Causes of Deceased Donors Loss and the Associated Factors Before Organ Retrieval

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IntroductionWhen potential brain dead donors are in line-up for organ retrieval, their loss would be such a disaster.[1] The aim of this study was to detect the occurrence of different disorders leading to pre-retrieval donor’s cardiac arrest and loss in order to prevent this energy and money wasting challenge.MethodsMedical records of potential donors who were lost after transfer to organ procurement unit and before organ donation were reviewed and weigh of every responsible disorder was tested.ResultsIn 14 years of experience in organ donation from 2003 to 2016, 46 (3.09%) out of 1485 potential donors were lost after their transfer to OPU with the aim of organ donation. Mean age of donors were not significantly different to actual donors. Similarly, the gender proportions were the same. (Male = 59% vs. 57.5% respectively) However, proportion of drug poisoning as the cause of brain death was more common in the lost donors. (19.5% versus 5.3%). Mean age of poisoned cases (actual donors and lost ones) was 26.7 ± 14.6 years. On the other hand, mean age of trauma-suffered cases was 29.4 ± 17.3 years. In contrast, CVA associated brain death victims had a mean age of 54.1 ± 8.6 years.13 (28.2%) cases had a documented history of ischemic heart disease, which was not as common in actual donors. (4 cases, 8.6%) After excluding hypotension and Diabetes Insipidus which are two common stations in natural course of brain death [2], the leading disorders among lost cases were metabolic acidosis, hypocalcaemia hyperglycemia, Thrombocytopenia, different presentations of coagulopathy and severe anemia.8 out 9 (88.85) poisoned lost cases had metabolic acidosis, which was higher than the other ones. (59.4%, p < 0.01) Clinical conditions of 22 (47.8%) cases were flared up by different severities of acute kidney injury and mean ALT levels were significantly higher than actual donors. (286.2 Versus 105.6, p < 0.001) All the above-mentioned disorders were significantly more common in lost donors than actual ones.ConclusionDrug toxicity, history of ischemic heart disease and occurrence of acute kidney injury and liver and lung dysfunction are associated with more potential donors’ loss before organ retrieval. Metabolic acidosis, Hyperglycemia, hypocalcaemia and coagulopathy are more common in unsuccessful organ donation effort. As a result, implementation of proper management especial guidelines for donors facing these abnormalities is recommended.Organ Procurement Unit (OPU) Study Group. NRITLD.References:1. Malinoski DJ, Patel MS, Daly MC, Oley-Graybill C, Salim A. The impact of meeting donor management goals on the number of organs transplanted per donor: results from the United Network for Organ Sharing Region 5 prospective donor management goals study. Critical care medicine. 2012; 40: 2773–2780.2. Dominguez-Roldan JM, Jimenez-Gonzalez PI, Garcia-Alfaro C, Hernandez-Hazanas F, Fernandez-Hinojosa E, Bellido-Sanchez R. Electrolytic disorders, hyperosmolar states, and lactic acidosis in brain-dead patients. Transplantation proceedings. 2005 ;37: 1987–1989.

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