Editorial
Uncontrolled non-heart beating donation: Need, opportunity and challenge
Donación en asistolia no controlada: necesidad, oportunidad y reto
R. Matesanz
, B. Domínguez-Gil, E. Coll
Corresponding author
Organización Nacional de Trasplantes, Madrid, Spain
Read
7777
Timeswas read the article
3135
Total PDF
4642
Total HTML
Share statistics
array:23 [ "pii" => "S2173572713000386" "issn" => "21735727" "doi" => "10.1016/j.medine.2013.01.005" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "561" "copyright" => "Elsevier España, S.L. and SEMICYUC" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Med Intensiva. 2013;37:221-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2617 "formatos" => array:3 [ "EPUB" => 122 "HTML" => 1718 "PDF" => 777 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569113000107" "issn" => "02105691" "doi" => "10.1016/j.medin.2013.01.006" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "561" "copyright" => "Elsevier España, S.L. y SEMICYUC" "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Med Intensiva. 2013;37:221-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5438 "formatos" => array:3 [ "EPUB" => 153 "HTML" => 4059 "PDF" => 1226 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Donación en asistolia no controlada: necesidad, oportunidad y reto" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "223" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Uncontrolled non-heart beating donation: need, opportunity and challenge" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Matesanz, B. Domínguez-Gil, E. Coll" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Matesanz" ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Domínguez-Gil" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Coll" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572713000386" "doi" => "10.1016/j.medine.2013.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572713000386?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569113000107?idApp=WMIE" "url" => "/02105691/0000003700000004/v1_201305100909/S0210569113000107/v1_201305100909/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173572713000374" "issn" => "21735727" "doi" => "10.1016/j.medine.2012.07.009" "estado" => "S300" "fechaPublicacion" => "2013-05-01" "aid" => "505" "copyright" => "Elsevier España, S.L. and SEMICYUC" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Med Intensiva. 2013;37:224-31" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2832 "formatos" => array:3 [ "EPUB" => 138 "HTML" => 1842 "PDF" => 852 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Alpha code. The start of a new non-heart beating donor program" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "224" "paginaFinal" => "231" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Código alfa. Inicio de un nuevo programa de donación en asistolia" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1403 "Ancho" => 2378 "Tamanyo" => 141827 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Alpha Code. Activation of the rapid response team. *Supervising nurse on duty: nurse in charge of guaranteeing continuity in nursing management during the duty shift. In the morning the ICU supervising nurse of Neurotraumatology participates in Alpha Code activation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Pérez-Villares, R. Lara-Rosales, F. Pino-Sánchez, P. Fuentes-García, E. Gil-Piñero, A. Osuna Ortega, J.M. Cozar Olmo" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Pérez-Villares" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Lara-Rosales" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Pino-Sánchez" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Fuentes-García" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Gil-Piñero" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Osuna Ortega" ] 6 => array:2 [ "nombre" => "J.M." "apellidos" => "Cozar Olmo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569112002471" "doi" => "10.1016/j.medin.2012.07.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569112002471?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572713000374?idApp=WMIE" "url" => "/21735727/0000003700000004/v1_201307160921/S2173572713000374/v1_201307160921/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Uncontrolled non-heart beating donation: Need, opportunity and challenge" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "223" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Matesanz, B. Domínguez-Gil, E. Coll" "autores" => array:3 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Matesanz" "email" => array:1 [ 0 => "rmatesanz@msssi.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "B." "apellidos" => "Domínguez-Gil" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Coll" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Organización Nacional de Trasplantes, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Donación en asistolia no controlada: necesidad, oportunidad y reto" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Third Global Consultation</span> of the World Health Organization (WHO) on donation and transplants was held in Madrid (Spain) in March 2010.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Through the <span class="elsevierStyleItalic">Madrid Resolution</span>, representatives of 70 countries from all over the world called for progress toward self-sufficiency in transplantation. Self-sufficiency is seen as a necessity not only to reduce mortality on the waiting list, but also to control ethically unacceptable practices such as trafficking in organs and transplant tourism.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> With almost 90 transplant procedures per million of population (pmp) in the year 2011, Spain is in a privileged position for achieving self-sufficiency, setting the bases for a roadmap that includes donation as an integral part of the end-of-life setting in all possible death circumstances.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Brain dead donors (BDD) are the most frequent source of organs for transplantation: approximately 90% of all donors in Spain are people in whom death has been diagnosed according to neurological criteria.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The donation levels reached in our country, fundamented upon BDD, come close to excellence–though this does not mean that there is no room for improvement.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> Nevertheless, BDD as an option is becoming exhausted both quantitatively and qualitatively. Continued auditing in the critical care units of hospitals authorized for organ donation in Spain reflects a dramatic decrease in the potential for donation in BDD, from 65 donors pmp in 2001 to 49 donors pmp in 2010.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This decrease is attributable to the reduction in traffic accident deaths and stroke mortality, common to all European countries, and to the more widespread practice of operations such as decompressive craniotomy in traumatic and atraumatic brain injuries. Furthermore, the mean age of BDD is progressively increasing, as a result of the current prevalence of cerebrovascular events as cause of death <span class="elsevierStyleItalic">versus</span> traumatic brain damage.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this context we need to find alternatives in donation to cover the transplantation demands. This has led our system to revisit non-heart beating donation (NHBD). This type of donation is as old as transplantation itself, since the first procedures were carried out with organs obtained from people who had died according to criteria which we would now call circulatory and respiratory criteria.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Furthermore, in the midst of debate about the ethical aspects of heart transplantation from non-heart beating donors, it should be remembered that the first heart transplant performed by Christiaan Barnard in 1967 involved the heart of a donor who had died according to the aforementioned circulatory criteria.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The interest in recovering non-heart beating donation is common to a number of countries, as evidenced on occasion of the first international congress on this aspect, held in Maastricht in 1995.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Since then there has been an exponential increase in the number of NHBD worldwide (an estimated 8% of the donors reported to the <span class="elsevierStyleItalic">Global Observatory on Donation and Transplantation</span> correspond to NHBD), though with the particularity that this increase has only occurred in a limited number of countries, and with clear polarization as regards the type of non-heart beating donation, depending on the country involved.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Thus, in countries such as Australia, Belgium, Canada, the United States, the Netherlands and the United Kingdom, among others, emphasis has been placed on so-called controlled donation after circulatory death (DCD), involving donation from people who die after limitation of life-sustaining treatment.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In contrast, the predominant type in Spain is uncontrolled NHBD, corresponding to people who die following cardiorespiratory arrest with failed cardiopulmonary resuscitation maneuvering–the modality addressed by Pérez-Villares et al. in their article in the present issue of <span class="elsevierStyleSmallCaps">Medicina Intensiva</span>.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Very few countries have been able to reproduce the Spanish experience. France is the only country to have developed a solid program similar to our own, and which was launched in 2006.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Other countries have had donors of this type, though always in very limited numbers.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> After estimating that uncontrolled NHBD could increase the pool of organ donors by 22,000 per year in the United States,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> the city of New York has worked on a protocol for years, though it has not yet been implemented.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The difficulty of introducing uncontrolled NHBD in other countries is related to ethical–legal issues on one hand and to the technical and organizational complexity inherent to this type of donation on the other.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In 1995, the Spanish National Transplant Organization coordinated the development of a <span class="elsevierStyleItalic">Consensus Document on Non-heart Beating donation</span>,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> in which it was agreed not to consider the development of DCD and to promote uncontrolled NHBD within a specific legal setting defined by Spanish <span class="elsevierStyleItalic">Royal Decree 2070/1999</span>.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Recently, the national consensus document has been updated, incorporating also DCD, and representing a clear impulse for uncontrolled NHBD in Spain.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> In fact, for years uncontrolled NHBD was confined to three cities in this country: A Coruña, Barcelona and Madrid–with quantitatively very significant activity in the latter two (there were also cases in Málaga during the 1990s). The abovementioned technical and organizational complexity was recognized as a clear hindering factor for applying new programs in other Spanish cities.</p><p id="par0030" class="elsevierStylePara elsevierViewall">With their experience, Pérez-Villares et al. have broken down barriers that were more imagined than real against the start of a program of this kind. In the development of such a protocol, vision, institutional support, organization and coordination effort, training of all the implicated professionals, and excellent communication have all been key elements. In our opinion, a number of salient aspects of the program summarized by the authors deserve special mention. On one hand, the program has been placed into operation with a population below or at the initially recommended limit of 500,000 inhabitants–demonstrating its feasibility and substantial impact upon the levels of donation and transplantation activity. Of note is the extraordinary effectiveness of the program, with a high percentage of potential donors transformed into real donors, and a high conversion rate of the latter into used donors. Such effectiveness is in contrast to the global situation in Spain, where performance is substantially lower–this being a source of concern in view of the enormous organizational, human and technical efforts required by each donation procedure. In our opinion, the described effectiveness is the result of extreme care in the selection of potential donors and the availability of different preservation techniques. Although randomized clinical trials are needed to contrast this clinical observation, the experience gained by some groups suggests superiority of extracorporeal membrane oxygenation (ECMO) under conditions of hypothermia, and particularly under normothermal conditions (NECMO), <span class="elsevierStyleItalic">versus in situ</span> cold preservation for the preservation of abdominal organs, in terms of both organ viability and post-transplantation outcomes.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> However, preservation with ECMO/NECMO implies technical complexity and costs which can pose obstacles for programs undergoing development. In addition, in some cases, the technique based on extracorporeal circulation is complicated by a lack of integrity of the vascular tree or other reasons–causing suspension of the donation process after the important efforts made. We therefore consider it a good strategy on the part of the authors to be able to have both preservation techniques available as a means to avoid unnecessary donor losses, particularly considering that such availability appears to be related to the obtainment of good post-transplantation results. Regarding this latter point, it is essential to stress the good results obtained with renal transplantation from such donors, and the promising beginnings of liver transplantation.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Finally, development of the program has been made without any major budget impact – this being particularly important considering the current economical restrictions in the country and their impact upon the healthcare system.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Many areas for improvement remain in uncontrolled NHBD. New strategies are needed to lessen the logistic complexity of the process, reducing the time restrictions as far as possible. An interesting point in this sense is the protocol recently described in Saint Petersburg, combining the administration of fibrinolytic agents, extracorporeal circulation and leukapheresis to allow warm ischemia times of up to 90<span class="elsevierStyleHsp" style=""></span>min from the diagnosis of death, with excellent post-transplantation renal function and no cases of primary graft non-function.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> The cost-effectiveness of these programs is also an issue meriting future evaluation with a view to defining the convenience of developing new Alpha Codes.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The difficulties and challenges inherent to uncontrolled NHBD give extraordinary value to the introduction and development of new programs such as that of Granada, San Juan (Alicante), Santander, Seville or Valencia. All of them have shown that enthusiasm, continued effort and, in many cases, inventiveness, are able to truly increase the transplantation possibilities for many patients and to establish donation as an integral part of end-of-life care in circumstances as complex as death following out-hospital cardiac arrest.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Matesanz R, et al. Donación en asistolia no controlada: necesidad, oportunidad y reto. Med Intensiva. 2013; 37: 221–3.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National responsibilities in meeting the needs of patients, guided by the WHO principles" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "The Madrid resolution on organ donation and transplantation" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.tp.0000399131.74618.a5" "Revista" => array:7 [ "tituloSerie" => "Transplantation" "fecha" => "2011" "volumen" => "91" "numero" => "Suppl. 11" "paginaInicial" => "S29" "paginaFinal" => "S31" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21633281" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Organ trafficking and transplant tourism and commercialism: the Declaration of Istanbul" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Steering Committee of the Istanbul Summit" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(08)60967-8" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2008" "volumen" => "372" "paginaInicial" => "5" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18603141" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Strategies to optimize deceased organ donation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Matesanz" 1 => "B. Dominguez-Gil" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Transplant Rev" "fecha" => "2007" "volumen" => "21" "paginaInicial" => "177" "paginaFinal" => "188" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Memoria anual de actividad de la Organización Nacional de Trasplantes. Página web de la ONT. Available from: <a id="intr0005" class="elsevierStyleInterRef" href="http://www.ont.es/">http://www.ont.es</a> [accessed 11.02.13]." ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish experience as a leading country: what kind of measures were taken?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Matesanz" 1 => "B. Domínguez-Gil" 2 => "E. Coll" 3 => "G. de la Rosa" 4 => "R. Marazuela" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1432-2277.2010.01204.x" "Revista" => array:6 [ "tituloSerie" => "Transpl Int" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "333" "paginaFinal" => "343" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21210863" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The 40 donors per million population plan: an action plan for improvement of organ donation and transplantation in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Matesanz" 1 => "R. Marazuela" 2 => "B. Domínguez-Gil" 3 => "E. Coll" 4 => "B. Mahillo" 5 => "G. de la Rosa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.transproceed.2009.09.011" "Revista" => array:6 [ "tituloSerie" => "Transplant Proc" "fecha" => "2009" "volumen" => "41" "paginaInicial" => "3453" "paginaFinal" => "3456" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19857769" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Continuously evaluating performance in deceased donation: the Spanish quality assurance program" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. De la Rosa" 1 => "B. Domínguez-Gil" 2 => "R. Matesanz" 3 => "S. Ramón" 4 => "J. Alonso-Álvarez" 5 => "J. Araiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-6143.2012.04138.x" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2012" "volumen" => "12" "paginaInicial" => "2507" "paginaFinal" => "2513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22703439" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The circulatory–respiratory determination of death in organ donation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Bernat" 1 => "A.M. Capron" 2 => "T.P. Bleck" 3 => "S. Blosser" 4 => "S.L. Bratton" 5 => "J.F. Childress" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3181c58916" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2010" "volumen" => "38" "paginaInicial" => "963" "paginaFinal" => "970" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20124892" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-heart-beating donor: an extraordinary example of translational medicine research" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Romano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Transl Med" "fecha" => "2012" "volumen" => "4" "paginaInicial" => "105" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Categories of non-heart-beating donors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Kootstra" 1 => "J.H. Daemen" 2 => "A.P. Oomen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Transplant Proc" "fecha" => "1995" "volumen" => "27" "paginaInicial" => "2893" "paginaFinal" => "2894" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7482956" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Observatorio Global de Donación y Trasplante. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.transplant-observatory.org/Pages/home.aspx">http://www.transplant-observatory.org/Pages/home.aspx</a> [accessed 11.02.13]." ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current situation of donation after circulatory death in European countries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Domínguez-Gil" 1 => "B. Haase-Kromwijk" 2 => "H. van Leiden" 3 => "J. Neuberger" 4 => "L. Coene" 5 => "P. Morel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1432-2277.2011.01257.x" "Revista" => array:6 [ "tituloSerie" => "Transpl Int" "fecha" => "2011" "volumen" => "24" "paginaInicial" => "676" "paginaFinal" => "686" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21504489" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Código alfa. Inicio de un nuevo programa de donación en asistolia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Pérez-Villares" 1 => "R. Lara-Rosales" 2 => "F. Pino-Sánchez" 3 => "P. Fuentes-García" 4 => "E. Gil-Piñero" 5 => "A. Osuna-Ortega" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Intensiva" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "223" "paginaFinal" => "230" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preliminary results of transplantation with kidneys donated after cardiocirculatory determination of death: a French single-centre experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Abboud" 1 => "D. Viglietti" 2 => "C. Antoine" 3 => "F. Gaudez" 4 => "P. Meria" 5 => "E. Tariel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ndt/gfr709" "Revista" => array:6 [ "tituloSerie" => "Nephrol Dial Transplant" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "2583" "paginaFinal" => "2587" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22187319" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Organ donation: opportunities for action" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Institute of Medicine (U.S.). Committee on increasing rates of organ donation" "etal" => false "autores" => array:2 [ 0 => "J.F. Childress" 1 => "C.T. Liverman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2006" "editorial" => "National Academies Press" "editorialLocalizacion" => "Washington, DC" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Derivation of the uncontrolled donation after circulatory determination of death protocol for New York City" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.P. Wall" 1 => "B.J. Kaufman" 2 => "A.J. Gilbert" 3 => "Y. Yushkov" 4 => "M. Goldstein" 5 => "J.E. Rivera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1600-6143.2011.03582.x" "Revista" => array:6 [ "tituloSerie" => "Am J Transplant" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "1417" "paginaFinal" => "1426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21711448" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de consenso español sobre extracción de órganos de donantes en asistolia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Matesanz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Nefrología" "fecha" => "1996" "volumen" => "16" "numero" => "Suppl. 2" "paginaInicial" => "48" "paginaFinal" => "53" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto 2070/1999, de 30 de diciembre, por el que se regulan las actividades de obtención y utilización clínica de órganos humanos y la coordinación territorial en materia de donación y trasplante de órganos y tejidos. Página web de la ONT. Available from: <a id="intr0015" class="elsevierStyleInterRef" href="http://www.ont.es/infesp/Legislacin/REAL_DECRETO_DONACION_Y_TRASPLANTE.pdf">http://www.ont.es/infesp/Legislacin/REAL_DECRETO_DONACION_Y_TRASPLANTE.pdf</a> [accessed 11.02.13]." ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Donación en asistolia en España: situación actual y recomendaciones. Documento de Consenso 2012. Página web de la ONT. Available from: <a id="intr0020" class="elsevierStyleInterRef" href="http://www.ont.es/infesp/DocumentosDeConsenso">http://www.ont.es/infesp/DocumentosDeConsenso</a> [accessed 11.02.13]." ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normothermic recirculation reduces primary graft dysfunction of kidneys obtained from non-heart-beating donors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Valero" 1 => "C. Cabrer" 2 => "F. Oppenheimer" 3 => "E. Trías" 4 => "J. Sánchez-Ibáñez" 5 => "F.M. de Cabo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Transpl Int" "fecha" => "2000" "volumen" => "13" "paginaInicial" => "303" "paginaFinal" => "310" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10959484" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new program of kidney transplantation from donors after cardiac death in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. De Gracia" 1 => "J.M. Osorio" 2 => "J.M. Pérez-Villares" 3 => "P. Galindo" 4 => "M.C. Ruiz" 5 => "A. Pérez-Marfil" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.transproceed.2012.09.040" "Revista" => array:6 [ "tituloSerie" => "Transplant Proc" "fecha" => "2012" "volumen" => "44" "paginaInicial" => "2518" "paginaFinal" => "2520" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23146441" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Kidney from uncontrolled donors after cardiac death with one hour warm ischemic time: resuscitation by extracorporal normothermic abdominal perfusion “in situ” by leukocytes-free oxygenated blood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "O. Reznik" 1 => "A. Skvortsov" 2 => "I. Loginov" 3 => "A. Ananyev" 4 => "S. Bagnenko" 5 => "Y. Moysyuk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1399-0012.2010.01333.x" "Revista" => array:6 [ "tituloSerie" => "Clin Transplant" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "511" "paginaFinal" => "516" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20973824" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000003700000004/v1_201307160921/S2173572713000386/v1_201307160921/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/0000003700000004/v1_201307160921/S2173572713000386/v1_201307160921/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572713000386?idApp=WMIE" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 14 | 18 |
| 2024 October | 48 | 57 | 105 |
| 2024 September | 55 | 45 | 100 |
| 2024 August | 54 | 53 | 107 |
| 2024 July | 53 | 42 | 95 |
| 2024 June | 46 | 46 | 92 |
| 2024 May | 39 | 47 | 86 |
| 2024 April | 52 | 36 | 88 |
| 2024 March | 40 | 39 | 79 |
| 2024 February | 36 | 37 | 73 |
| 2024 January | 38 | 40 | 78 |
| 2023 December | 27 | 42 | 69 |
| 2023 November | 55 | 44 | 99 |
| 2023 October | 32 | 46 | 78 |
| 2023 September | 32 | 48 | 80 |
| 2023 August | 33 | 31 | 64 |
| 2023 July | 29 | 42 | 71 |
| 2023 June | 29 | 25 | 54 |
| 2023 May | 46 | 36 | 82 |
| 2023 April | 35 | 18 | 53 |
| 2023 March | 56 | 40 | 96 |
| 2023 February | 56 | 38 | 94 |
| 2023 January | 52 | 29 | 81 |
| 2022 December | 76 | 41 | 117 |
| 2022 November | 54 | 40 | 94 |
| 2022 October | 49 | 63 | 112 |
| 2022 September | 44 | 45 | 89 |
| 2022 August | 39 | 51 | 90 |
| 2022 July | 41 | 41 | 82 |
| 2022 June | 34 | 39 | 73 |
| 2022 May | 50 | 48 | 98 |
| 2022 April | 42 | 57 | 99 |
| 2022 March | 71 | 75 | 146 |
| 2022 February | 73 | 46 | 119 |
| 2022 January | 90 | 46 | 136 |
| 2021 December | 50 | 57 | 107 |
| 2021 November | 68 | 48 | 116 |
| 2021 October | 69 | 70 | 139 |
| 2021 September | 46 | 55 | 101 |
| 2021 August | 51 | 54 | 105 |
| 2021 July | 43 | 63 | 106 |
| 2021 June | 47 | 47 | 94 |
| 2021 May | 62 | 56 | 118 |
| 2021 April | 134 | 83 | 217 |
| 2021 March | 99 | 36 | 135 |
| 2021 February | 86 | 30 | 116 |
| 2021 January | 69 | 38 | 107 |
| 2020 December | 63 | 20 | 83 |
| 2020 November | 49 | 19 | 68 |
| 2020 October | 63 | 32 | 95 |
| 2020 September | 55 | 26 | 81 |
| 2020 August | 43 | 21 | 64 |
| 2020 July | 45 | 18 | 63 |
| 2020 June | 56 | 24 | 80 |
| 2020 May | 33 | 20 | 53 |
| 2020 April | 48 | 28 | 76 |
| 2020 March | 17 | 17 | 34 |
| 2020 February | 95 | 42 | 137 |
| 2020 January | 49 | 31 | 80 |
| 2019 December | 42 | 40 | 82 |
| 2019 November | 30 | 29 | 59 |
| 2019 October | 81 | 27 | 108 |
| 2019 September | 36 | 26 | 62 |
| 2019 August | 36 | 22 | 58 |
| 2019 July | 69 | 34 | 103 |
| 2019 June | 43 | 21 | 64 |
| 2019 May | 54 | 79 | 133 |
| 2019 April | 51 | 28 | 79 |
| 2019 March | 37 | 29 | 66 |
| 2019 February | 36 | 31 | 67 |
| 2019 January | 31 | 29 | 60 |
| 2018 December | 43 | 39 | 82 |
| 2018 November | 92 | 43 | 135 |
| 2018 October | 54 | 29 | 83 |
| 2018 September | 25 | 5 | 30 |
| 2018 August | 27 | 6 | 33 |
| 2018 July | 31 | 5 | 36 |
| 2018 June | 36 | 10 | 46 |
| 2018 May | 23 | 4 | 27 |
| 2018 April | 34 | 7 | 41 |
| 2018 March | 27 | 3 | 30 |
| 2018 February | 30 | 6 | 36 |
| 2018 January | 31 | 6 | 37 |
| 2017 December | 23 | 5 | 28 |
| 2017 November | 22 | 7 | 29 |
| 2017 October | 27 | 6 | 33 |
| 2017 September | 28 | 6 | 34 |
| 2017 August | 18 | 8 | 26 |
| 2017 July | 33 | 5 | 38 |
| 2017 June | 42 | 13 | 55 |
| 2017 May | 29 | 10 | 39 |
| 2017 April | 42 | 13 | 55 |
| 2017 March | 21 | 2 | 23 |
| 2017 February | 33 | 9 | 42 |
| 2017 January | 24 | 6 | 30 |
| 2016 December | 41 | 11 | 52 |
| 2016 November | 53 | 17 | 70 |
| 2016 October | 58 | 19 | 77 |
| 2016 September | 36 | 6 | 42 |
| 2016 August | 32 | 6 | 38 |
| 2016 July | 23 | 6 | 29 |
| 2016 June | 1 | 0 | 1 |
| 2016 May | 2 | 0 | 2 |
| 2016 February | 3 | 0 | 3 |
| 2015 December | 2 | 0 | 2 |
Show all
