CHAPTER 8. Editors: Dr Omar Sulaiman Dr Hooi Lai Seong

Transcription

1 CHAPTER 8 DECEASED (CADAVERIC) ORGAN Editors: Dr Omar Sulaiman Dr Hooi Lai Seong Expert Panel: Dr Omar Sulaiman (Chairperson) Dr Hooi Lai Seong Dr Rosnawati Yahya Dato' Dr Sharifah Suraya Syed Mohd Tahir Matron Jamaliah Kario Contents 1.0 Introduction 8.1 Potential Donor Referrals 8.2. Actual Donations 8. Donor Characteristics 8.4 Donor Management

2 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry POTENTIAL DONOR REFERRALS 20 0 Referrals Suspected Brain Dead-195 (64.%) Cardiac Death-108 (5.7%) Medically Eligible-184 (94.%) Medically not Eligible-11 (5.6%) Medically Eligible-94 (87%) Medically Not Eligible-14 (1%) Brain Death test done-105 (57.1%) Brain Death test not done/not completed-79 (42.9%) *Refer Table Brain Dead Cardiac Death Family Approached- 101 (96.2%) * Refer Table Family Not Approached- 7 (.8%) * Refer Table 8.1. Family Approached- 50 (6..0%) * Refer Table Family Not Approached- 29 (6.7%) * Refer Table 8.1. Family Approached- 86 (91.5%) *Refer Table Family Not Approached- 8 (8.5%) * Refer Table 8.1. Consented- (2.7%) Not Consented-68 (67.%) Consented-5 (9.1%) Not Consented-50 (90.9%) Consented-8 (44.2%) Not Consented-48 (55.8%) Organ and Tissue Donor-0 Tissue donor-2 Tissue Donor- Tissue Donor-6 Organ/Tissue Donor=71 Conversion Rate=71/278 (25.5%) Organ Donor=0 Figure Potential Donor Referrals, 20. 2

3 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry 20 Table 8.1.1: Reason for brain death test not done, 20 Reason for brain test not done n % Unable to correct parameters for brain death diagnosis 24 0 No clearance from family 7 9 No clearance from primary doctor 5 6 Proceeded to cardiac death before test can be done 4 4 AOR discharge 5 6 Others* Table 8.1.2: Person who made the initial request, 20 Brain death Cardiac death Families approached n % n % TOP team Family Transplant coordinator Ward doctor Others Table 8.1.: Reason for not approaching the family, 20 Confirmed brain death Cardiac death Reason family not approached n % n % No clearance from primary doctor Family did not accept death Staff uncomfortable about making the request Unable to contact family AOR discharge Donor not suitable Others Table 8.1.4: Potential donor referrals and actual donations by month, 20 Actual donors referred cases Month Brain death donors (BD) Cardiac death tissue donors (CD) n n n January 27 4 February 25 5 March 42 4 April 28 4 May June 2 July 28 5 August 19 0 September 17 0

4 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN October November December TOTAL Figure 8.1.2: Referred Cases and Actual Donations by Month, 20 Table 8.1.5: Donor referral institutions, 20 Donor referral institution n % MOH State/federal hospitals MOH Specialist hospitals 8 27 MOH Non Specialist hospitals 2 1 University hospitals 7 2 Private hospitals

5 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry ACTUAL DONATIONS Table 8.2.1: Number of Donations by Year, Year Number of referrals Number of brain death: organ and * tissue donor Number of cardiac death: tissue donor number of donors Rate of procurement (per million population) *2 out of 2 brain death donors donated only tissue Table 8.2.2: Number of Organ Donors by Year, Year Number of organ donors Rate of organ donors (per million population) 5

6 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN Figure 8.2.1: Number of Donations by Year, Table 8.2.: Number of Organs Procured by Year, Organs procured Cornea Heart Liver Kidney Heart valve Bone Skin Lung *6 out of 58 kidneys procured were not transplanted 6

7 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN 8. DONOR CHARACTERISTICS Donor s age (years) Table 8..1: Age Distribution of Donors, n=5 98 n=7 99 n= n=24 02 n=0 n % n % n % n % n % n % n % n % n % n % n % n % < No data Mean SD Median Minimum <1* 8 1* 1 Maximum ** n= Donor s age (years) 09 n=9 10 n=8 11 n= n=56 =71 n=55 n % n % n % n % n % n % n % n % < No data Mean SD Median Minimum <1* <1* Maximum ** ** 7

8 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry 20 Figure 8..1: Donor s Age Group, * The youngest tissue donors were 25 days old and 7 days old who donated heart valves in 2009 and 200 respectively; the youngest organ donor was 14.5 months old who donated kidneys in 2007 ** The oldest tissue donor was 84 year old who donated eyes in 201; the oldest organ donor was 66 year old who donated kidneys in 2001 Figure 8..2: Donor s Age Group, 20 8

9 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN Table 8..2: Distribution of paediatric donors (below 18 years old), Year Organ donor Tissue donor Table 8..: Donor s Gender, Donor s n=5 n=7 n=4 n=24 n=0 n=16 gender n % n % n % n % n % n % n % n % n % Male Female Donor s n=9 n=8 n=47 n=56 n=71 n=55 gender n % n % n % n % n % n % n % n % n % n % n % Male Female Figure 8..: Donor s Gender,

10 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry 20 Table 8..4: Donor s Ethnic Group, Donor s ethnic 97 n=5 98 n=7 99 n= n=24 02 n= n=16 05 group n % n % n % n % n % n % n % n % n % Malay Chinese Indian Others Donor s ethnic n=9 10 n=8 11 n= n-56 n=71 n=55 group n % n % n % n % n % n % n % n % n % n % n % Malay Chinese Indian Others Figure 8..4: Donor s Ethnic Group, Table 8..5: Donor s Religion, Donor s religion 97 n=5 98 n=7 99 n= n=24 02 n= n=16 05 n % n % n % n % n % n % n % n % n % Islam Buddhism Hinduism Christianity Others Unknown

11 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN Donor s n=9 n=8 n=47 n=56 n=71 n=55 religion n % n % n % n % n % n % n % n % n % n % n % Islam Buddhism Hinduism Christianity Others Unknown Figure 8..5: Donor s Religion, Table 8..6: Donor s Nationality, Nationality 97 n=5 98 n=7 99 n= n=24 02 n= n=16 05 n % n % n % n % n % n % n % n % n % Malaysian Non- Malaysian Nationality n=9 10 n=8 11 n= n=56 n=71 n=55 n % n % n % n % n % n % n % n % n % n % N % Malaysian Non Malaysian 11

12 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry 20 Figure 8..6: Donor s Nationality, Table 8..7: Donor s State of Residence, Donor s state of residence 97 n=5 98 n=7 99 n= n=24 02 n= n=16 05 n % n % n % n % n % n % n % n % 1 8 Johor Malacca Negeri Sembilan Selangor WP Kuala Lumpur WP Putrajaya Perak Kedah Perlis Pulau Pinang Pahang Terengganu Kelantan Sabah Sarawak Unknown

13 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN Donor s state of residence n=9 10 n=8 11 n= n=56 n=71 n=55 n % n % n % n % n % n % n % n % n % n % n % Johor Malacca Negeri Sembilan Selangor WP Kuala Lumpur WP Putrajaya Perak Kedah Perlis Pulau Pinang Pahang Terengganu Kelantan Sabah Sarawak Unknown Table 8..8: Donors who were registered pledgers, Donor s pledged 97 n=5 98 n=7 99 n= n=24 02 n= n=16 05 status n % n % n % n % n % n % n % n % n % Pledged Non- Pledged Unknown Donor s pledged n=9 10 n=8 11 n= n=56 n=71 n=55 status n % n % n % n % n % n % n % n % n % n % n % Pledged Non- Pledged Unknown

14 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry 20 Figure 8..7: Donors who were registered pledgers, Table 8..9(a): Brain Dead Donor s Cause of Death, 20 Cause of Death n=2 n % Traumatic Head Injury Road Traffic Accident Homicide 1 Others 2 6 Spontaneous Intracranial Hemorrhage 11 4 Thromboembolic brain infarct 1 Brain hypoxic encephalopathy 1 Intracranial tumors 2 6 Table 8..9(b): Cardiac Death Donor s Cause of Death, 20 Cause of Death n=9 n % Traumatic Injury Road Traffic Accident 14 6 Fall 6 Suicide 1 Heart Disease 7 18 Respiratory Disease 1 Infection 1 Others

15 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN Table 8..10: Organ Donor s Blood Group, n (%) Blood group n=4 n=6 n=4 n=11 n=20 n=9 n=9 n=5 A 1 (25) 1 (17) 0 (0) 1 (9) 5 (25) (2) 4 (44) 2 (22) 1 (20) B 0 (0) 1 (17) 1 (25) 5 (45) 4 (20) (2) () 4 (44) 2 (40) AB 1 (25) 1 (17) 0 (0) 0 (0) 1 (5) 0 (0) 0 (0) 0 (0) 0 (0) O 2 (50) 2 () (75) 5 (45) 10 (50) 7 (54) 2 (22) () 2 (40) Unknown 0(0) 1(17) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) n (%) Blood group n= n=18 10 n=18 11 n=2 12 n=18 1 n=16 14 n=22 n=0 6 A 4 (1) 7 (50) 4 (1) 6 () 4 (22) 2 (9) 4 (22) 5(1) 8 (6) 4 (1) 66 (25) B 5 (8) (21) 2 () 2 (11) 5 (28) (65) 6 () (19) 4 (18) 5 (17) 7 (27) AB 2 () 0 (0) 0 (0) 1 (6) 2 (11) 1 (4) 2 (11) 0(0) 1 (5) 5 (17) 17 (6) O 2 () 4 (29) 7 (54) 9 (50) 7 (9) 5 (22) 6 () 8(50) 9 (41) 16(5) 109(41) Unknown 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0 (0) 1 (0) Figure 8..8a: Organ Donor s Blood Group 20 Figure 8..8b: Organ Donor s Blood Group,

16 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry DONOR MANAGEMENT Table 8.4.1: State where organ and tissue procurement took place, State 97 n=5 98 n=7 99 n= n=24 02 n= n= n % n % n % n % n % N % n % n % n % n % Johor Kedah Kelantan Malacca Negeri Sembilan Pahang Perak Perlis Pulau Pinang Sabah Sarawak Selangor Terengganu WP Kuala Lumpur WP Labuan WP Putrajaya Unknown

17 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN State n=9 10 n=8 11 n= n=56 n=71 n=55 n % n % n % n % n % n % n % n % n % n % Johor Kedah Kelantan Malacca Negeri Sembilan Pahang Perak Perlis Pulau Pinang Sabah Sarawak Selangor Terengganu WP Kuala Lumpur WP Labuan WP Putrajaya Unknown Table 8.4.2: Institutions where organ and tissue procurement took place, Donor s Institution of Procurement MOH State/Federal hospitals MOH Specialist hospitals MOH Non-Specialist hospitals 97 n=5 98 n=7 99 n= n=24 02 n= n= n % n % n % n % n % n % n % n % n % n % University hospitals Private hospitals Others

18 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry 20 Donor s Institution of Procurement n=9 10 n=8 11 n= n=56 n=71 n=55 n % n % n % n % n % n % n % n % n % n % MOH State/Federal hospitals MOH Specialist hospitals MOH Non- Specialist hospitals University hospitals Private hospitals Others Figure 8.4.1: Institutions where organ and tissue procurement took place,

19 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN Table 8.4.: Location where donors were referred, Donor Referral Site 97 n=5 98 n=7 99 n= n=24 02 n= n= n % n % n % n % n % N % n % n % n % n % ICU Ward Emergency department Mortuary Home Others Unknown/Missing Donor Referral Site n=9 10 n=8 11 n= n=56 n=71 n=55 n % n % n % n % n % n % n % n % n % n % ICU Ward Emergency department Mortuary Home Others Unknown/Missing Figure 8.4.2: Location where donors were referred,

20 DECEASED (CADAVERIC) ORGAN Twelfth Report of the National Transplant Registry 20 Table 8.4.4: Serology Profile, Serology HBs Antigen Positive HBsAb & Hep B Core Ab Positive HBsAb Negative & Anti Hep B Core Ab Positive HBsAb Positive Hep B Core Ab Positive No data No data No data No data Serology HBs Antigen Positive HBsAb & HB Core Ab Positive No data HBsAb Negative & HB Core Ab Positive No data HBsAb Positive No data HB Core Ab Positive Table 8.4.5: Inotrope Usage, 20 Inotropes 20 n % Noradrenaline only Adrenaline and Noradrenaline 2 10 Dobutamine and Noradrenaline 2 10 Dopamine and Noradrenaline 1 5 Adrenaline, Dobutamine and Noradrenaline 1 5 Dopamine, Dobutamine and Noradrenaline 2 10 Adrenaline, Dopamine, Dobutamine and Noradrenaline Table 8.4.6: Donor s medical history, 20 Medical History n=71 % Heart disease 4 6 Hypertension Diabetes 4 Asthma or any lung disease 4 6 Liver disease or jaundice 1 1 Arthritis or joint disease 1 1 Ever had a cancer 1 1 Had serious illness, operation or surgery performed in 4 the past 6 History of long term fever, infection or unexplained 1 weight loss 1 History of blood transfusion 4 6 Had a tattoo, body piercing, stud piercing, acupuncture 6 Exposure to toxic substances 1 1 Drank alcohol

21 Twelfth Report of the National Transplant Registry 20 DECEASED (CADAVERIC) ORGAN Smoked 1 18 Been hospitalised in the past 2 years 6 8 Ever used non prescribed drugs or illegal drugs 2 Others 2 None 26 7 *Donor can have more than one medical history Table 8.4.7: Cold Ischaemic Duration for Various Organs, 20 Organs Heart Lung Heart & Lung Liver Kidney No. Of Organs Mean (Time, hours) SD (Time, hours) Median (Time, hours) Minimum (Time, hours) Maximum (Time, hours)