Characteristics of postmortem organ donors in N.V. Sklifosovsky Research Institute for Emergency Medicine and the donor hospitals of FMBA of Russia (2008–2017)

Rationale. There have been only single studies conducted in the Russian Federation to characterize the posthumous donor population.

Objective: Identifying the main characteristics of the donor pool in N.V. Sklifosovsky Research Institute for Emergency Medicine of Moscow Healthcare Department and in the State Research Center – A.I. Burnasyan Federal Medical Biophysical Center, FMBA, for the period from 2008–2017.

Material and methods. The clinical records of 429 actual and effective posthumous donors were analyzed retrospectively. The following characteristics were studied: gender, age, permanent place of residence, cause of death, the duration of mechanical lung ventilation, type of donation, total number of harvested organs, and number of organs recovered per donor.

Results. There were 281 male and 148 female donors. The increase in the mean age of donors from 37 to 48.5 years was noted. Cerebrovascular disease and traumatic brain injury became the main causes of death. Since 2012, the rate of cerebrovascular diseases as the cause of donor death has increased from 30% to 70%. Of 429 actual donors, the brain death was diagnosed in 366 (85.3%). Four hundred eight deceased became effective donors. A total of 1,247 donor organs (744 kidneys, 220 livers, 42 pancreas, 2 intestines, 180 hearts, 58 lungs, and 1 facial vascularized composite allograft) were obtained. The mean number of donor organs recovered per donor was 3.06.

Conclusions. The results obtained can be used to develop unified protocols and results of posthumous donors and to assess the possible volume of transplant care. In the period 2008–2017 an increase in the average age of posthumous donors (from 38.1 to 48.7 years) due to the proportion of donors in the 18–29 age group (from 29 to 4%) and an increase in the proportion of donors in the age group over 60 (from 3 to 15%). From 2012 to 2017 (from 68 to 29%) due to an increase in the number of donors who died as a result of cerebrovascular diseases (from 30 to 71%). Among the posthumous donors delivered by ambulance teams directly to the intensive care units, 69% of the consciousness level was depressed to 5 and lower on the Glasgow coma scale.

1. Rana A., Gruessner A., Agopian V.G., et al. Survival benefit of solid-organ transplant in the United States. JAMA Surg. 2015;150(3):252–259. PMID:25629390 DOI:10.1001/jamasurg.2014.2038

2. Navarro A., Escalante J.L., Andrés A. Donor detection and organ procurement in the Madrid region. Group of Transplant Coordinators of the Region of Madrid. Transplant Proc. 1993;25(6):3130–3131. PMID:826648

3. Matezanz R., Domingues-Gil B. The Spanish model: organization and determinat factors. In: Manyalich M., Valero R., Páez G., eds. Transplant Coordination Manual. TPM – Fundació IL3 – Universitat de Barcelona, Barcelona (España), 2007. 381–398.

4. Bagnenko S.F., Polushin Yu.S., Moysyuk Ya.G., et al. Analysis of reasons for organ donor shortage and the main directions of its overcoming. Transplantologiya. The Russian Journal of Transplantation. 2011;(2–3):10–22. (In Russian).

5. Domínguez-Gil B., Delmonico F.L., Shaheen F.A., et al. The critical pathway for deceased donation: reportable uniformity in the approach to deceased donation. Transpl Int. 2011;24(4):373–378. PMID:21392129DOI:10.1111/j.14322277.2011.01243.x

6. Global Glossary of Terms and Definitions on Donation and Transplantation. Geneva, November 2009. Available at: http://www.who.int/entity/transplantation/activities/GlobalGlossaryonDonationTransplantation.pdf?ua=1

7. Israni A.K., Zaun D., Rosendale J.D., et al. OPTN/SRTR 2016 Annual Data Report: Deceased Organ Donation. Am J Transplant. 2018;18(Suppl 1):434–463. PMID:29292599DOI:10.1111/ajt.14563

8. Rao P.S., Ojo A. The alphabet soup of kidney transplantation: SCD, DCD, ECD--fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol. 2009;4(11):1827–1831. PMID:19808229 DOI:10.2215/CJN.02270409

9. Add Vascularized Composite Allografts to the Definition of Organs Covered by the Rule Governing the Operation of the Organ Procurement and Transplantation Network (OPTN). Available at: https://optn.transplant.hrsa.gov/media/1118/05_vca_implementation.pdf

10. Meeting of the Competent Authorities for Tissues and Cells. Summary Report. Sommission of the European communities. Health and consumers directorategeneral. Brussels, 7–8 June 2012. Available at: https://ec.europa.eu/health//sites/health/files/blood_tissues_organs/docs/tissues_mi_20120607_en.pdf

11. Uyba V.V., Gubarev K.K., Volokh S.E., et al. The donor management algorithm in transplantation of a composite facial tissue allograft. First experience in Russia. Transplantologiya. The Russian Journal of Transplantation. 2016;(4):8–18. (In Russian).

12. Tong Y.-F., Koo J., Cheng B. Review of Organ Donation in Hong Kong: 1996–2009. Hong Kong J Nephrol. 2010;12(2):62–73. DOI:10.1016/S15615413(10)60014-2

13. Reznik O.N. Organizational and technological foundations of obtaining and selection of kidneys for transplantation: ... Dr. med. sci. diss. Synopsis. Moscow, 2008. 47 p. (In Russian).

14. Minina M.G. Development and introduction of an innovative model of organ donation into health practice: Dr. med. sci. diss. Synopsis. Moscow, 2016. 46 p. (In Russian).

15. Organización Nacional de Trasplantes. Memoria de Actividad. ONT 2016. 2.1. Actividad de donación. Available at: http://www.ont.es/infesp/Memorias/Memoria%20Donaci%C3%B3n%202016.pdf

16. Min S.I., Kim S.Y., Park Y.J., et al. Trends in deceased organ donation and utilization in Korea: 2000–2009. J Korean Med Sci. 2010;25(8):1122– 1127. PMID:20676320 DOI:10.3346/jkms.2010.25.8.1122

17. Branger P., Samuel U. Annual Report 2016, Eurotransplant International Foundation. Available at: https://www.eurotransplant.org/cms/mediaobject.php?file=Eurotransplant+JV+PDF.pdf

18. Loginov I.V. Analysis of the reasons for the shortage of organ donors and the main directions for overcoming it: Cand. med. sci. diss. Synopsis. Moscow, 2008. 27 p. (In Russian).

19. Martín-Dávila P., Fortún J., LópezVélez R., et al. Transmission of tropical and geographically restricted infections during solid-organ transplantation. Clin Microbiol Rev. 2008;21(1):60– 96. PMID:18202437 DOI:10.1128/CMR.00021-07

20. On the donation of organs, parts of human organs and their transplantation: the draft federal law of the Russian Federation. Available at: https://www.rosminzdrav.ru/open/discuss/projects/archive/53 (In Russian).

21. Weiss J.H., Keel I., Immer F.F., et al. Swiss Monitoring of Potential Organ Donors (SwissPOD): a prospective 12-month cohort study of all adult ICU deaths in Switzerland. Swiss Med Wkly. 2014;144:w14045. PMID:25341720 DOI:10.4414/smw.2014.14045.

22. Chute D.F., Sise M.E. Effect of the Opioid Crisis on the Donor Pool for Kidney Transplantation: An Analysis of National Kidney Deceased Donor Trends from 2010–2016. Am J Nephrol. 2018;47(2):84–93. PMID:29439266 DOI:10.1159/000486516

23. Goldberg D.S., Blumberg E, McCauley M., et al. Improving Organ Utilization to Help Overcome the Tragedies of the Opioid Epidemic. Am J Transplant. 2016;16(10):2836–2841. PMID:27438538 DOI:10.1111/ajt.13971.

24. Ibanes J.S., Garcia A.F., Caamano E.B. Vazquez M.A. Donor detection, clinical evaluation and expanded criteria. In: Manyalich M., Valero R., Páez G., eds. Transplant Coordination Manual. TPM – Fundació IL3 – Universitat de Barcelona, Barcelona (España), 2007. 27–45. ISBN:978-84-612-0565-3

25. ANZOD Registry, 2017. Annual Report, Section 3: Deceased Organ Donor Pathway. Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia. 2017. Available at: http://www.anzdata.org.au/anzod/ANZODReport/2017/c03_pathway_v1.0_20171027.pdf

26. Nijboer W.N., Moers C., Leuvenink H.G., Ploeg R.J. How important is the duration of the brain death period for the outcome in kidney transplantation? Transpl Int. 2011;24(1):14–20. PMID:20819191 DOI:10.1111/j.14322277.2010.01150.x

27. Christmas A.B., Bogart T.A., Etson K.E., et al. The reward is worth the wait: a prospective analysis of 100 consecutive organ donors. Am Surg. 2012;78(3):296– 299. PMID:22524766

28. Westphal G.A., Coll E., de Souza R.L., et al. Positive impact of a clinical goaldirected protocol on reducing cardiac arrests during potential brain-dead donor maintenance. Crit Care. 2016;20(1):323. PMID:27724931 DOI:10.1186/s13054016-1484-1

29. Gautier S.V., Khomyakov S.M. Organ donation and transplantation in the Russian Federation in 2016 9th report of the National Registry. Russian Journal of Transplantology and Artificial Organs. 2017;19(2):6–26. (In Russian). DOI:10.15825/1995-1191-2017-2-6-26