miércoles, 10 de mayo de 2017

Donación y transplante / Donation and transplantation

Mayo 4, 2017. No. 2679







Donación de órganos y transplantes en México. Perspectiva de los profesionales de la salud sobre los trasplantes
Organ donation and transplantation in Mexico. A transplantation health professionals' perspective.
Salud Publica Mex. 2017 Jan-Feb;59(1):53-58. doi: 10.21149/7755.
Abstract
OBJECTIVE: We aimed to explore organ donation and transplantation in Mexico from the point of view of transplantation health professionals. MATERIALS AND METHODS: A qualitative study was carried out. Twenty six organ transplantation health professionals from seven states of Mexico participated. Semi-structured face-to-face interviews were conducted mainly in hospital settings. Critical discourse analysis was performed. RESULTS: According to participants, living organ transplantation offers benefits for recipients as well as for donors. Several factors influence the field of transplantation negatively, among them the scarcity of resources that impedes the incorporation of new health personnel, as well as conflicts between transplantation teams with diverse health professionals and authorities. CONCLUSION: Besides increasing economic resources, transplantation health personnel should be sensitized to find solutions in order to avoid conflicts with different health professionals. Studies on organ donation and transplants also should include other social actors' viewpoint.
Donación después de la determinación de la circulación cerebral de la muerte.
Donation after brain circulation determination of death.
BMC Med Ethics. 2017 Feb 23;18(1):15. doi: 10.1186/s12910-017-0173-1.
Abstract
BACKGROUND: The fundamental determinant of death in donation after circulatory determination of death is the cessation of brain circulation and function. We therefore propose the term donation after brain circulation determination of death [DBCDD]. RESULTS: In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain circulation may resume after the determination of death; 3] complete circulatory cessation is verified; and 4] the cessation of brain function is permanent and complete. Death should be determined by the confirmation of the cessation of systemic circulation; the use of brain death tests is invalid and unnecessary. Because this concept differs from current standards, consensus should be sought among stakeholders. The patient or surrogate should provide informed consent for organ donation by understanding the basis of the declaration of death. CONCLUSION: In cases of circulatory cessation, such as occurs in DBCDD, death can be defined as the permanent cessation of brain functions, determined by the permanent cessation of brain circulation.
KEYWORDS: Brain criterion of death; Determination of death; Donation after circulatory determination of death [DCDD]; Ethics; Extracorporeal membrane oxygenation [ECMO]; Transplantation

Donación de órganos y ventilación electiva. Una estrategia necesaria
Organ Donation and Elective Ventilation: A Necessary Strategy.
Biomed Res Int. 2017;2017:7518375. doi: 10.1155/2017/7518375. Epub 2017 Jan 15.
Abstract
Organ transplantation is the sole treatment to improve or save the life of patients with final-stage organ failure. The shortage of available organs for transplantation constitutes a universal problem, estimating that 10% of patients on waiting lists die. Brain death is an undesirable result; nevertheless, it has beneficial side-effects since it is the most frequent source of organs for transplantation. However, this phenomenon is relatively uncommon and has a limited potential. One of the options that focuses on increasing organ donation is to admit patients with catastrophic brain injuries (with a high probability of brain death and nontreatable) to the Intensive Care Unit, with the only purpose of donation. To perform elective nontherapeutic ventilation (ENTV), a patient's anticipated willingness to donate organs and/or explicit acceptance by his/her relatives is required. This process should focus exclusively on those patients with catastrophic brain injuries and imminent risk of death which, due to its acute damage, are not considered treatable. This article defends ENTV as an effective strategy to improve donation rate, analyzing its ethical and legal basis.

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