PMC:28989 / 1979-4464 JSONTXT

{"project":"2_test","denotations":[{"id":"11056697-3512878-23650332","span":{"begin":253,"end":254},"obj":"3512878"},{"id":"11056697-4068158-23650333","span":{"begin":332,"end":333},"obj":"4068158"},{"id":"11056697-1995979-23650334","span":{"begin":462,"end":463},"obj":"1995979"},{"id":"11056697-7015626-23650335","span":{"begin":800,"end":801},"obj":"7015626"},{"id":"11056697-3565973-23650336","span":{"begin":802,"end":803},"obj":"3565973"},{"id":"11056697-2648042-23650337","span":{"begin":1112,"end":1113},"obj":"2648042"},{"id":"11056697-7778746-23650338","span":{"begin":1200,"end":1202},"obj":"7778746"},{"id":"11056697-7778743-23650339","span":{"begin":1203,"end":1205},"obj":"7778743"},{"id":"11056697-7778744-23650340","span":{"begin":1444,"end":1446},"obj":"7778744"}],"text":"Introduction\nBetween 1990 and 1995, the organ transplant waiting list in the US more than doubled to over 43,000 patients [1]. The donor pool necessary to meet current US transplantation needs has been projected to between 10,000 and 15,000 per year [2,3]. The major obstacle to organ transplantation is the limited organ supply [2,4]. Consequently, in the early 1990s, nearly 2000 patients died in the US each year while on organ transplantation waiting lists [5]; currently, this number may be as high as 3500 [1]. It has been estimated that between 12,500 and 27,000 potential organ donors die each year in the US [2,6]. Despite what seems to be an adequate donor pool, only 15 to 20% of potential donors become actual donors, approximately 98% of whom originate from intensive care units (ICUs) [7,8]. Because many factors contribute to the shortage of organs, early donor recognition, rapid and accurate declaration of brain death, physiological maintenance of potential organ donors, and coordination with the local organ procurement organization (OPO) are all important aspects of organ donor management [9].\nOnce a potential donor has been identified, brain death must be legally determined [10,11]. The multiple physiological derangements which the potential organ donor manifests require aggressive, labor intensive management in order to maintain organ function until legal brain death is declared and procurement can be undertaken [12]. One recent review suggests that the medical failures occurring prior to organ procurement in brain dead patients may be largely preventable by the use of invasive hemodynamic monitoring, aggressive rewarming and liberal transfusion therapy [13]. The level of care necessary to sustain potential organ donors until legal brain death is declared is expensive [14]. These charges, accrued before the OPO assumes financial responsibility, may be unknowingly referred to donor families, essentially penalizing them for the altruistic act of organ donation. \nThis review was performed in order to measure the impact of altering the use of the brain death determination protocol at the University of Pennsylvania Medical Center, in an attempt to decrease the time between the first examination consistent with brain death and actual legal determination of brain death (brain death stay). The impact on the organ procurement process, including hospital charges, length of brain death stay, and number of organs procured per patient was studied."}

{"project":"Colil","denotations":[{"id":"T2","span":{"begin":800,"end":801},"obj":"7015626"},{"id":"T3","span":{"begin":802,"end":803},"obj":"3565973"},{"id":"T4","span":{"begin":1112,"end":1113},"obj":"2648042"},{"id":"T5","span":{"begin":332,"end":333},"obj":"4068158"},{"id":"T6","span":{"begin":1200,"end":1202},"obj":"7778746"},{"id":"T7","span":{"begin":1444,"end":1446},"obj":"7778744"},{"id":"T8","span":{"begin":1203,"end":1205},"obj":"7778743"},{"id":"T9","span":{"begin":462,"end":463},"obj":"1995979"},{"id":"T1","span":{"begin":253,"end":254},"obj":"3512878"}],"namespaces":[{"prefix":"_base","uri":"http://pubannotation.org/docs/sourcedb/PubMed/sourceid/"}],"text":"Introduction\nBetween 1990 and 1995, the organ transplant waiting list in the US more than doubled to over 43,000 patients [1]. The donor pool necessary to meet current US transplantation needs has been projected to between 10,000 and 15,000 per year [2,3]. The major obstacle to organ transplantation is the limited organ supply [2,4]. Consequently, in the early 1990s, nearly 2000 patients died in the US each year while on organ transplantation waiting lists [5]; currently, this number may be as high as 3500 [1]. It has been estimated that between 12,500 and 27,000 potential organ donors die each year in the US [2,6]. Despite what seems to be an adequate donor pool, only 15 to 20% of potential donors become actual donors, approximately 98% of whom originate from intensive care units (ICUs) [7,8]. Because many factors contribute to the shortage of organs, early donor recognition, rapid and accurate declaration of brain death, physiological maintenance of potential organ donors, and coordination with the local organ procurement organization (OPO) are all important aspects of organ donor management [9].\nOnce a potential donor has been identified, brain death must be legally determined [10,11]. The multiple physiological derangements which the potential organ donor manifests require aggressive, labor intensive management in order to maintain organ function until legal brain death is declared and procurement can be undertaken [12]. One recent review suggests that the medical failures occurring prior to organ procurement in brain dead patients may be largely preventable by the use of invasive hemodynamic monitoring, aggressive rewarming and liberal transfusion therapy [13]. The level of care necessary to sustain potential organ donors until legal brain death is declared is expensive [14]. These charges, accrued before the OPO assumes financial responsibility, may be unknowingly referred to donor families, essentially penalizing them for the altruistic act of organ donation. \nThis review was performed in order to measure the impact of altering the use of the brain death determination protocol at the University of Pennsylvania Medical Center, in an attempt to decrease the time between the first examination consistent with brain death and actual legal determination of brain death (brain death stay). The impact on the organ procurement process, including hospital charges, length of brain death stay, and number of organs procured per patient was studied."}