CORR reports that 21,451 transplants have been performed from 1981-1996. Approximately 78% of these have been kidney transplantations. Survival statistics revealed that progress has been made to improve both patient and graft survival, particularly during the period between 1991-1996. Consequently, the number of patients being followed with a functioning transplant increased to 11,645. There has been a rise in the number of kidney transplants, which is largely attributed to an increase in the number of living donors. Data also revealed that there was increasing acceptance of elderly patients, who were not transplant candidates, into dialysis programs. Furthermore, the percentage of the number of patients alive with functioning kidney transplants to the total number of patients with ESRD increased from 41% in 1981 to 46% in 1996. Non-renal transplant activity has increased in the recent past. Overall, 5-year patient and graft survival was about 70%. This improvement in survival was associated with a reduction in 30-, 60- and 90-day mortality. The organ donation rate has increased slightly from 13.9 donors per million population in 1994 to 14.1 in 1996. The majority of Canadian donors were multi-organ donors, while fewer were kidney, liver, heart or lung-specific donors only. The proportion of female donors has increased. The number of patients waiting for transplants continues to increase. Approximately 3,072 patients are on waiting lists; the majority are for kidney transplants. As the increase in the number of donors does not match the increasing numbers of transplants needed, this suggests that greater efforts are necessary to reduce this difference.
The aim of this study was to assess knowledge, attitudes, and proficiency in relation to organ donation among staff members of intensive care units (ICUs) in donor hospitals, and possibly identify areas for improvement. The investigation was carried out as a collaboration between the transplant center and appointed key persons in all 17 ICUs in 15 hospitals in northern Denmark. A total of 1168 structured questionnaires were distributed to the health care professionals in the ICUs in the region; 689 were returned, giving a response rate of 59%. In general, there is a positive attitude among health care professionals toward organ donation. However, a considerable fraction of 11% declares to be against organ donation. Only 49% of the ICU health care professionals are willing to donate their own organs after death. By comparison, 74% of the general Danish population are willing to donate organs after death. Doctors are more positive toward organ donation than the nursing staff. Thus, 95% of the doctors are positive to organ donation compared to 81% of the nurses; 70% of the doctors will donate own organs after death compared to 45% of the nurses. Further, the survey demonstrates as expected a significant lack of experience in organ donation. Our data show a considerable need for more education and training, especially on how to inform and support the donor relatives and how to identify potential donors. The survey also discloses a substantial need for information regarding the results of transplantation.
In Denmark, organ donation-rates are below the average in the western countries. We investigated the donor potential and identified barriers toward organ donation in a Danish university hospital.
All patients who died in Aalborg University Hospital in 2012 were retrospectively identified. Patients with a CT- or MRI-proven deadly brain-lesion were eligible for inclusion.
Eighty-five patients with deadly brain-lesions were included, and of these 47 patients died in the intensive care unit (ICU). Older age and diagnosis of brain-hemorrhage and infarction were associated with admission to general ward (GW). In 62.4% of the patients the potential of becoming a donor was not identified. No donations occurred from patients dying from intracerebral hemorrhage or brain-infarction although they represented 44.7% of the potential donors.
This study reveals a huge, unrecognized donation potential at our hospital. About 30% was lost because they were never admitted to the ICU. After primary admission to the ICU, 15.3% of the potential donors were lost because they were transferred to the GW. In patients who died in the ICU 17.6% of the patients were not evaluated as potential donors. The relatives refused donation in 17.6% of cases.
It would be possible to raise the donation rate considerably if patients with donation potential are intubated and admitted to the ICU. When active treatment is considered withdrawn, possibility of organ donation should be evaluated, and the next of kin be approached by experienced staff.
The annual number of cadaveric organ donors increased from 13.1 per million inhabitants in the period 1989-92 to 15.8 in the period 1993-96. Multiple organ harvesting was performed in 68% of the donors. There are significant differences in donation rate between health regions. An increase to 20 organ donors per year per million inhabitants is required to meet the anticipated need for organs. Strategies to increase organ donation are discussed.
The severity of preoperative liver disease influences the outcome of liver transplantation, is commonly used to determine priority on liver transplant waiting lists, and may differ between countries with different rates of liver disease and organ allocation systems. We compared the relative severity of liver disease in transplant recipients with chronic liver disease in the United States, Canada, and the United Kingdom and its relation to outcome. Data were obtained from national databases on patients who received transplants in the year 2000. The data included age, gender, diagnosis, the status at the time of transplantation, and indices of chronic liver disease [serum bilirubin and international normalized ratio (INR), and serum creatinine] from which a comparative score [model for end-stage liver disease (MELD) score] was calculated. The data revealed marked differences between the three countries. No patient in the United Kingdom was in intensive care before transplantation compared with 19.3% of recipients in the United States and 7.5% in Canada. The median model MELD score of recipients in the United Kingdom was 10.9 compared with 16.1 in the United States and 17 in Canada. The median MELD score of transplant recipients in North America did not vary according to diagnosis, whereas in the United Kingdom, patients with cholestatic liver disease had a lower median MELD score (8.5) than those with alcoholic liver disease (15.7) at the time of transplantation. In conclusion, the disease severity of UK liver transplant recipients varied by diagnosis and was lower than recipients in North America; the 1-year survival rate was, however, similar between the countries.
The results of 3,165 kidney transplants from deceased donors during the 3 time periods, 1986-92 (n=882), 1993-99 (n=1,107) and 2000-06 (n=1,176) were analysed and following conclusions could be made: 1. One-year patient survival improved from 93.2% to 98.1%, one-year graft survival improved from 86.1% to 95.1% and one-year death censored graft survival improved from 90.4% to 96.6%. Patient death due to cardiovascular disease decreased significantly. Despite that, patient death with a functioning graft became the main cause of graft loss after the first posttransplant year in our most recent cohort. The estimated graft half-life has improved from 9.3 to 20.4 years. 2. The rejection incidence decreased from 28.1% to 14.1%. 3. The mean donor age increased from 35.5 to 47.8 years. The proportion of donors fulfilling the UNOS criteria for extended criteria donors increased from 2.9% to 26.3%. The long-term effects of donor factors on these transplants need to be critically evaluated. 4. A good HLA match remains a sound basis for kidney allocation. Provisions should be made for highly immunized patients and those with unusually long waiting times.
The mortality rate for pediatric patients on the waiting list for transplantation has a major impact on the overall effectiveness of pediatric small bowel transplantation. This review was undertaken to determine the fate of Canadian children assessed for small bowel transplant and the outcome of those who undergo transplant in the tacrolimus era.
The authors reviewed retrospectively all of the pediatric small bowel patients listed since 1988 through the Canadian Organ Replacement Register and all the children referred to our program in its first year. All children who received a small bowel transplant between January 1993 and December 1999 also were reviewed.
The mortality rate for pediatric patients on the small bowel transplant list was 53% after an average of 105 days on the list compared with 212 days for those who underwent transplant. Patients who died while on the list were younger and had signs of advanced liver disease at the time of listing. Thirteen Canadian children have received a small bowel transplant with an overall 1-year patient and graft survival rate of 61% and 53%, respectively. Survivors are all independent from total parenteral nutrition.
Many Canadian children miss their opportunity for a successful small bowel transplant because of late referrals and a shortage of donor organs.