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Introduction: Kidney Donor Profile Index (KDPI) has been incorporated in the United States to improve the kidney transplant allocation system., Objectives: To evaluate deceased kidney donors' profile using KDPI and compare to the previous United Network for Organ Sharing (UNOS) definition of expanded criteria donors (ECD) and assess the KDPI applicability to predict five-year graft survival and renal function in our sample., Methods: Retrospective cohort of 589 kidney transplants from deceased donors performed from January 2009 to May 2013 with follow-up until May 2018., Results: In 589 kidney transplants, 36.6% of donors were classified as ECD and 28.8% had KDPI ≥ 85%. Mean KDPI was 63.1 (95%CI: 60.8-65.3). There was an overlap of standard and ECD in KDPI between 60 and 95 and a significantly lower death-censored graft survival in KDPI ≥ 85% (78.6%); KDPI 0-20: 89.8%, KDPI 21-59: 91.6%, and KDPI 60-84: 83.0%; p = 0.006. The AUC-ROC was 0.577 (95%CI: 0.514-0.641; p = 0.027). Renal function at 5 years was significantly lower according to the incremental KDPI (p < 0.002). KDPI (HR 1.011; 95%CI 1.001-1.020; p = 0.008), donor-specific antibodies (HR 2.77; 95%CI 1.69-4.54; p < 0.001), acute rejection episode (HR 1.73; 95%CI 1.04-2.86; p = 0.034) were independent and significant risk factors for death-censored graft loss at 5 years., Conclusion: In our study, 36.6% were classified as ECD and 28.8% had KDPI ≥ 85%. KDPI score showed a moderate power to predict graft survival at 5 years. Renal function was significantly lower in patients with higher KDPI.

Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors., Competing Interests: None.

Introduction: Today there is an insufficient number of donated organs in Brazil. This is particularly due to the general population's and health care professionals' lack of information. Therefore, with this project we intend to consolidate knowledge on organ donation to teach health care students of different areas so they are able to propagate such knowledge., Materials and Methods: In 2006, at Universidade Federal de Ciências da Saúde de Porto Alegre, an "Organ donation and transplants" subject was created, with the aim to educate health care students. In the next years, it was split in two subjects, named "Introduction to transplants" and "Donation and transplants." By enrolling, students get theoretical classes and practical experience in out- and inpatient facilities and in surgical environments at the Santa Casa Hospital Complex. Furthermore, they can participate in campaigns at parks, stadiums, and health care fairs that take place at several schools in Porto Alegre. To finish the subjects, students present a conclusion report., Results: Seven years after implementation of the subject, and with more than 400 students enrolled, several accomplishments can be highlighted. For example, the creation of the Organ Transplantation League, the implementation of a day to spread conception of the donation-transplant process (with the elaboration of a Web page on the subject), and the release of a book on the subject written by students and professors., Discussion and Conclusion: Health care professionals' education is a central point in donation and transplant process. This is because they become, inevitably, educators, and this brings a long-term consequence, consisting of enhanced logistics skills on brain-death diagnosis and further transfer of information to the population (hopefully reducing denial by families at the time of the donation). We conclude that this is a project to be followed by other medical schools so that, effectively, the number of donors increases and, consequently, the transplantation of organs and tissues as well., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To evaluate changes in the profile of potential dead donors brain as to age, gender, and cause of death between 1988 to 2004, as well as the notification rates of potential donors, the donation itself, and family non-authorization., Patients and Methods: Records of 2,757 potential donors were reviewed in three periods: I: 1988-1992 (n = 465), II: 1993-1997 (n = 567), and III: 1998-2004 (n = 1,725)., Results: The mean age which was similar in periods I and II (30.8 and 29.8 years), increased in period III (38.3 + 18.5 years); (P < .05). The frequency of male donors decreased from 71% and 69%, to 57% (P < .05). The cranium-encephalic trauma decreased from 63.2% and 54.7% to 34.8% (P < .05), while the brain-vascular accidents (CVA) increased from 28.0% and 34.5% to 49.4% (P < .05). The rate of potential donors notified increased from 10.7 per million population per year (pmp/y) and 11.9 to 24.6 pmp/y, while the donation rate increased from 4.4 pmp/y (42.4%) and 7.7 pmp/y (64.3%) to 9.6 pmp/y (38.8%), in periods I, II and III, respectively. The family's nonauthorization changed from 41.5% and 21.7% to 31.9%., Conclusions: We observed a similar trend as that in developed countries, that is, a significant increases in the ages of potential donors, in the proportion of female donors, and in the CVA brain death. There has been a significant increase in the notification rate and the donation itself, without a significant modification in family nonauthorization rate.

Unlabelled: Various strategies have evolved to expand the donor pool due to the extreme shortage of organs. Herein we reviewed our experience with en bloc pediatric kidney transplantation since 1998., Methods: From January 1998 to December 2004, nine adult patients underwent kidney transplantation using en bloc kidneys from donors <5 years old (range, 1 to 4). The mean age of the recipients was 45.1 years (range, 34 to 57)., Results: In recipients of en bloc pediatric transplantation, cold ischemia time ranged from 14 to 26.2 hours (mean, 21.3 hours). Mean serum creatinine at 3, 6, and 12 months after transplantation was 1.53 +/- 0.57, 1.27 +/- 0.27, and 1.15 +/- 0.26 mg/dL compared with 1.93 +/- 1.35, 1.81 +/- 1.17, and 1.73 +/- 0.85 (P = .08) in recipients of single kidneys from ideal cadaveric donors (UNOS criteria, n = 368). Patient and graft survival at 1 year were 88.8% compared with 91.2% and 85% with ideal donors (P = NS), respectively. Three cases required additional surgery. There was one death due to a cerebral vascular accident., Conclusion: The present study confirmed the excellent results achieved with transplantation using en bloc kidneys from young donors.

Introduction: There are still few publications about brain death caused by electric shock and the use of organs for donation in this situation. We sought to present our experience, with brain dead pediatric donors caused by electric shock., Material and Methods: Notification registers of potential donors were analyzed from 1998 to 2005., Results: During this period, 2086 potential donors were secured, of whom 307 (14.7%) were less than 18 years old. Four pediatric potential donors (1.3%) suffered brain death due to anoxia by electric shock. Six kidneys, three livers, six corneas, and three heart valves were used for transplantation. The hearts and the lungs were not offered, because of a lack of compatible patients on the waiting list. The pediatric donors showed significant alterations of cardiac enzymes and two had altered liver enzymes., Conclusion: Brain death caused by electric shock is not a contraindication for organ donation. Follow-up of the recipients is necessary to determine if the transplants were successful.

Introduction: There are few reports in the literature analyzing brain death epidemiology in suicides, or the rate of donation and family authorization in such situations., Objective: The objectives of this study were to analyze the frequency of suicide as a cause of brain death and to compare the donation rates among this population with other causes of brain death., Patients and Methods: We reviewed records from 2627 potential donors between 1988 and 2004., Results: Within that period, 101 (3.8%) cases of brain death were recorded as suicides. The mean age was significantly lower (P < .05) in cases of suicide than for other causes (26.2 + 11.1 vs 34.4 + 16.5 years); there was a male prevalence (76.2% vs 60.8%). As to suicides, the donation rate was significantly higher than in other situations (62.3% vs 43.8%). This was due to a lower rate of negative family responses (17.8% vs 32.1%)., Conclusions: Suicide is a frequent cause of brain death (3.8%), mainly among young men. The donation rate in this group is higher than that due to other causes of death because of a lower negative response rate by the family. The explanation remains to be clarified for such a low refusal rate for organ donation by the relatives of potential donors due to suicide.