Jul 27, 2014 - pediatric cardiac graft survival differs when the heart is harvested with or without .... Kidney, Liver and Metabolic Diseases, Hannover Medical School, ...... of Medicine, Suita, Osaka, Japan; 2Dept. of Advanced Technology for.
Poster Sessions: All Organs
The World Transplant Congress 2014 Abstract Supplement is jointly published by the American Journal of Transplantation and Transplantation on behalf of the American Society of Transplant Surgeons, The Transplantation Society and the American Society of Transplantation. © The Authors. Compilation © The American Society of Transplant Surgeons, The Transplantation Society and the American Society of Transplantation
All presenters are required to disclose relevant conflicts of interest. All such disclosures are published within the Abstract Book following each abstract. Any presenters who have nothing to disclose have been omitted from the disclosure listing.
Pediatric: Other Sunday, July 27, 2014 6:30 PM - 8:00 PM Exhibit Hall
preservation and venting of effluent. This approach is quicker than the routine practice of thoracolaparotomy and abdominal aortic cannulation. It is also equally applicable to DBD and DCD and, in our experience, has led to recovery of organs with successful subsequent transplantation.
Abstract# A473
Abstract# A471
Paediatric Organ Donation Issues Following Donor Treatment With Extracorporeal Devices. O. Mownah, J. Newby, R. Coates, F. Afridi, C. Wilson, D. Talbot, J. Smith. Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
Acceptance of The 2011 Revised Pediatric Brain Death Guidelines By Pediatric Intensivists: A Follow-Up Survey. T. Nakagawa,1 M. Mysore,2 M. Mathur.3 1Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC; 2Pediatrics, UNMC College of Medicine, Omaha, NE; 3 Pediatrics, Loma Linda University Children’s Hospital, Loma Linda, CA.
Introduction: Extracorporeal devices provide life sustaining cardiac and respiratory support for paediatric patients.Death in the presence of such therapy raises the possibility of organ donation.Whilst donation is achievable in this setting we describe three instances when donation was planned but did not proceed. Case Report: Patient (I) was an 8-month old female suffering brainstem death following treatment with a Berlin Heart for 2 months.Parental consent for donation was granted but did not proceed due to coroner refusal as the need for autopsy was an unresolved issue. Patient (II) was a 6-month old male suffering irreversible deterioration following treatment with VA ECMO.The decision was taken to withdraw treatment with parental consent for donation granted.However prior to withdrawal inspection of the heart demonstrated signs of potential recovery.ECMO remained active and the organ recovery team stood down. Patient (III) was a 6-year old male treated with a Novalung referred for donation after circulatory death.However three hours following withdrawal the patient remained alive and the recovery team stood down. Discussion: In all cases parents agreed for withdrawal to take place in the operating theatre. This would eliminate the difficulties of transferring patients to the operating room with extracorporeal devices. The parents would be present with their child during withdrawal, with the scrubbed organ recovery team on stand-by in an adjacent room. Our experience highlights the potential for paediatric organ donation involving in situ extracorporeal devices but also the need for greater clarity in determination of circulatory death following deactivation of such devices.Additionally cooperation may need to be improved between coroner services and clinicians to facilitate donation.As well as the lost opportunity to obtain healthy organs, the failure to proceed to organ donation may place additional distress on grieving parents.
Purpose of this study: Revised guidelines for determination of brain death in infants and children were published in 2011. We surveyed attending pediatric intensivists to assess guideline acceptance and utilization in clinical practice. Methods: An online survey specifically targeted for attending pediatric intensivists was sent to members of Pediatric Section of the Society of Critical Care Medicine (SCCM) in July 2013. Data was collected by SCCM and the authors tabulated responses and reviewed free text comments. This study was approved by the IRB at Wake Forest University School of Medicine. Results: 2600 surveys were distributed to the pediatric section of SCCM. 300 surveys were returned [11.5% response rate]. 93% respondents were attending pediatric intensivists. 84.6% were based in the United States. 92.1% stated their hospital had a brain death policy, 5.5% did not, 2.4% did not know. Attending pediatric intensivists declare brain death [99.2%], only 2 stated Fellows declare brain death. 76% already use or are in the process of adopting the 2011 pediatric brain death guidelines. 12.2% use internal hospital guidelines while 8.6% use State-determined criteria. 1.2% do not use any guidelines. 75.2% stated all division members use the guidelines, 15.3% stated most use the guideline, and 9.5% said no division member uses the guidelines. 83% found the revised pediatric brain death guidelines useful in their clinical practice while 10.6% had not yet used the revised guidelines. Only 3% found the guidelines complicated and confusing and 2.6% stated they were not useful in clinical practice. 84.8% said the accompanying checklist provided more consistency, clarity, and uniform documentation for the determination of brain death in infants and children. Conclusions: A high degree of awareness and acceptance of the revised 2011 brain death guidelines for infants and children exists. Major recommendations from the 2011 brain death guidelines are already being adopted into many clinical practices. The revised guidelines have providing more standardization for determination of brain death in infants and children. Further awareness and education are needed for more consistent implementation.
Abstract# A474 Does Simultaneous Abdominal Organ Harvesting Impact Cardiac Graft Survival in Children? M. Khan,1 F. Zafar,1 R. Bryant III,1 C. Castleberry,2 J. Jefferies,2 D. Morales.1 1Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; 2 Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH.
Abstract# A472 Recovery of Organs From Paediatric Donors With In Situ Mechanical Circulatory Support. O. Mownah, J. Newby, R. Coates, F. Afridi, C. Wilson, D. Talbot, J. Smith. Institute of Transplantation, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
Purpose Harvesting multiple organs involves longer, more technically complex dissection and personnel coordination than harvesting a single organ. This prolongation in surgical time along with the differences in the process of preservation of abdominal versus thoracic organs may impact the survival of the transplanted organs. Whether pediatric cardiac graft survival differs when the heart is harvested with or without an abdominal organ is unknown. Method Retrospective review of the United Network of Organ Sharing database for all pediatric (
