Universal Time: 09:12  |  Local Time: 09:12 (3h GMT)
Select your timezone:

Maximizing deceased donation

Monday September 23, 2024 - 16:50 to 18:30

Room: TBD

ORGAN DONATION AFTER EUTHANASIA IN SPAIN: A SUMMARY OF THE FIRST RESULTS

Alicia Pérez, Spain

Dr
Organización Nacional de Trasplantes

Abstract

ORGAN DONATION AFTER EUTHANASIA IN SPAIN: A SUMMARY OF THE FIRST RESULTS

Alicia Pérez1, Javier J Sanchez1, Rebeca R Bajo1, Haizea H Olasagasti2, Gabriel Moreno3, Nuria N Masnou4, Teresa Pont5, Juan Araiz6, Rafael Badenes7, Fernando Martínez- Soba8, Beatriz Domínguez-Gil1.

1Deceased donation , Organización Nacional de Trasplantes , Madrid, Spain; 2Donor coordinator, Osakidtza, Vitoria, Spain; 3Donor coordinator, Hospital Univ. de Bellvitge, Barcelona, Spain; 4Donor coordinator, Hospital Univ. Doctor Josep Trueta, Gerona, Spain; 5Donor coordinator, Hospital Univ. Vall d´Hebrón, Barcelona, Spain; 6Donor coordinator, Hospital Clínico Univ. Lozano Blesa, Zaragoza, Spain; 7Donor coordinator, Hospital Clínico Univ. de Valencia, Valencia, Spain; 8Donor coordinator, Hospital San Pedro, La Rioja, Spain

BACKGROUND

The euthanasia law entered into force in Spain in July 2021. A national protocol on organ donation after euthanasia (ODE) was officially adopted in July 2022. The guidance emphasizes that euthanasia should be prioritized over donation being the patient’s comfort paramount. 

OBJECTIVE

To describe the experience on ODE in Spain.

METHOD

A retrospective study of cases of ODE performed since August 2021 to December 2022 and the post-transplant outcomes of the thoracic organs.

RESULTS

In total, 49 patients donated organs after euthanasia, seven in 2021 and 42 in 2022. Donors were most frequently males (n=28; 57%) and mean age was 59.8 (SD: 10.6) years. Underlying diseases were amyotrophic lateral sclerosis (n=19; 39%), multi systemic atrophy (n=4; 8%), spinal cord injury (n=4; 8%), Alzheimer (n=3; 6%), multiple sclerosis (n=2; 4%), Parkinson (n=2; 4%) and other (n=15; 31%). All patients were directly admitted in the ICU (66%) or the ward (44%) except four who were transferred in a medicalized ambulance after receiving sedation at home. Patients were subsequently transfer to the operating theater where euthanasia medication was delivered and death declared. Of the 49 donors 96% were utilized donors. 135 transplant procedures were performed (69 kidney, 29 liver, 23 lung, 5 heart, 5 combined kidney-pancreas and 4 combined kidney-liver transplants). The mean organs retrieved per donor was 3.9 and the mean organs transplanted per donor was 3.3. Table 1

Organ recovery was based on abdominal (A-NRP) or thoracoabdominal normothermic regional perfusion(TA-NRP)(n=44; 90%) or standard rapid recovery (n=5; 10%). 2 hearts were recovered after the abdomen was perfused using A-NRP (an intra-aortic balloon occluding the iliac artery was previously inserted) while the 3 aortic arch vessels were vented. 3 hearts were recovered using  TA-NRP (the 3 aortic arch vessels were previously  vented) from the beginning of the procedure. Median time from administration of euthanasia medication to cardiac arrest was of 8.5 minutes (IQR 4-14). Table 2

Of the  131 recipients, mean age 57.4 (SD 12.3), (62.6%) were men. 2- year- heart survival is 80%. 1 of the heart recipients died at 28th post-transplant, due to pericardial tamponade. Of the 23 lung recipients, 7 (30.4%) presented primary organ dysfunction, of those two died at 6th month and another died at 12th post-transplant.

CONCLUSIONS

ODE is respectful with patient’s end-of-life plans and allows waitlisted patients to receive life-saving and life-enhancing organ transplants.

 

 

References:

[1] euthanasia, organ donation, cDCD, deceased donation, transplantation

© 2024 TTS 2024