followed by successful transplantation of liver extracted from a person with brain death in 1988, organ transplantation has been already one of most crucial medical arts in Korean and global medicine. Here, organ transplantation consists of 2 processes; one is transplanting organs for medical treatment of patients, and the other is extracting necessary organs from organ donor. The organ transplantation includes auto-transplantation(organ recipient = organ donor), xenograft(replacement with animal organs), insertion of mechanical organs and more. These cases don't involve any special legal issue except general issues in surgical operation such as medical adaptation for such treatments, technical criteria about such medical behaviors and patient’s agreement. But in case of xenograft that needs different organ donor from organ recipient, any one party concerned faces inevitable issues like lost organs or damaged corpse, and the other party benefits from survival or recovered health via transplantation. Because of this contradiction, the organ transplantation involves a question about how to resolve relevant legal issues. As shown here, it is also necessary to discuss extra legal considerations about different interests in organ transplantation between organ donor and recipient. Although there are issues concerned with organ transplantation in terms of organ recipient, it may be construed as general medical behaviors in regard to the nature of medical cure. However, from the standpoint of organ donor, even though the extraction of organ is indispensable for the cure of organ recipient, such extraction itself is not inherent behaviors of medical cure, so it is necessary to build up a series of legal principles to legitimate such behaviors. Here, they depend on whether certain organ is extracted from living organism or dead one. Furthermore, the extraction of organ from living or dead body involves a series of questions like whether to follow the intent of person who has a disposition authority, who the person is, which legitimate effects the expression of his/her intent may have in force, and so forth. In addition, in terms of organ transplantation from living organism for successful transplantation, conflicts concerned with brain death related to beginning and end of person as principal with capacity of enjoyment of rights have been already controversial in discussions between legal and medical circles since long decades ago. Fortunately, the latest enactment and enforcement of “Organ and Equivalent Transplantation Act” gives a clue to resolve these conflicts, but there are still little reviews and studies about potential issues concerned with human respect. It is possibly expected that there will be a series of brisk academic discussions about these issues. From this viewpoint, this paper focuses on posing questions related to organ transplantation and suggesting corresponding solutions.

Successful Management of Potential Non-Heart-Beating Donor with Extracorporeal Membrane Oxygenation -A Case Report-

Young Hwan Kim,Gui Yun Sohn,Yooun Joong Jung,Kyu Hyouck Kyoung,Suk-Kyung Hong 대한중환자의학회 2012 Acute and Critical Care Vol.27 No.4

Hemodynamics of a brain-dead donor can change rapidly during management. It frequently leads to loss of the donor or deterioration of organ functions. Various efforts have been made not to lose potential donors. Extracorporeal membrane oxygenation (ECMO) and non-heart-beating donation (NHBD) are good examples of such efforts. A 47 year-old woman with a history of hypertension, diabetes mellitus and atrial fibrillation was diagnosed with cerebral infarction and hemorrhage. Cardiopulmonary resuscitation was performed three times before transfer to our hospital. Her family agreed to organ donation. ECMO was applied due to her unstable vital signs, which made the first declaration of brain death possible. However, considering the deteriorating vital signs and expected cardiac arrest, it was decided to switch to NHBD under the family’s consent. All life-support devices including ECMO were turned off in the operation room. After cardiac death was declared, the harvesting of liver and kidneys was performed with perfusion through an ECMO catheter. The liver and kidneys were successfully transplanted to three recipients.

Single-Center Pharmacokinetic Study and Simulation of a Low Meropenem Concentration in Brain-Dead Organ Donors

Lee, Jae-Myeong,Lee, Joo Won,Jeong, Tae Seok,Bang, Eun Sook,Kim, So Hee American Society for Microbiology 2018 Antimicrobial Agents and Chemotherapy Vol.62 No.10

<P>Meropenem is an ultrabroad-spectrum antibiotic of the carbapenem family. In brain-dead organ donors, administration of standard meropenem dosages does not reach therapeutic levels. Our objectives were to determine the plasma concentration of meropenem after the administration of standard meropenem dose and to estimate an improved dosage regimen for these patients. One gram of meropenem was administered as a 1-h infusion every 8 h for 1 to 3 days, and blood samples were collected. The plasma concentration of meropenem was measured and subjected to pharmacokinetic analysis. Simcyp simulation was performed to predict the optimum plasma levels and dosage based on the patients' individual pharmacokinetic parameters. The maximum plasma concentration of meropenem was 3.29 mu g/ml, which was lower than four times the MIC of 8 mu g/ml. Although the mean creatinine clearance of patients was moderately low (67.5 ml/min), the apparent volume of distribution at steady state (V-ss) and time-averaged total body clearance (CL) of meropenem were markedly elevated (4.97 liters/kg and 2.06 liters/h/kg, respectively), owing to massive fluid loading to decrease the high sodium levels and to treat shock or dehydration. The simulation revealed that dose and infusion time of meropenem should be increased based on patients' V-ss and CL, and a loading dose is recommended to reach rapidly the target concentration. In conclusion, a standard meropenem regimen is insufficient to achieve optimal drug levels in brain-dead patients, and an increase in dose and extended or continuous infusion with intravenous bolus administration of a loading dose are recommended for these patients.</P>

잠재 뇌사자에서 성공적 장기 기증과 기증 동의와 관련된 인자

이은우,장혜연,한상엽,한금현,오세원,노영남 대한이식학회 2017 Korean Journal of Transplantation Vol.31 No.1

Background: This study was conducted to identify the factors influencing successful organ donation and families’ consent to donate after brain death. Methods: Medical records and data regarding organ donation counseling with the families of 107 brain-dead potential donors between September 2012 and March 2016 at a single tertiary medical center were retrospectively reviewed. Results: The final consent rate was 57.9% (62/107), and successful donation was performed in 40.2% (43/107) of cases. Univariate and multivariate analyses revealed that the independent factors associated with successful organ donation were age <60 years (odds ratio [OR], 3.384; 95% confidence interval [CI], 1.350 to 8.484; P=0.009), systolic blood pressure ≥90 mmHg (OR, 6.261; 95% CI, 1.418 to 27.653; P=0.015), and serum sodium level ≥150 mEq (OR, 4.215; 95% CI, 1.655 to 10.733; P=0.003). Family’s consent to donate was significantly associated with head trauma (OR, 3.538; 95% CI, 1.104 to 11.334; P=0.033) and serum sodium level ≥150 mEq (OR, 3.392; 95% CI, 1.404 to 8.194; P=0.007). Conclusions: Successful organ donation was associated with patient age, systolic blood pressure and serum sodium level. Family’s consent to donate was associated with head trauma and serum sodium level.