The removal of donor heart stopped began in France

The removal of organs from heart-beating donor began a few pilot sites with very specific framing protocol, it was learned during a scientific meeting on the samples.
Save a life by life
The French establishment grafts (EFG) has already indicated that consideration was being on the collection of heart-beating donors from the avenues explored to increase the donor pool, given the shortage facing the levy on donor heart beating.

For now, the regulations do not allow: debit authorizations are given to institutions for donor brain-dead (EME) beating heart, because the data of the literature in the past were rather unfavorable. But the situation has changed and now the results are considered very good. Several countries have already moved in this direction.

A number of communications from the sixteenth day of Bicetre on harvesting organs for transplantation, held in the Kremlin Bicetre Hospital (Val-de-Marne), have addressed this issue and illustrated the difficulties can cause this type of sample, justifying precautions.

The EFG convened a working group. Ethical aspects have been analyzed and the evolution of regulation is under discussion with the Ministry, said Dr. Corinne Antoine, a doctor at EFG's strategic research and development center, when she was invited to speak on the new rules of distribution of kidney transplants during this meeting.

The collection of heart-beating donor should be tested on several pilot sites with an accurate and consistent protocol for evaluation in six months and one year, she announced.

Professor Gerard Benedict, head of Urology Department at Bicetre and organizer of the day, discussed the technical pitfalls during levies heart stopped.

In its inception, the levy on heart-beating donor has a long history. He was suspended at the request of the EFG, but now this activity is resumed.

The results of transplants performed with these bodies are comparable to those grafts with beating heart donors as figures show survival at 1 year, 5 years and 10 years of Bicetre Hospital. Organs function as well, and "this is so that we are always supporters realize even if it is difficult," said Dr. Benedict.

Of the 700 samples, 60 were at the heart stopped, he said to Reuters Health.

Avoid pitfalls, including cardiac arrest more than 30 minutes because beyond the body not infused never refonctionnera, he warned.

"It is essential to be prepared with a procedure established in advance to go to the resuscitation unit and a member of the team must have a stopwatch to monitor the 30 minutes," he recommended. He also felt that the machine pulsatile perfusion could be useful to assess the quality of the graft in this situation.

As it is a difficult technique, it is important to test first trained in centers and if the results are good, the spread to other institutions samples, he said.

A strict supervision, transparent practices
The expert stressed the need for strict supervision to help professionals and avoid confusion in the minds of families who could believe that doctors do not have everything to save their loved one.

Team Bicetre reduced its harvesting practices to heart stopped and no commitment for patients with cardiac arrest, where the dialogue with the family for the gift has already been initiated and the register of refusals already questioned.

"However, intensivists much better stabilize the hemodynamic monitoring of these patients is therefore move closer to cardiac arrest," he told Reuters Health.

The procedure is used to remove the kidneys, but also livers. A Bicetre, 8 livers have been removed.

Professor Benedict believes that the beating heart could provide 5-10% more donors, much more.

Other sources of potential donors, it has also been subject of severe traumatic brain injury. Again, difficulties remain, as noted by Dr. Bernard Vigué, anesthetist at the Bicetre hospital.

Based on recent survey data practices in Ile-de-France, Dr. Vigué has shown that the management of severe head injury by the UAS is far from optimal, with deviations recommendations for clinical practice. Transport delays are excessive and cerebral hemodynamics is not stabilized optimally. In addition, the management of these patients upon arrival at the hospital is not perfect either.

Total mortality in Ile-de-France is very heavy and has not changed since 1995, said the specialist. This decision in a non-optimal load induced unease looking for potential organ donors.

"We would be more comfortable if everything was done in compliance with the recommendations and better organization. Success rates would be better for these patients, half die. If they could not be saved, it would be easier to decide to stop treatment and thus consider a levy. Moreover, the transition to brain death would be less brutal because of treatments, so that the bodies would be taken better, "explained Dr. Vigué.