The Preliminary Experience of Deceased Organ Transplantation in Local Hospital

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Abstract

Backgrounds

Deceased donor organ transplantation(DDOT) in Asia is small in number compared to living one. There are many factors involved such as socio-cultural value. Especially local hospital in Asia has many obstacles to develop DDOT. But in ethical aspects, DDOT should be preceded before living donor organ transplantation. As a local hospital in South Korea, we have the preliminary experience of deceased donor kidney transplantation(DDKT) during last few years and expect sharing our experience to give motivations in improving DDOT in Asia.

Materials and Methods

From Mar. 2012 to Dec. 2016 we experienced 17 patients DDKT and their medical records were reviewed.

Results and Discussion

Donors were from 18 to 61 years old, diagnosed of brain dead state due to brain injury such as hemorrhage or infarction and had no direct kidney injury. Most donors were local residents and the rests were travelers. Recipients were HLA negative, aged from 21 to 59yrs, mostly had diabetes mellitus and/or hypertension. They received hemodialysis or peritoneal dialysis at the time of transplantation. Panel reactive antibody(PRA) was negative in all the patients except one. The range of cold ischemic time were 2 to 5 hours. The durations of hospital stay were 14 to 21 days. The range of serum creatinine levels were 1.1~2.6 mg/dl at 1 month after transplantation. Two patients had surgical complications, urinary leakage and wound dehiscence with seroma. Two patients developed chronic rejections. There were no graft loss or patient loss.

Results and Discussion

There were helps by experienced surgeons as an supervisor from university hospitals initially. All the donated organs used at our hospital were incentive kidneys and the incentive system made DDKT possible in our hospital. National organ donation agency were involved in the agreement of donation from donor’s family and the role of the agency was important in the process of consent and also in respectful management of donor’s family. The close contact between nephrologist and surgeon made fast and early management of patient possible especially in case of complications. There were limitations of local hospital in unchanged preference for big center and mistrust of local hospital. Small number in cases is always obstacle of DDOT in local hospital.

Conclusion

Although our experience was small in number, the results showed some expectations of successful DDOT in local hospital in Asia. Development of DDOT in local hospital can contribute to basic expansion of transplantation and derive the understanding of deceased organ donation. And this achievements will increase the organ donation. For this purpose, the systemic approach of hospital, governmental organization and local society will be needed.

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