Donör havuzunun gizli hazinesi: greft olarak kullanılmayan donör kalplerinin analizi

Öz

Amaç: Bu çalışmada beyin ölümü gerçekleşen hastalarda organ bağışının seyrini araştırmak, organ bağışından organ nakline kadar olan aşamaları incelemek, kullanılmayan veya reddedilen vericilerin nedenlerini ortaya çıkarmak ve çözüm önerileri ortaya konması amaçlandı. Gereç ve Yöntemler: Ocak 2015-Aralık 2016 tarihleri arasında, aile izinleri olan tüm kadavra bağışçılarının Sağlık Bakanlığı Ulusal Koordinasyon Merkezi Başkanlığı arşivlerindeki donör kayıt verilerini inceledik. Donör adaylarının demografik verileri, yoğun bakım kalış süresindeki verileri ve donör olarak kullanılmama nedenleri incelendi. Sonuçlar: 985 donör incelendi; %65'i erkek, ortalama yaş 47.5 (0-96) idi ve donörlerin %65'inde nörolojik nedenlerle beyin ölümü gerçekleşmişti. Ortalama beyin ölümü rapor süresi 5.4 ± 9.3 (1-169) gündü. Donörlerin 169’unda (%17.1) enfeksiyon tespit edildi. Ortalama yoğun bakımda kalış süresi 8,55 ± 4,42 (2-38) gündü. Donörlerin sadece 159’undan (%16,2) kalp grefti alındı. 495 (%50,2) donör tıbbi nedenlerle reddedildi, 64 (%6,5) donör, alıcı merkezler tarafından reddedildiği için kalp nakli için uygun değildi. Potansiyel bağışçıların %20'sinde kalp bağışı için aile onayı alınmadı. Aile onayı olmayan bağışçıların %70'i 65 yaşın altındaydı ve %67'sinin greft olarak kalp kullanımından kaçınmak için herhangi bir tıbbi sorunu yoktu. Kalp onayı olmayan donörlerde greft olarak karaciğer kullanım oranı %71, böbrek için kullanım oranı %70 idi. Sonuç: Beyin ölümü tanısından donörlerin bakımına kadar olan süreci yürütecek ve yönlendirecek organ nakli ekiplerine ihtiyacımız vardır.

Anahtar Kelimeler

• kalp nakli
• beyin ölümü
• donör

The hidden treasure of the donor pool: An analysis of donor hearts not used as grafts

Öz

Aim: The aim was to investigate the course of organ donation in patients with brain death, examine the steps from organ donation to transplant, reveal the reasons of donors that are not used or are refused and to propose a solution. Material and Methods: Between January 2015 to December 2016, we reviewed data of donor registry in Ministry of Health, Department of the National of Coordination Center archives of all cadaveric donors whose family permit approved were investigated. Data of demographics, intensive care unit data and reasons of unused as donor were analyzed. Results: 985 donors were examined; 65% was male, mean age was 47.5 (0-96) and 65% of the donors had brain death due to neurological reasons. Mean brain death report duration was 5.4 ± 9.3 (1-169) days. A total of 169 (17.1%) infections in donors were detected. Mean intensive care unit stay was 8.55 ± 4.42 (2-38) days. Only 16.2% (159) heart grafts were used in donors. 495 (50.2%) donors were rejected for medical reasons, 64 donors (6.5%) were not eligible for heart grafts due to rejection by centers. Family approval for the heart donation was not obtained in 20% of the potential donors. 70% of donors without family approval was under 65 year-old and 67% of them did not have any medical problems for avoiding heart usage as a graft. In donors without heart approval as a graft, rate of liver use as a graft was 71% and rate for kidney was 70%. Conclusion: We need organ transplant teams who will conduct and lead the process from the diagnosis of brain death to the care of donors.

Anahtar Kelimeler

• organ donation
• heart
• organ transplantation
• brain death

Kaynakça

1. Public Disclosure Platform Systems TTDIS, Ministry of Health; 2018 [updated 17 No-vember 2019. Available from: https://organkds.saglik.gov.tr/dss/PUBLIC/WL_Hearth.aspx.
2. Fiorelli AI, Stolf NA, Pego-Fernandes PM, Oliveira Junior JL, Santos RH, Contreras CA, et al. Recommendations for use of marginal donors in heart transplantation: Brazilian Association of Organs Transplantation guideline. Transplant Proc. 2011;43(1):211-5.
3. Redelmeier DA, Markel F, Scales DC. Organ donation after death in Ontario: a population-based cohort study. CMAJ. 2013;185(8):E337-44.
4. Conversion Rate for Deceased Organ Donation: Trillium Gift of Life Network; 2019 [up-dated 17 November 2019. Available from: https://www.giftoflife.on.ca/en/publicreporting.htm#donors-cal.
5. Shemie SD, Ross H, Pagliarello J, Baker AJ, Greig PD, Brand T, et al. Organ donor man-agement in Canada: recommendations of the forum on Medical Management to Optimize Donor Organ Potential. CMAJ. 2006;174(6):S13-32.
6. Shemie SD, Baker AJ, Knoll G, Wall W, Rocker G, Howes D, et al. National recommenda-tions for donation after cardiocirculatory death in Canada: Donation after cardiocirculatory death in Canada. CMAJ. 2006;175(8):S1.
7. Oczkowski SJW, Arnold E, Centofanti J, Durepos P, Sarti A, Arseneau E, et al. A mixed-methods study of organ donation in the intensive care unit: 22 actionable practices to improve organ donation. Can J Anaesth. 2019;66(6):686-95.
8. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, et al. The Interna-tional Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipi-ents. J Heart Lung Transplant. 2010;29(8):914-56.

9. Donation activity charts: IRODAT; 2017 [updated 17 November 2019. Available from: http://www.irodat.org/?p=database#data.
10. Jensen AMB, Larsen JB. The public debate on organ donation and presumed consent in Denmark: Are the right issues being addressed? Scand J Public Health. 2019:1403494819833797.
11. Escudero D, Valentin MO, Escalante JL, Sanmartin A, Perez-Basterrechea M, de Gea J, et al. Intensive care practices in brain death diagnosis and organ donation. Anaesthesia. 2015;70(10):1130-9.
12. Organ Nakil İstatistikleri: Ministry of Health; 2018 [updated 17 November 2019. Available from: https://organ.saglik.gov.tr/0TR/70Istatistik/OrganNakilIstatistikKamusal.aspx.
13. Ghorbani F, Khoddami-Vishteh HR, Ghobadi O, Shafaghi S, Louyeh AR, Najafizadeh K. Causes of family refusal for organ donation. Transplant Proc. 2011;43(2):405-6.
14. Kıraklı C, Uçar, ZZ., Anıl, AB. Yoğun Bakım’da Beyin Ölümü Kesin Tanı Süresinin Kısalmasının Organ Bağışı Oranlarına Etkisi. Türk Anesteziyoloji ve Reanimasyon Derneği 43 Ulusal Kongresi; Antalya, Turkey2009.
15. Martinez Soba F, Masnou Burrallo N, de la Rosa Rodriguez G, Povar Marco J, grupo colaborativo OS. [Emergency department staff and the organ donation process: recommendations from the joint working group of the National Transplant Organization and the Spanish Society of Emergency Medicine (ONT-SEMES)]. Emergencias. 2016;28(3):193-200.
16. Costas-Lombardia E, Castiel JF. The easy success of the Spanish model for organ trans-plantation. Artif Organs. 2011;35(9):835-7.
17. Zivcic-Cosic S, Busic M, Zupan Z, Pelcic G, Anusic Juricic M, Jurcic Z, et al. Develop-ment of the Croatian model of organ donation and transplantation. Croat Med J. 2013;54(1):65-70.
18. Lustbader D, O'Hara D, Wijdicks EF, MacLean L, Tajik W, Ying A, et al. Second brain death examination may negatively affect organ donation. Neurology. 2011;76(2):119-24.
19. Sandroni C, D'Arrigo S, Callaway CW, Cariou A, Dragancea I, Taccone FS, et al. 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.
20. Mehra MR, Jarcho JA, Cherikh W, Vaduganathan M, Lehman RR, Smits J, et al. The Drug-Intoxication Epidemic and Solid-Organ Transplantation. N Engl J Med. 2018;378(20):1943-5.
21. Cakici M, Gumus F, Inan MB, Akar AR. Alternative Transplant Waiting Lists to Maximize the Use of Marginal Cadaveric Hearts in Patients with Advanced Heart Failure. Turkiye Klinikleri J Cardiovasc Surg-Special Topics. 2018;10(2):180-90.
22. Hunt SA, Baldwin J, Baumgartner W, Bricker JT, Costanzo MR, Miller L, et al. Cardio-vascular management of a potential heart donor: a statement from the Transplantation Committee of the American College of Cardiology. Crit Care Med. 1996;24(9):1599-601.
23. Khasati NH, Machaal A, Barnard J, Yonan N. Donor heart selection: the outcome of "unac-ceptable" donors. J Cardiothorac Surg. 2007;2:13.
24. Massad MG. Current trends in heart transplantation. Cardiology. 2004;101(1-3):79-92.
25. Toyoda Y, Guy TS, Kashem A. Present status and future perspectives of heart transplanta-tion. Circ J. 2013;77(5):1097-110.
26. Fiorelli AI, Branco JN, Dinkhuysen JJ, Oliveira Junior JL, Pereira TV, Dinardi LF, et al. Risk factor analysis of late survival after heart transplantation according to donor profile: a multi-institutional retrospective study of 512 transplants. Transplant Proc. 2012;44(8):2469-72.
27. Joseph JT, Mulvihill MS, Yerokun BA, Bell SM, Milano CA, Hartwig MG. Elevated do-nor hemoglobin A1c does not impair early survival in cardiac transplant recipients. Clin Transplant. 2017;31(7).