CHAPTER 8 DECEASED (CADAVERIC) ORGAN AND TISSUE DONATION. Editor: Datin Dr Fadilah Zowyah Lela Yasmin Mansor Dr Hooi Lai Seong

Transcription

1 CHAPTER 8 DECEASED (CADAVERIC) ORGAN AND TISSUE DONATION Editor: Datin Dr Fadilah Zowyah Lela Yasmin Mansor Dr Hooi Lai Seong Expert Panel Datin Dr Fadilah Zowyah Lela Yasmin Mansor (Chairperson) Dr Hooi Lai Seong Dr Rosnawati Yahya Dr Omar Sulaiman Dato' Dr Sharifah Suraya Syed Mohd Tahir Matron Jamaliah Kario Contents 8. Potential Donor Referrals 8.2. Actual Donations 8.3 Donor Characteristics 8.4 Donor Management

2 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the 8. POTENTIAL DONOR REFERRALS Referrals Suspected Brain Dead-75 (64.8%) Cardiac Death-95 (35.2%) Medically Eligible-60 (9.4%) Medically not Eligible-5 (8.6%) Medically Eligible-82 (86.3%) Medically Not Eligible-3 (3.7%) Brain Death test done-75 (46.9%) Brain Death test not done/not completed-85 (53.%) *Refer Table 8.. Brain Dead Cardiac Death Family Approached- 68 (90.6%) * Refer Table 8..2 Family Not Approached- 7 (9.3%) * Refer Table 8..3 Family Approached- 5 (60.0%) * Refer Table 8..2 Family Not Approached- 34 (40.0%) * Refer Table 8..3 Family Approached- 72 (87.8%) *Refer Table 8..2 Family Not Approached- 0 (2.2%) * Refer Table 8..3 Consented-24 (35.3%) Not Consented-44 (64.7%) Consented-3 (5.9%) Not Consented-48 (94.%) Consented-32 (44.4%) Not Consented-40 (55.6%) Organ and Tissue Donor-2 Tissue donor-2 Tissue Donor-3 Organ and Tissue Donor- (DCD) Tissue donor-29 Total Organ/Tissue Donor=56* Conversion Rate=56/242 (23.%) Total Organ Donor=22 Figure 8.8. Potential Donor Referrals,

3 Eleventh Report of the DECEASED ORGAN AND TISSUE DONATION Table 8..: Reason for brain death test not done, 204 Reason for brain test not done n % Unable to correct parameters for brain death diagnosis No clearance from family 3 5 No clearance from primary doctor 2 2 Proceeded to cardiac death before test can be done AOR discharge 3 4 Others* 3 4 Total *Patients were not in ICU Table 8..2: Person who made the initial request, 204 Brain death Cardiac death Families approached n % n % TOP team Family Transplant coordinator Ward doctor Others Total Table 8..3: Reason for not approaching the family, 204 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 Total *Others-4 out of 9 cardiac death referrals were suspected brain dead at initial detection but were found to be hemodynamically unstable 3

4 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the Table 8..4: Potential donor referrals and actual donations by month, 204 Actual donors Total referred cases Month Brain death donors (BD) Cardiac death tissue donors (CD) n n n January February 9 4 March April May 6 June July * August 2 September October November December TOTAL * One DCD donor donated kidneys Figure 8..2: Total Referred Cases and Actual Donations by Month, 204 Table 8..5: Donor referral institutions, 204 Donor referral institution n % MOH State hospitals MOH Specialist hospitals University hospitals 7 3 Private hospitals 3 Home 2 Total

5 Eleventh Report of the DECEASED ORGAN AND TISSUE DONATION 8.2 ACTUAL DONATIONS Table 8.2.: Number of Donations by Year, Year Number of referrals Number of brain death: organ and * tissue donor Number of cardiac death: tissue donor ** Total number of donors Rate of procurement (per million population) *2 out of 23 brain death donors donated only tissue ** DCD donor who donated kidneys 5

6 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the Table 8.2.2: Number of Organ Donors by Year, Year Number of organ donors Rate of organ donors (per million population) Figure 8.2.: Number of Donations by Year, Table 8.2.3: Number of Organs Procured by Year, Organs procured Cornea Heart Liver Kidney * Heart valve Bone Skin Lung *2 out of 42 kidneys procured but not transplanted 6

7 Eleventh Report of the DECEASED ORGAN AND TISSUE DONATION 8.3 DONOR CHARACTERISTICS Donor s age (years) Table 8.3.: Age Distribution of Donors, n=5 98 n=7 99 n= n=24 02 n=30 n % n % n % n % n % n % n % n % n % n % n % n % < No data Total Mean SD Median Minimum <* * Maximum ** n= Donor s age (years) 09 n=39 0 n=38 n= n=56 Total n=482 n % n % n % n % n % n % n % < No data Total Mean SD Median Minimum <* <* Maximum ** 8 84** 7

8 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the Figure 8.3.: Donor s Age Group, * The youngest tissue donors were 25 days old and 37 days old who donated heart valves in 2009 and 2003 respectively; the youngest organ donor was 4.5 months old who donated kidneys in 2007 ** The oldest tissue donor was 84 year old who donated eyes in 203; the oldest organ donor was 66 year old who donated kidneys in 200 Figure 8.3.2: Donor s Age Group, 204 8

9 Eleventh Report of the DECEASED ORGAN AND TISSUE DONATION Table 8.3.2: Distribution of paediatric donors (below 8 years old), Year Organ donor Tissue donor Total Table 8.3.3: Donor s Gender, Donor s n=5 n=7 n=4 n=24 n=30 n=6 gender n % n % n % n % n % n % n % n % Male Female Total Donor s n=39 n=38 n=47 n=56 n=482 gender n % n % n % n % n % n % n % n % n % n % n % Male Female Figure 8.3.3: Donor s Gender,

10 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the Table 8.3.4: Donor s Ethnic Group, Donor s ethnic 97 n=5 98 n=7 99 n= n=24 02 n= n=6 group n % n % n % n % n % n % n % n % Malay Chinese Indian Others Donor s ethnic n=39 0 n=38 n= n-56 Total n=482 group n % n % n % n % n % n % n % n % n % n % n % Malay Chinese Indian Others Figure 8.3.4: Donor s Ethnic Group, Table 8.3.5: Donor s Religion, Donor s religion 97 n=5 98 n=7 99 n= n=24 02 n= n=6 n % n % n % n % n % n % n % n % Islam Buddhism Hinduism Christianity Others Unknown

11 Eleventh Report of the DECEASED ORGAN AND TISSUE DONATION Total Donor s n=39 n=38 n=47 n=56 n=482 religion n % n % n % n % n % n % n % n % n % n % n % Islam Buddhism Hinduism Christianity Others Unknown Figure 8.3.5: Donor s Religion, Table 8.3.6: Donor s Nationality, Nationality 97 n=5 98 n=7 99 n= n=24 02 n= n=6 n % n % n % n % n % n % n % n % Malaysian Non-Malaysian Nationality n=39 0 n=38 n= n=56 Total n=482 n % n % n % n % n % n % n % n % n % n % N % Malaysian Non Malaysian

12 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the Figure 8.3.6: Donor s Nationality, Table 8.3.7: Donor s State of Residence, Donor s state of residence 97 n=5 98 n=7 99 n= n=24 02 n= n=6 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 Donor s state of residence n=39 0 n=38 n= n=56 Total n=482 n % n % n % n % n % n % n % n % n % n % n % Johor Malacca Negeri Sembilan

13 Eleventh Report of the DECEASED ORGAN AND TISSUE DONATION Donor s state of residence n=39 0 n=38 n= n=56 Total n=482 n % n % n % n % n % n % n % n % n % n % n % Selangor WP Kuala Lumpur WP Putrajaya Perak Kedah Perlis Pulau Pinang Pahang Terengganu Kelantan Sabah Sarawak Unknown Table 8.3.8: Donors who were registered pledgers, Donor s pledged 97 n=5 98 n=7 99 n= n=24 02 n= n=6 status n % n % n % n % n % n % n % n % Pledged Non-Pledged Unknown Donor s pledged n=39 0 n=38 n= n=56 Total n=482 status n % n % n % n % n % n % n % n % n % n % n % Pledged Non- Pledged Unknown

14 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the Figure 8.3.7: Donors who were registered pledgers, Table 8.3.9(a): Brain Dead Donor s Cause of Death, 204 Cause of Death 204 n=23 n % Traumatic Head Injury Road Traffic Accident 0 43 Fall Spontaneous Intracranial Hemorrhage 9 39 Intracranial tumors 4 Intracranial infection 4 Brain hypoxic encephalopathy 4 Others 4 Table 8.3.9(b): Cardiac Death Donor s Cause of Death, 204 Cause of Death 204 n=33 n % Traumatic Injury Road Traffic Accident 3 39 Fall 3 9 Homicide 3 Heart Disease 7 2 Endocrine disease 3 Respiratory Disease 3 9 Poisoning 3 Others 4 2 4

15 Eleventh Report of the DECEASED ORGAN AND TISSUE DONATION Table 8.3.0: Organ Donor s Blood Group, No. (%) Blood group n=4 n=6 n=4 n= n=20 n=9 n=9 A (25) (7) 0 (0) (9) 5 (25) 3 (23) 4 (44) 2 (22) B 0 (0) (7) (25) 5 (45) 4 (20) 3 (23) 3 (33) 4 (44) AB (25) (7) 0 (0) 0 (0) (5) 0 (0) 0 (0) 0 (0) O 2 (50) 2 (33) 3 (75) 5 (45) 0 (50) 7 (54) 2 (22) 3 (33) Unknown 0 (0) (7) 0(0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) n (%) Blood group Total n=5 n=4 n=8 n=8 n=23 n=8 n=6 n=22 n=235 A (20) 4 (3) 7 (50) 4 (3) 6 (33) 4 (22) 2 (9) 4 (22) 5(3) 8 (36) 54 (25) B 2 (40) 5 (38) 3 (2) 2 (5) 2 () 5 (28) 5 (65) 6 (33) 3(9) 4 (8) 64 (30) AB 0 (0) 2 (5) 0 (0) 0 (0) (6) 2 () (4) 2 () 0(0) (5) (5) O 2 (40) 2 (5) 4 (29) 7 (54) 9 (50) 7 (39) 5 (22) 6 (33) 8(50) 9 (4) 84 (39) Unknown 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) () Figure 8.3.8a: Organ Donor s Blood Group, 204 Figure 8.3.8b: Organ Donor s Blood Group,

16 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the 8.4 DONOR MANAGEMENT State Table 8.4.: State where organ and tissue procurement took place, n=5 98 n=7 99 n=4 00 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 n=24 02 n= n=6 05 State n=39 0 n=38 n= n=56 Total n=482 n % n % n % n % n % n % n % n % n % n % Johor Kedah Kelantan Malacca Negeri Sembilan

17 Eleventh Report of the DECEASED ORGAN AND TISSUE DONATION State n=39 0 n=38 n= n=56 Total n=482 n % n % n % n % n % n % n % n % n % n % 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 n=5 n=7 n=4 n=24 n=30 n=6 Procurement n % n % n % n % n % n % n % n % n % MOH State hospitals MOH Specialist hospitals MOH Non-Specialist hospitals University hospitals Private hospitals Others Total Donor s Institution n=39 n=38 n=47 n=56 n=482 of Procurement n % n % n % n % n % n % n % n % n % n % MOH State hospitals MOH Specialist hospitals MOH Non-Specialist hospitals University hospitals Private hospitals Others

18 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the Figure 8.4.: Institutions where organ and tissue procurement took place, Table 8.4.3: Location where donors were referred, Donor Referral Site 97 n=5 98 n=7 99 n= n=24 02 n= n=6 05 n % n % n % n % n % N % n % n % 7 54 ICU Ward Emergency department Mortuary Home Others Unknown/Missing Donor Referral Site n=39 0 n=38 n= n=56 Total n=482 n % n % n % n % n % n % n % n % n % n % ICU Ward Emergency department Mortuary Home Others Unknown/Missing

19 Eleventh Report of the DECEASED ORGAN AND TISSUE DONATION Figure 8.4.2: Location where donors were referred, 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 Total 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

20 DECEASED ORGAN AND TISSUE DONATION Eleventh Report of the Table 8.4.5: Inotrope Usage, 204 Inotropes 204 n % Noradrenaline only 8 57 Dopamine only 7 Adrenaline and Noradrenaline 7 Dobutamine and Noradrenaline 2 4 Dobutamine, Noradrenaline and Vasopressin 7 Adrenaline, Dopamine, Dobutamine and Noradrenaline 7 Total 4 00 Table 8.4.6: Donor s medical history, 204 Medical History Number (n=56) % Heart disease 8 4 Hypertension 9 6 Diabetes 4 7 Asthma or any lung disease 3 5 Eye Disease 2 4 Arthritis or joint disease 2 Dementia or brain disease 2 Ever had a cancer 2 Ever received an organ and tissue transplant 2 Had serious illness or operation performed in the past 5 9 History of blood transfusion 2 4 Had a tattoo, body piercing, stud piercing, acupuncture 4 7 Been vaccinated or immunised in the past 2 months 2 Exposure to toxic substances 2 Drank alcohol 8 4 Smoked 6 Taken any medication on a regular basis 5 9 Been hospitalised in the past 2 years 5 9 Ever used non prescribed drugs or illegal drugs 2 Took traditional medication 2 None 2 38 *Donor can have more than one medical history Table 8.4.7: Cold Ischaemic Duration for Various Organs, 204 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)