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Darren Malinoski - One of the best experts on this subject based on the ideXlab platform.
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deceased Organ Donor factors influencing pancreatic graft transplantation and survival
2019Co-Authors: Mitchell B Sally, Madhukar S Patel, Claus U Niemann, Tahnee Groat, Margaret Katherine Ellis, Michael P Hutchens, Elizabeth A Swanson, Darren MalinoskiAbstract:Pancreatic transplantation has become a standard of care for complicated type 1 diabetes therapy. In the United States in 2015, there were approximately 1000 patients awaiting pancreas transplant, with the percentage of active listings at 65%, the highest in decades.1 Solid Organ pancreata can be transplanted individually, after a kidney transplant (pancreas-after-kidney [PAK]), or with a simultaneous pancreas-kidney (SPK) transplant. As diabetes is cited as a major, in- creasing public health burden,2 pancreas transplant has been recommended by the American Diabetes Association and other national guidelines as an accepted treatment, particularly when coupled with end-stage renal disease.3 Benefits to pancreas transplantation, SPK, and PAK are well described, having both improvements in mortality when compared to those on the waiting list4 and better overall glycemic control, reducing number of hypoglycemic episodes compared to those on insulin regimens.5 In addition, pancreas transplantation has been shown to delay secondary complications of diabetes, such as cardiovascular disease6 and nervous system complications.7 Despite these demonstrated advantages for pancreatic transplantation, only approximately 10% of available Organs are recovered from Donors after brain death (DBD). Additionally, there has been an overall decline in pancreatic transplantation over the past decade.8 In pancreatic transplantation, inconsistent Donor management and Organ acceptance practices are pervasive. Potentially contributing to this lack of consistency in Donor management is the fact that the current risk-adjustment models used to predict both Organ procurement Organization (OPO) Donor pancreas utilization and transplant center graft survival models lack detailed Donor critical care data. In an effort to increase standardization and data collection, several OPOs have collaborated to develop a checklist of critical care endpoints to guide the bedside care of potential Organ Donors. These endpoints are also known as Donor management goals (DMGs), and they represent normal hemodynamic, respiratory, renal, acid-base, and endocrine parameters for an Organ Donor. Multiple studies have shown improvements in both Organ utilization rates9–13 and recipient graft outcomes14–16 when these goals are met. The link between optimal management of the potential Organ Donor after brain death (DBD) and pancreatic graft utilization and function has not yet been explored in the literature, and we sought to further elucidate this relationship using a deceased Organ Donor database containing demographic and critical care data at 4 time points during Donor management. Given anecdotal reports of insulin requirements being used as criteria for pancreatic acceptance or denial, we also sought to determine the relationship between insulin dose and pancreatic usage and function.
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state of the science in deceased Organ Donor management
2018Co-Authors: Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Darren MalinoskiAbstract:Research in deceased Organ Donor management offers an opportunity to increase the quantity and quality of Organs available for transplantation. This article aims to appraise the current literature with a focus on reviewing deceased Donor intervention trials. Aggressive critical care management after determination of brain death resulting in meeting of a Donor management goal bundle has consistently demonstrated an association with significantly more Organs transplanted per Donor as well as improved graft outcomes. Although there is a dearth of experience with randomized Donor intervention studies, dopamine and targeted mild therapeutic hypothermia have been found to significantly reduce delayed graft function in kidney recipients. Progress in understanding the ethical, legal, regulatory, policy, and Organizational elements of Organ Donor research has provided a mechanism that allows for the endorsement of potentially impactful Donor management studies. Ongoing trials should incorporate methods to ensure safety to all Organs donated from Donors enrolled in interventional trials.
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deceased Organ Donor management does hospital volume matter
2017Co-Authors: Madhukar S Patel, Mitchell B Sally, Darren Malinoski, Tahnee Groat, Jahan Mohebali, Parsia A Vagefi, David C ChangAbstract:Background Identification of strategies to improve Organ Donor use remains imperative. Despite the association between hospital volume and outcomes for many common disease processes, there have been no studies that assess the impact of Organ Donor hospital volume on Organ yield. Study Design A prospective observational study of all deceased Organ Donors managed by 10 Organ procurement Organizations across United Network for Organ Sharing regions 4, 5, and 6 was conducted from February 2012 to June 2015. To study the impact of hospital volume on Organ yield, each Donor was placed into a hospital-volume quartile based on the number of Donors managed by their hospital. Stepwise logistic regression was used to identify the independent effect of hospital volume on the primary outcomes measure of having ≥4 Organs transplanted per Donor. Results Data from 4,427 Donors across 384 hospitals were collected and hospitals were assigned quartiles based on their volume of deceased Donors. Hospitals managed a mean ± SD of 3.3 ± 5.2 Donors per hospital per year. After adjusting for age, ethnicity, Donor type, blood type, BMI, creatinine, and Organ procurement Organization/Donor service area, being managed in hospitals within the highest volume quartile remained a positive independent predictor of ≥4 Organs transplanted per Donor (odds ratio = 1.52; 95% CI 1.29 to 1.79; p Conclusions Deceased Organ Donor hospital volume impacts Organ yield, with the highest-volume centers being 52% more likely to achieve ≥4 Organs transplanted per Donor. Efforts should be made to share practices from these higher-volume centers and consideration should be given to centralization of Donor care.
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management of the potential Organ Donor in the icu society of critical care medicine american college of chest physicians association of Organ procurement Organizations consensus statement
2015Co-Authors: Robert M Kotloff, Darren Malinoski, Luis F Angel, Sandralee Blosser, Gerard J Fulda, Vivek N Ahya, Matthew C Byrnes, Michael A Devita, Thomas E Grissom, Scott D HalpernAbstract:This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care medicine, Organ Donor management, and transplantation. Members of the task force were divided into 13 subcommittees, each focused on one of the following general or Organ-specific areas: death determination using neurologic criteria, donation after circulatory death determination, authorization process, general contraindications to donation, hemodynamic management, endocrine dysfunction and hormone replacement therapy, pediatric Donor management, cardiac donation, lung donation, liver donation, kidney donation, small bowel donation, and pancreas donation. Subcommittees were charged with generating a series of management-related questions related to their topic. For each question, subcommittees provided a summary of relevant literature and specific recommendations. The specific recommendations were approved by all members of the task force and then assembled into a complete document. Because the available literature was overwhelmingly comprised of observational studies and case series, representing low-quality evidence, a decision was made that the document would assume the form of a consensus statement rather than a formally graded guideline. The goal of this document is to provide critical care practitioners with essential information and practical recommendations related to management of the potential Organ Donor, based on the available literature and expert consensus.
Madhukar S Patel - One of the best experts on this subject based on the ideXlab platform.
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deceased Organ Donor factors influencing pancreatic graft transplantation and survival
2019Co-Authors: Mitchell B Sally, Madhukar S Patel, Claus U Niemann, Tahnee Groat, Margaret Katherine Ellis, Michael P Hutchens, Elizabeth A Swanson, Darren MalinoskiAbstract:Pancreatic transplantation has become a standard of care for complicated type 1 diabetes therapy. In the United States in 2015, there were approximately 1000 patients awaiting pancreas transplant, with the percentage of active listings at 65%, the highest in decades.1 Solid Organ pancreata can be transplanted individually, after a kidney transplant (pancreas-after-kidney [PAK]), or with a simultaneous pancreas-kidney (SPK) transplant. As diabetes is cited as a major, in- creasing public health burden,2 pancreas transplant has been recommended by the American Diabetes Association and other national guidelines as an accepted treatment, particularly when coupled with end-stage renal disease.3 Benefits to pancreas transplantation, SPK, and PAK are well described, having both improvements in mortality when compared to those on the waiting list4 and better overall glycemic control, reducing number of hypoglycemic episodes compared to those on insulin regimens.5 In addition, pancreas transplantation has been shown to delay secondary complications of diabetes, such as cardiovascular disease6 and nervous system complications.7 Despite these demonstrated advantages for pancreatic transplantation, only approximately 10% of available Organs are recovered from Donors after brain death (DBD). Additionally, there has been an overall decline in pancreatic transplantation over the past decade.8 In pancreatic transplantation, inconsistent Donor management and Organ acceptance practices are pervasive. Potentially contributing to this lack of consistency in Donor management is the fact that the current risk-adjustment models used to predict both Organ procurement Organization (OPO) Donor pancreas utilization and transplant center graft survival models lack detailed Donor critical care data. In an effort to increase standardization and data collection, several OPOs have collaborated to develop a checklist of critical care endpoints to guide the bedside care of potential Organ Donors. These endpoints are also known as Donor management goals (DMGs), and they represent normal hemodynamic, respiratory, renal, acid-base, and endocrine parameters for an Organ Donor. Multiple studies have shown improvements in both Organ utilization rates9–13 and recipient graft outcomes14–16 when these goals are met. The link between optimal management of the potential Organ Donor after brain death (DBD) and pancreatic graft utilization and function has not yet been explored in the literature, and we sought to further elucidate this relationship using a deceased Organ Donor database containing demographic and critical care data at 4 time points during Donor management. Given anecdotal reports of insulin requirements being used as criteria for pancreatic acceptance or denial, we also sought to determine the relationship between insulin dose and pancreatic usage and function.
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current practices in deceased Organ Donor management
2019Co-Authors: Madhukar S Patel, Peter L AbtAbstract:Purpose of reviewOptimizing the management of deceased Organ Donors focuses on providing critical care that prevents, mitigates, or repairs the pathophysiologic sequelae of brain death. This review discusses protocol-based care; approaches to monitoring, resuscitation, hormone replacement therapy, a
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state of the science in deceased Organ Donor management
2018Co-Authors: Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Darren MalinoskiAbstract:Research in deceased Organ Donor management offers an opportunity to increase the quantity and quality of Organs available for transplantation. This article aims to appraise the current literature with a focus on reviewing deceased Donor intervention trials. Aggressive critical care management after determination of brain death resulting in meeting of a Donor management goal bundle has consistently demonstrated an association with significantly more Organs transplanted per Donor as well as improved graft outcomes. Although there is a dearth of experience with randomized Donor intervention studies, dopamine and targeted mild therapeutic hypothermia have been found to significantly reduce delayed graft function in kidney recipients. Progress in understanding the ethical, legal, regulatory, policy, and Organizational elements of Organ Donor research has provided a mechanism that allows for the endorsement of potentially impactful Donor management studies. Ongoing trials should incorporate methods to ensure safety to all Organs donated from Donors enrolled in interventional trials.
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deceased Organ Donor management does hospital volume matter
2017Co-Authors: Madhukar S Patel, Mitchell B Sally, Darren Malinoski, Tahnee Groat, Jahan Mohebali, Parsia A Vagefi, David C ChangAbstract:Background Identification of strategies to improve Organ Donor use remains imperative. Despite the association between hospital volume and outcomes for many common disease processes, there have been no studies that assess the impact of Organ Donor hospital volume on Organ yield. Study Design A prospective observational study of all deceased Organ Donors managed by 10 Organ procurement Organizations across United Network for Organ Sharing regions 4, 5, and 6 was conducted from February 2012 to June 2015. To study the impact of hospital volume on Organ yield, each Donor was placed into a hospital-volume quartile based on the number of Donors managed by their hospital. Stepwise logistic regression was used to identify the independent effect of hospital volume on the primary outcomes measure of having ≥4 Organs transplanted per Donor. Results Data from 4,427 Donors across 384 hospitals were collected and hospitals were assigned quartiles based on their volume of deceased Donors. Hospitals managed a mean ± SD of 3.3 ± 5.2 Donors per hospital per year. After adjusting for age, ethnicity, Donor type, blood type, BMI, creatinine, and Organ procurement Organization/Donor service area, being managed in hospitals within the highest volume quartile remained a positive independent predictor of ≥4 Organs transplanted per Donor (odds ratio = 1.52; 95% CI 1.29 to 1.79; p Conclusions Deceased Organ Donor hospital volume impacts Organ yield, with the highest-volume centers being 52% more likely to achieve ≥4 Organs transplanted per Donor. Efforts should be made to share practices from these higher-volume centers and consideration should be given to centralization of Donor care.
Mitchell B Sally - One of the best experts on this subject based on the ideXlab platform.
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deceased Organ Donor factors influencing pancreatic graft transplantation and survival
2019Co-Authors: Mitchell B Sally, Madhukar S Patel, Claus U Niemann, Tahnee Groat, Margaret Katherine Ellis, Michael P Hutchens, Elizabeth A Swanson, Darren MalinoskiAbstract:Pancreatic transplantation has become a standard of care for complicated type 1 diabetes therapy. In the United States in 2015, there were approximately 1000 patients awaiting pancreas transplant, with the percentage of active listings at 65%, the highest in decades.1 Solid Organ pancreata can be transplanted individually, after a kidney transplant (pancreas-after-kidney [PAK]), or with a simultaneous pancreas-kidney (SPK) transplant. As diabetes is cited as a major, in- creasing public health burden,2 pancreas transplant has been recommended by the American Diabetes Association and other national guidelines as an accepted treatment, particularly when coupled with end-stage renal disease.3 Benefits to pancreas transplantation, SPK, and PAK are well described, having both improvements in mortality when compared to those on the waiting list4 and better overall glycemic control, reducing number of hypoglycemic episodes compared to those on insulin regimens.5 In addition, pancreas transplantation has been shown to delay secondary complications of diabetes, such as cardiovascular disease6 and nervous system complications.7 Despite these demonstrated advantages for pancreatic transplantation, only approximately 10% of available Organs are recovered from Donors after brain death (DBD). Additionally, there has been an overall decline in pancreatic transplantation over the past decade.8 In pancreatic transplantation, inconsistent Donor management and Organ acceptance practices are pervasive. Potentially contributing to this lack of consistency in Donor management is the fact that the current risk-adjustment models used to predict both Organ procurement Organization (OPO) Donor pancreas utilization and transplant center graft survival models lack detailed Donor critical care data. In an effort to increase standardization and data collection, several OPOs have collaborated to develop a checklist of critical care endpoints to guide the bedside care of potential Organ Donors. These endpoints are also known as Donor management goals (DMGs), and they represent normal hemodynamic, respiratory, renal, acid-base, and endocrine parameters for an Organ Donor. Multiple studies have shown improvements in both Organ utilization rates9–13 and recipient graft outcomes14–16 when these goals are met. The link between optimal management of the potential Organ Donor after brain death (DBD) and pancreatic graft utilization and function has not yet been explored in the literature, and we sought to further elucidate this relationship using a deceased Organ Donor database containing demographic and critical care data at 4 time points during Donor management. Given anecdotal reports of insulin requirements being used as criteria for pancreatic acceptance or denial, we also sought to determine the relationship between insulin dose and pancreatic usage and function.
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state of the science in deceased Organ Donor management
2018Co-Authors: Madhukar S Patel, Claus U Niemann, Mitchell B Sally, Darren MalinoskiAbstract:Research in deceased Organ Donor management offers an opportunity to increase the quantity and quality of Organs available for transplantation. This article aims to appraise the current literature with a focus on reviewing deceased Donor intervention trials. Aggressive critical care management after determination of brain death resulting in meeting of a Donor management goal bundle has consistently demonstrated an association with significantly more Organs transplanted per Donor as well as improved graft outcomes. Although there is a dearth of experience with randomized Donor intervention studies, dopamine and targeted mild therapeutic hypothermia have been found to significantly reduce delayed graft function in kidney recipients. Progress in understanding the ethical, legal, regulatory, policy, and Organizational elements of Organ Donor research has provided a mechanism that allows for the endorsement of potentially impactful Donor management studies. Ongoing trials should incorporate methods to ensure safety to all Organs donated from Donors enrolled in interventional trials.
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deceased Organ Donor management does hospital volume matter
2017Co-Authors: Madhukar S Patel, Mitchell B Sally, Darren Malinoski, Tahnee Groat, Jahan Mohebali, Parsia A Vagefi, David C ChangAbstract:Background Identification of strategies to improve Organ Donor use remains imperative. Despite the association between hospital volume and outcomes for many common disease processes, there have been no studies that assess the impact of Organ Donor hospital volume on Organ yield. Study Design A prospective observational study of all deceased Organ Donors managed by 10 Organ procurement Organizations across United Network for Organ Sharing regions 4, 5, and 6 was conducted from February 2012 to June 2015. To study the impact of hospital volume on Organ yield, each Donor was placed into a hospital-volume quartile based on the number of Donors managed by their hospital. Stepwise logistic regression was used to identify the independent effect of hospital volume on the primary outcomes measure of having ≥4 Organs transplanted per Donor. Results Data from 4,427 Donors across 384 hospitals were collected and hospitals were assigned quartiles based on their volume of deceased Donors. Hospitals managed a mean ± SD of 3.3 ± 5.2 Donors per hospital per year. After adjusting for age, ethnicity, Donor type, blood type, BMI, creatinine, and Organ procurement Organization/Donor service area, being managed in hospitals within the highest volume quartile remained a positive independent predictor of ≥4 Organs transplanted per Donor (odds ratio = 1.52; 95% CI 1.29 to 1.79; p Conclusions Deceased Organ Donor hospital volume impacts Organ yield, with the highest-volume centers being 52% more likely to achieve ≥4 Organs transplanted per Donor. Efforts should be made to share practices from these higher-volume centers and consideration should be given to centralization of Donor care.
Alvin E Roth - One of the best experts on this subject based on the ideXlab platform.
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incentivizing Organ Donor registrations with Organ allocation priority
2017Co-Authors: Avraham Stoler, Judd B Kessler, Tamar Ashkenazi, Alvin E Roth, Jacob LaveeAbstract:How Donor Organs are allocated for transplant can affect their scarcity. In 2008, Israel's Parliament passed an Organ Transplantation Law granting priority on Organ Donor waiting lists to individuals who had previously registered as Organ Donors. Beginning in November 2010, public awareness campaigns advertised the priority policy to the public. Since April 2012, priority has been added to the routine medical criteria in Organ allocation decisions. We evaluate the introduction of priority for registered Organ Donors using Israeli data on Organ Donor registration from 1992 to 2013. We find that registrations increased when information about the priority law was made widely available. We find an even larger increase in registration rates in the 2 months leading up to a program deadline, after which priority would only be granted with a 3-year delay. We also find that the registration rate responds positively to public awareness campaigns, to the ease of registration (i.e. allowing for registering online and by phone) and to an election drive that included placing registration opportunities in central voting locations. Copyright © 2016 John Wiley & Sons, Ltd.
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don t take no for an answer an experiment with actual Organ Donor registrations
2014Co-Authors: Judd B Kessler, Alvin E RothAbstract:Over 10,000 people in the U.S. die each year while waiting for an Organ. Attempts to increase Organ transplantation have focused on changing the registration question from an opt-in frame to an active choice frame. We analyze this change in California and show it decreased registration rates. Similarly, a "field in the lab" experiment run on actual Organ Donor registration decisions finds no increase in registrations resulting from an active choice frame. In addition, individuals are more likely to support donating the Organs of a deceased who did not opt-in than one who said "no" in an active choice frame.
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don t take no for an answer an experiment with actual Organ Donor registrations
2014Co-Authors: Judd B Kessler, Alvin E RothAbstract:Over 10,000 people in the U.S. die each year while waiting for an Organ. Attempts to increase Organ transplantation have focused on changing the registration question from an opt-in frame to an active choice frame. We analyze this change in California and show it decreased registration rates. Similarly, a "field in the lab" experiment run on actual Organ Donor registration decisions finds no increase in registrations resulting from an active choice frame. In addition, individuals are more likely to support donating the Organs of a deceased who did not opt-in than one who said "no" in an active choice frame.Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.
Cynthia S Goldsmith - One of the best experts on this subject based on the ideXlab platform.
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transmission of rabies virus from an Organ Donor to four transplant recipients
2005Co-Authors: Arjun Srinivasan, Wunju Shieh, Elizabeth C Burton, Matthew J Kuehnert, Charles E Rupprecht, William L Sutker, Thomas G Ksiazek, Christopher D Paddock, Jeannette Guarner, Cynthia S GoldsmithAbstract:Background In 2004, four recipients of kidneys, a liver, and an arterial segment from a common Organ Donor died of encephalitis of an unknown cause. Methods We reviewed the medical records of the Organ Donor and the recipients. Blood, cerebrospinal fluid, and tissues from the recipients were tested with a variety of assays and pathological stains for numerous causes of encephalitis. Samples from the recipients were also inoculated into mice. Results The Organ Donor had been healthy before having a subarachnoid hemorrhage that led to his death. Encephalitis developed in all four recipients within 30 days after transplantation and was accompanied by rapid neurologic deterioration characterized by agitated delirium, seizures, respiratory failure, and coma. They died an average of 13 days after the onset of neurologic symptoms. Mice inoculated with samples from the affected patients became ill seven to eight days later, and electron microscopy of central nervous system (CNS) tissue demonstrated rhabdovirus pa...
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transmission of rabies virus from an Organ Donor to four transplant recipients
2003Co-Authors: Arjun Srinivasan, Wunju Shieh, Elizabeth C Burton, Matthew J Kuehnert, Charles E Rupprecht, William L Sutker, Thomas G Ksiazek, Christopher D Paddock, Jeannette Guarner, Cynthia S GoldsmithAbstract:Background In August 2002, fever and mental-status changes developed in recipients of Organs from a common Donor. Transmission of West Nile virus through Organ transplantation was suspected. Methods We reviewed medical records, conducted interviews, and collected blood and tissue samples for testing with a variety of assays. Persons who donated blood to the Organ Donor and associated blood components were identified and tested for West Nile virus. Results We identified West Nile virus infection in the Organ Donor and in all four Organ recipients. Encephalitis developed in three of the Organ recipients, and febrile illness developed in one. Three recipients became seropositive for West Nile virus IgM antibody; the fourth recipient had brain tissue that was positive for West Nile virus by isolation and nucleic acid and antigen assays. Serum specimens obtained from the Organ Donor before and immediately after blood transfusions showed no evidence of West Nile virus; however, serum and plasma samples obtained...