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liver&#44; lungs&#44; etc&#46;&#41;&#44; is an important potential source of organs&#44; along with brain dead donation &#40;DBD&#41;&#8212;which to date has represented the main source of donations in our setting&#44; and which likewise allows the harvesting of tissues and organs &#40;kidneys&#44; liver&#44; pancreas&#44; heart&#44; lungs&#44; etc&#46;&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">With the purpose of offering an adequate framework for the development of multiple NHBD programs in our country&#44; the Spanish National Organization of Transplants &#40;<span class="elsevierStyleItalic">Organizaci&#243;n Nacional de Trasplantes</span> &#91;ONT&#93;&#41; developed a consensus document for NHBD<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> in 2012&#44; with the opportune and necessary ethical and legal considerations&#46; Cardiocirculatory death is defined as the irreversible cessation of cardiac function&#44; 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modified&#41;&#44; in view of the importance of establishing whether cardiac arrest &#40;CA&#41; occurs in the out- or in-hospital setting&#46; Type <span class="elsevierStyleSmallCaps">I</span> corresponds to patients suffering sudden death &#40;of traumatic origin or otherwise&#41; occurring out of hospital&#44; and which for obvious reasons are not amenable to resuscitation&#46; Type <span class="elsevierStyleSmallCaps">II</span> corresponds to patients that suffer CA and are subjected to resuscitation maneuvering that proves unsuccessful&#46; These cases in turn are subclassified into Type IIa &#40;out-hospital CA&#41; and Type IIB &#40;in-hospital CA&#41;&#46; Type <span class="elsevierStyleSmallCaps">III</span> corresponds to patients in which CA is expected in view of the seriousness of the clinical condition&#44; and in which the limitation of life support treatment &#40;LLST&#41; is decided in agreement with the family or the pre-stated will of the patient&#46; It is important to distinguish LLST from donation as two independent processes&#58; in effect&#44; the decision to apply LLST is first made in agreement with the family and&#47;or relatives and the medical team&#44; and once this decision has been made&#44; the possibility of donation after death is commented with the family or patient&#46; Lastly&#44; Type <span class="elsevierStyleSmallCaps">IV</span> corresponds to patients that suffer CA during or after the diagnosis of brain death&#46; Donation can also be classified as either controlled or non-controlled&#44; in reference to the likeliness of CA&#44; and which can lead to the decision to adopt earlier preservation measures in a &#8220;controlled&#8221; manner&#8212;with the consequent shortening of the ischemia times&#46; Types <span class="elsevierStyleSmallCaps">I</span> and <span class="elsevierStyleSmallCaps">II</span> are regarded as &#8220;non-controlled&#8221; donors&#44; while types <span class="elsevierStyleSmallCaps">III</span> and <span class="elsevierStyleSmallCaps">IV</span> are regarded as &#8220;controlled&#8221; donors&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In Spain&#44; the drafting of the <span class="elsevierStyleItalic">Spanish consensus document on organ harvesting from non-heart beating donors</span>&#44; published in 1995&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> and the legal reform embodied in Spanish Royal Decree 2070&#47;1999&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a> made it possible for certain hospital centers to develop type <span class="elsevierStyleSmallCaps">II</span> non-heart beating donation programs&#44; with increasingly better outcomes&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">6&#8211;10</span></a> Type <span class="elsevierStyleSmallCaps">III</span> non-heart beating donation has been the procedure routinely used in Europe&#44; the United States&#44; Canada and Australia&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">11&#44;12</span></a> Very good outcomes have been recorded in terms of both survival of the graft and of the patient receiving the organ&#44; in the case of kidney&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">13</span></a> liver<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">14</span></a> and lung transplants&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In order to clarify the terminology referred to donors in the course of the donation process&#44;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">16&#44;17</span></a> &#8220;possible donors&#8221; are defined as patients with serious brain damage or with circulatory failure and no apparent medical contraindications to organ donation&#46; In turn&#44; &#8220;potential donors&#8221; are patients in which circulatory function has ceased and in which resuscitation maneuvers will not be started or continued&#44; or individuals in which the cessation of circulatory function is expected in a period of time allowing the harvesting of organs for transplantation&#46; &#8220;Eligible donors&#8221; are those without medical contraindications to donation&#44; in which death has been evidenced by the irreversible cessation of circulatory function as established by current legislation&#44; and in a period of time allowing the harvesting of organs for transplantation&#46; &#8220;Real donors&#8221; are eligible donors in which consent to donation has been obtained and where a surgical incision has been made for the harvesting of organs for transplantation&#44; or in which at least one organ has been harvested for transplantation&#46; Lastly&#44; &#8220;used donors&#8221; are real donors from which at least one organ has been transplanted&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Many patients that die in hospital and which could be candidates for NHBD are lost in practice&#46; Knowing the number of potential NHBD cases we could detect&#44; as well as their characteristics and origin&#44; may provide an orientation as to how to implement an NHBD program and which hospital Departments should be targeted in this context&#46; On the other hand&#44; we could explore whether it is possible to identify the subgroups of patients that are most likely to be potential non-heart beating donors&#44; and to identify the most frequent contraindications to NHBD that might be avoided by adopting certain protocols in the hospital &#40;such as LLST or sepsis protocols&#41;&#46; The present study was therefore carried out to&#58; determine the number of potential donors among people suffering cardiocirculatory death between 2006 and 2014 in Elche University General Hospital &#40;Alicante&#44; Spain&#41; &#40;Health Department 20 of the Valencian Community&#41;&#59; identify the Departments of origin of the potential donors&#59; analyze the potential donors according to category &#40;type <span class="elsevierStyleSmallCaps">II</span> and type <span class="elsevierStyleSmallCaps">III</span>&#41; and organ viability&#59; and study those characteristics related to the contraindications that result in an increased loss of potential donors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Patients and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">A cross-sectional retrospective study was made of all adult cardiocirculatory deaths recorded between 2006 and 2014 in Elche University General Hospital&#46; The NHBD project was approved by the Ethics Committee of our hospital for the development of the full NHBD program&#46; The present study constitutes a preamble to implementation of the program&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We first generated a list of all the deceased patients from the mortality records of our hospital corresponding to the period 2006&#8211;2014&#46; Using the electronic case history database of our hospital&#44; which includes the codes of all diagnoses referred to all diseases in International Classification of Diseases &#8211; Ninth Edition &#40;ICD-9&#41; format&#44; we selected those patients between 15 and 65 years of age that did not meet the general exclusion criteria referred to donor candidates&#44; based on the recommendations of the ONT<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">18&#44;19</span></a> &#40;document on infections and tumors of the ONT specifying those chronic infections and tumors that discard possible donation&#41; and documented in the electronic case history &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The acute infections contraindicating donation were subsequently reviewed on examining the case history in paper format&#44; in order to determine whether the acute infection was active at the time of death or was a disease antecedent&#8212;i&#46;e&#46;&#44; a condition of the past and which at the time of death would not have constituted a contraindication to donation&#46; We also excluded those patients that died according to neurological criteria &#40;brain death&#41;&#44; and those cases in which access to the full clinical information did not prove possible&#46; A detailed review was made of the case histories of all the selected patients&#44; which were divided into two groups&#58; type <span class="elsevierStyleSmallCaps">II</span> possible non-heart beating donors &#40;NHBDII&#41;&#40;those dying of unexpected CA&#41;&#44; or type <span class="elsevierStyleSmallCaps">III</span> possible non-heart beating donors &#40;NHBDIII&#41;&#40;those in which LLST was considered before death&#41;&#46; We discarded those cases meeting other general exclusion criteria &#40;acute infection&#44; organ failure&#44; sepsis&#44; etc&#46;&#44; at the time of death&#41; and those meeting some specific exclusion criterion for each type of donation&#58; in the case of NHBDII this would be CA not witnessed&#44; while in the case of NHBDIII it would correspond to a time of over 120<span class="elsevierStyleHsp" style=""></span>min between LLST and CA&#46; We reviewed the type of LLST &#40;withdrawal of treatments&#44; no new life support treatment measures&#44; no admission to the Intensive Care Unit &#91;ICU&#93;&#44; instructions against resuscitation&#44; etc&#46;&#41;&#46; It should be noted that no type <span class="elsevierStyleSmallCaps">III</span> NHBD program had been implemented up to that time&#59; as a result&#44; it was to be expected that patients with LLST would not have undergone any resuscitation maneuvering&#46; This in turn would imply a lack of information referred to parameters such as resuscitation time&#44; critical ischemia time&#44; etc&#46;&#44; since maneuvers causing discomfort &#40;e&#46;g&#46;&#44; the recording of vital signs&#41; are avoided in patients of this kind&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Lastly&#44; we assessed pre-CA viability of the organs of the potential donors &#40;lungs&#44; kidneys and liver&#41;&#46; The contraindications to kidney donation were the presence of chronic renal failure &#40;chronic serum creatinine or urea elevation&#44; with creatinine clearance &#60;60<span class="elsevierStyleHsp" style=""></span>ml&#47;min according to the Cockroft formula&#41;&#44; the presence of proteinuria in the nephrotic range &#40;&#62;0&#46;5<span class="elsevierStyleHsp" style=""></span>g&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; and primary kidney disease &#40;diabetic nephropathy&#44; hypertensive disease&#44; polycystosis&#44; etc&#46;&#41;&#46; In the case of the liver&#44; we considered the following contraindications&#58; previous liver disease &#40;cirrhosis&#44; steatosis &#62;40&#37;&#44; hepatic polycystosis&#44; chronic hepatitis&#41;&#44; non-controlled intraabdominal infection&#44; intoxications with liver involvement&#44; and liver rupture or trauma&#46; Lastly&#44; the following contraindications were considered in relation to lung donation&#58; age over 55 years&#44; chronic lung disease and trauma&#44; a history of chest surgery&#44; presence of lung infiltrates on chest X-rays&#44; bronchoaspiration and&#47;or purulent secretions&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Qualitative variables were expressed as proportions and quantitative variables as the median and percentiles &#40;P25 and P75&#41;&#46; The comparison of quantitative variables was carried out using the Student <span class="elsevierStyleItalic">t</span>-test&#44; while qualitative variables were compared using the chi-squared test&#46; The identification of factors associated to greater or lesser contraindication to donation in general was based on the generation of a binary logistic regression predictive model&#46; Statistical significance was considered for <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The SPSS version 19 statistical package was used throughout&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">A total of 1510 patients died in our center during the study period&#46; Of these patients&#44; 462 met the inclusion criteria according to age and electronic diagnostic code&#46; Eighty-six patients &#40;18&#46;6&#37;&#41; evolved toward BD&#44; and in 20 cases the case history could not be retrieved&#8212;these subjects being excluded from the study&#46; We subsequently reviewed the case histories of the remaining 356 patients&#44; discarding those meeting donation exclusion criteria&#46; In accordance to the type of death&#44; 288 of these patients corresponded to possible NHBDII and 68 to possible NHBDIII&#46; Following detailed review of the case histories&#44; we identified 70 potential NHBDII and 10 potential NHBDIII during the 9-year study period &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; On considering the mean rejection rate in our hospital during those years &#40;9&#46;3&#37;&#59; data not published&#41;&#44; we could assume an average of 8&#46;9 donors a year in the context of NHBD&#46; On extrapolating these data to the recruitment population of our hospital &#40;approximately 170&#44;000 inhabitants&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a> it may be concluded that there was an increase of 47 donors per million population &#40;pmp&#41;&#46; The time course of the potential NHBD &#40;types <span class="elsevierStyleSmallCaps">II</span> and <span class="elsevierStyleSmallCaps">III</span>&#41; calculated with respect to the real brain dead donors are shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The main Departments implicated in possible NHBDII were the Intensive Care Unit &#40;32&#46;3&#37;&#41;&#44; followed by Internal Medicine &#40;14&#46;1&#37;&#41;&#44; the Postanesthesia Resuscitation Unit &#40;13&#46;8&#37;&#41;&#44; Digestive Diseases &#40;13&#46;8&#37;&#41; and Emergency Care &#40;10&#46;4&#37;&#41;&#46; The Departments implicated in possible NHBDIII were the Intensive Care Unit &#40;42&#46;6&#37;&#41;&#44; followed by Internal Medicine &#40;20&#46;6&#37;&#41;&#44; Digestive Diseases &#40;11&#46;7&#37;&#41;&#44; Neurology&#8212;Neurosurgery &#40;10&#46;3&#37;&#41; and Pneumology &#40;6&#37;&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">As regards the type of LLST&#44; the decision not to introduce new life support treatments was made in 59&#37; of the cases&#44; with the withdrawal of life support measures in 10&#37;&#44; and discharge from the ICU in 4&#37;&#46; In 26&#46;5&#37; of the cases no limitation measures were stated in the case history &#40;though this information was recorded by the nursing staff&#41;&#46; With regard to the time elapsed from the decision referred to LLST and patient death&#44; we only obtained information corresponding to 26 patients&#44; where the median was found to be 24<span class="elsevierStyleHsp" style=""></span>h &#40;P<span class="elsevierStyleInf">25</span>&#58; 1&#46;75&#59; P<span class="elsevierStyleInf">75</span>&#58; 48&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">On comparing NHBDII versus NHBDIII &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; we recorded a greater proportion of males in the former group&#44; though statistical significance was not reached&#46; Significantly longer stays were recorded in NHBDIII&#44; and these patients died more often in the hospital ward&#44; with a greater proportion of neurological disease upon admission&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">With regard to organ viability&#44; the organs potentially amenable to donation comprised 77 livers&#44; 34 lungs and 138 kidneys&#46; The causes of non-viable livers were&#58; three cases of cirrhosis and one case of acute hepatitis&#46; The lungs were found to be non-viable in 58 patients&#44; due to the following reasons&#58; age in 27 cases&#44; acute lung edema in 12&#44; severe chronic obstructive pulmonary disease in 10&#44; pulmonary thromboembolism in four&#44; pulmonary hypertension in three&#44; pneumonia in 5&#44; cystic fibrosis in one&#44; and acute respiratory distress syndrome in one patient&#46; With regard to the kidneys&#44; donation was not viable in 11 patients due to the presence of chronic renal failure&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">On examining the causes of contraindication to donation according to the Department attending the patient &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; multiorgan failure &#40;MOF&#41; due to sepsis was seen to predominate&#44; followed by shock and infection&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the variables exhibiting differences on comparing the groups with contraindications versus those without contraindications&#44; based on the univariate analysis&#46; On entering these variables in the logistic regression model&#44; with contraindications to donation as the dependent variable&#44; the results identified the following parameters as protectors against contraindication &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#58; patient death in the emergency room&#44; cardiological disease&#44; admission due to CA&#44; respiratory and neurological disease upon admission&#44; and CA during hospital stay&#46; The variable death in the Department of Internal Medicine was associated to an increased risk of contraindications to donation&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The donation potential of the NHBD programs in Spain has not been fully established&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">21&#44;22</span></a> The experience of San Carlos Clinic Hospital&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> involving very strict screening criteria&#44; indicates that the number of used donors from NHBD programs is currently in the range of 15&#8211;16 donors pmp&#46; Barcelona Clinic Hospital<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a> offers similar figures&#44; in the order of 13 real donors pmp&#46; The data are almost exclusively referred to out-hospital cardiac arrest NHBD cases&#46; There are not enough data regarding donation following LLST&#46; In our study we have estimated 80 potential type <span class="elsevierStyleSmallCaps">II</span> and <span class="elsevierStyleSmallCaps">III</span> NHBD in the 9-year study period &#40;2006&#8211;2014&#41;&#46; On considering the mean rejection rate in our hospital during those years &#40;9&#46;3&#37;&#41;&#44; we could assume an average of 8&#46;9 donors a year in the context of NHBD&#46; A full 87&#46;5&#37; of the increment would be at the expense of NHBDII&#44; while the remaining 12&#46;5&#37; would correspond to NHBDIII&#46; On extrapolating these data to the recruitment population of our hospital &#40;approximately 170&#44;000 inhabitants&#41;&#44; this may imply an increase of 47 donors pmp&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">As regards the characteristics of the patients studied&#44; it is logical for NHBDIII cases to show longer stays than NHBDII patients&#46; In effect&#44; they are individuals in which it takes some time to consider LLST&#44; since the majority do not have treatment limitations upon admission&#44; and LLST is contemplated only as their clinical course becomes extremely unfavorable&#46; Such NHBDIII cases also die more often in the ICU and in the hospital ward &#40;particularly Neurology&#8212;Neurosurgery&#41;&#44; since it is in these Departments where LLST is considered after a period of maximum therapeutic effort&#44; as evidenced by some recent studies&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">A large proportion of potential NHBDIII patients are carriers of multiresistant microorganisms &#40;MOF&#41;&#8212;this being related to their longer hospital stay&#46; The leading contraindication to donation in both groups is the presence of MOF due to sepsis&#46; This suggests that the early detection and treatment of sepsis in the hospital setting&#44; even in patients with LLST&#44; could result in fewer contraindications among the potential donors&#46; In the specific case of NHBDIII&#44; the next most common contraindication to donation would be a time from LLST to death of over 120<span class="elsevierStyleHsp" style=""></span>min&#46; In this regard&#44; an adequate LLST protocol&#44;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">25&#44;26</span></a> with adequate diffusion among the implicated Departments&#44; could improve the process and the recording of LLST&#44; since we found that such records often do not exist &#40;no indication in 26&#37; of the cases&#41;&#44; or the data are very scarce &#40;limited to not performing resuscitation maneuvers in most cases &#91;no CPR in 48&#37;&#93;&#41;&#46; Of note is the observation that we recorded no NHBDIII cases in the emergency and resuscitation services&#44; since no patient with LLST was registered&#46; In the case of emergency care&#44; these data do not coincide with the findings of a study carried out in France and Belgium&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> where up to 45&#37; of the patients over 65 years of age were indeed subjected to LLST upon admission to the emergency room&#46; This may be explained by the limited diffusion of living wills or advanced directives in Spain&#44; and the tendency toward low LLST rates as evidenced by the Ethicus study<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> in the Mediterranean areas&#46; With regard to the patients admitted to resuscitation&#44; LLST probably is applied but is not recorded&#44; and the case is referred to the surgical departments&#44; where LLST is then effectively registered&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In relation to the contraindications to donation in both NHBD groups&#44; we found that patients admitted to Internal Medicine and Digestive Diseases had a greater percentage of contraindications&#46; Following a detailed review of the data&#44; we found that this was due to a large incidence of infectious disease with MOF in Internal Medicine and Digestive Diseases&#44; and a large number of patients with MOF secondary to terminal liver disorders in Digestive Diseases&#46; Patients admitted to the ICU and the emergency service had a lesser proportion of contraindications to donation&#46; There were significantly fewer contraindications in patients admitted due to cardiac arrest&#44; cardiological disease &#40;no CA&#41; and respiratory illness&#46; On the other hand&#44; there was a greater proportion of contraindications in the patients with gastrointestinal disease upon admission&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As a protective factor against contraindications to donation&#44; we identified patient death in the emergency service&#44; while death in Internal Medicine was identified as a risk factor for the presence of contraindications to donation&#46; Patients dying in emergency care have fewer contraindications&#44; since hospital stay is shortened by passing through this service&#58; the patients are not moved to the hospital ward&#44; and they consequently have fewer evolutive complications and nosocomial infections&#8212;particularly those admitted under conditions of CA&#46; On the other hand&#44; patients in Internal Medicine often have associated comorbidities&#44; and this Department moreover has a specific area for infectious patients under their care&#46; The observed result is therefore logical considering the type of disorders involved&#46; It also must be taken into account that a form of LLST is the decision not to admit patients to services such as ICU but to refer them to areas such as Internal Medicine&#46; These are typically elderly patients with multiple disease conditions&#44; and with many chances of having contraindications to donation in general&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">The estimates referred to donation potential&#44; and specifically the percentage losses due to family refusal&#44; are limited by the fact that the historical rejection rates are extrapolated from family refusals recorded in those years among brain dead donors&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In Spain&#44; it is known that the family refusal rates in type <span class="elsevierStyleSmallCaps">II</span> NHBD are in the order of 6&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a> while data referred to type <span class="elsevierStyleSmallCaps">III</span> NHBD are not yet available&#46; These rejection rates may vary among different types of donors&#59; this fact therefore could be regarded as a limitation of our study&#46; With regard to organ viability&#44; due consideration is required of the number of organs considered not valid after macroscopic assessment by the surgical team&#46; This aspect was logically not evaluable in our study&#59; the data obtained therefore probably overestimate the real number of organs for transplantation&#46; It also must be mentioned that we did not take into consideration the possible losses due to prolonged resuscitation or ischemia times in maintaining these potential donors&#44; since patients with LLST are not subjected to such maneuvers&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In contraposition&#44; the fact that we found very poor and scarce &#40;or inexistent&#41; LLST records suggests that the real number of patients with LLST is underestimated&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; and despite all the limitations involved&#44; it seems useful to incorporate an NHBDII and NHBDIII protocol in our hospital&#44; considering that we could increase our donation activity by 47 donors pmp&#46; These patients mainly originate from the Department of Intensive Care Medicine&#44; the emergency service&#44; resuscitation units&#44; Internal Medicine&#44; Digestive Diseases and Neurology&#46; The most frequent cause of contraindication to NHBD in general is the development of MOF due to sepsis&#44; and in the specific case of NHBDIII the leading cause is a prolonged time between LLST and patient death&#46; These data&#44; together with poor specification of the treatment measures to be limited&#44; suggest that developing and improving the hospital sepsis and LLST protocols would be of great help in improving the performance and yield of an NHBD program&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authorship</span><p id="par0140" class="elsevierStylePara elsevierViewall">Ms&#46; Eva Tenza has carried out the study entitled&#58; <span class="elsevierStyleItalic">Estimation of potential donors after cardiocirculatory death in Elche University General Hospital &#40;Alicante&#44; Spain&#41;</span> as an end of Master project corresponding to the course 2014&#8211;2015&#44; within the Master in Research in Organ Donation and Transplantation of the University of Barcelona&#46; This study has not been submitted for publication to date&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Mr&#46; Ricard Valero and Mr&#46; Vicente Arraez contributed as directors of the project and participated in the review of the manuscript&#46; All of them agree to the final version of the article&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-03-17"
    "fechaAceptado" => "2016-08-25"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec823546"
          "palabras" => array:4 [
            0 => "Cardiocirculatory donors"
            1 => "Potential donors"
            2 => "Limitation of life-sustaining treatments"
            3 => "Cardiocirculatory death"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec823547"
          "palabras" => array:4 [
            0 => "Donaci&#243;n en asistolia"
            1 => "Potenciales donantes"
            2 => "Limitaci&#243;n de tratamientos de soporte vital"
            3 => "Muerte cardiocirculatoria"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the number and characteristics of potential organ donors among cardiocirculatory death cases&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design and setting</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational study was made of individuals between 15 and 65 years of age who died in the period 2006&#8211;2014 in Elche University General Hospital &#40;Alicante&#44; Spain&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Intervention</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A univariate analysis and binary logistic regression predictive model were performed to discriminate factors related to donation contraindication&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Variables of interest</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Identification of patients with donation contraindication&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Of the 1510 patients who died in the mentioned period&#44; 1048 were excluded due to the application of exclusion criteria&#59; 86 due to evolution toward brain death&#59; and 20 due to losses&#46; A total of 356 patients were analyzed&#44; divided into two groups&#58; 288 in non-heart beating donation II and 68 in non-heart beating donation III&#46; Seventy patients were found to be potential non-heart beating donation II and 10 were found to be potential non-heart beating donation III&#44; which could increase donation activity by 8&#8211;9 donors a year&#46; The patients died in the ICU&#44; Resuscitation&#44; Emergency Care&#44; Internal Medicine&#44; Digestive Diseases and Neurology&#46; The following protective factors against organ donation contraindication were identified&#58; death in Emergency Care&#44; cardiorespiratory arrest before or during admission&#44; and heart&#44; respiratory and neurological disease as the cause of admission&#46; Death in Internal Medicine was associated to an increased risk of donation contraindication&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Implementing a non-heart beating donation protocol in our hospital could increase the donation potential by 8&#8211;9 donors a year&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Design and setting"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Intervention"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Variables of interest"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Results"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclusions"
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        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estimar el n&#250;mero y las caracter&#237;sticas de potenciales donantes de &#243;rganos de personas fallecidas por muerte cardiocirculatoria&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Dise&#241;o y &#225;mbito</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo observacional de los fallecidos entre 15-65 a&#241;os entre el 2006 y 2014 en el Hospital General Universitario de Elche&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Intervenci&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Realizaci&#243;n de an&#225;lisis univariante y modelo predictivo de regresi&#243;n log&#237;stica binaria para discriminar los factores relacionados con la contraindicaci&#243;n para la donaci&#243;n&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Variables de inter&#233;s</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Identificar los pacientes con contraindicaciones para la donaci&#243;n&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">De los 1&#46;510 pacientes fallecidos se excluyeron 1&#46;048 por criterios cr&#243;nicos de exclusi&#243;n&#44; 86 por evolucionar a muerte encef&#225;lica y 20 por p&#233;rdidas&#46; Se analizaron 356 pacientes en 2 grupos&#58; 288 en donaci&#243;n en asistolia <span class="elsevierStyleSmallCaps">ii</span> y 68 en donaci&#243;n en asistolia <span class="elsevierStyleSmallCaps">iii</span>&#46; Resultaron potenciales donantes en asistolia <span class="elsevierStyleSmallCaps">ii</span> 70 pacientes y 10 donantes en asistolia <span class="elsevierStyleSmallCaps">iii</span>&#44; lo que podr&#237;a incrementar la actividad de donaci&#243;n en 8-9 donantes&#47;a&#241;o&#46; Los pacientes fallecieron en&#58; UCI&#44; reanimaci&#243;n&#44; urgencias&#44; medicina interna&#44; digestivo y neurolog&#237;a&#46; Resultaron variables protectoras frente a contraindicaci&#243;n para la donaci&#243;n&#58; fallecer en urgencias&#44; parada cardiorrespiratoria previa o durante el ingreso&#44; la enfermedad cardiol&#243;gica&#44; respiratoria y neurol&#243;gica como causa de ingreso&#46; Fallecer en el servicio de medicina interna se asoci&#243; a un mayor riesgo de contraindicaciones para la donaci&#243;n&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Poner en marcha un protocolo de donaci&#243;n en asistolia en nuestro hospital podr&#237;a incrementar el potencial de donaci&#243;n en unos 8-9 donantes&#47;a&#241;o&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Dise&#241;o y &#225;mbito"
          ]
          2 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Intervenci&#243;n"
          ]
          3 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Variables de inter&#233;s"
          ]
          4 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Resultados"
          ]
          5 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Conclusiones"
          ]
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      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Tenza E&#44; Valero R&#44; Arraez V&#46; Estimaci&#243;n de potenciales donantes en muerte cardiocirculatoria en el Hospital General Universitario de Elche&#46; Med Intensiva&#46; 2017&#59;41&#58;153&#8211;161&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Flow chart of the analyzed patients&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Time course of the number of potential non-heart beating &#40;type II and III&#41; donors and real dead brain donors in our center&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Values reported as median&#44; percentile 25 and percentile 75&#44; or number &#40;percentage&#41;&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">MOF&#58; multiorgan failure&#59; &#62;120 LLST-death&#58; time between limitation of life support treatment and death &#62;120<span class="elsevierStyleHsp" style=""></span>min&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type II NHBD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>288&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type III NHBD &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>68&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;38&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;51&#59; 61&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;1&#59; 14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;7&#59; 23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Death in ward</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Internal Medicine&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;57&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Digestive Diseases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;10&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgery&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;4&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;10&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Death in ICU</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;42&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Death in emergency care</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Death in resuscitation</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Multiresistant organisms</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;10&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Contraindication to donation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">219 &#40;75&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;80&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">040&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Causes of contraindication</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>218&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;7&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infectious&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;11&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;5&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Systemic disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;2&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>MOF&#47;sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">124 &#40;56&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;44&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bleeding lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;3&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;11&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;5&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-witnessed CA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;120 LLST-death &#40;&#42;&#42;&#42;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;6&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Diagnosis upon admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiac arrest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;11&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;13&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;12&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;13&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;8&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;11&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infectious&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;16&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;11&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neurological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#40;9&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;17&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Digestive Disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70 &#40;24&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;23&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;17&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;7&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Ward &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>143&#41;</th><th class="td" title="table-head  " align="left" valign="top" scope="col">ICU &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">RESUS &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">EMERG &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Digestive Diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Neurology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systemic disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">MOF&#47;sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Bleeding lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Shock&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Non-witnessed CA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#62;120<span class="elsevierStyleHsp" style=""></span>min LLST-death&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Values reported as median&#44; percentile 25 and percentile 75&#44; or number &#40;percentage&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No contraindication &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Contraindication &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>276&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;48&#46;2&#59; 62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56 &#40;46&#46;2&#59; 61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex &#40;males&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;66&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">198 &#40;71&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Admission to ICU</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83 &#40;30&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Admission to resuscitation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;14&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Admission to emergency care</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;23&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Admission to ward</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143 &#40;51&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Internal Medicine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;18&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Digestive Diseases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neurology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;4&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18 &#40;6&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;6&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Multiresistant organisms</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">39 &#40;14&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Cause of admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiac arrest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;27&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;7&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;28&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;7&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;17&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;17&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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              "identificador" => "bib0145"
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                0 => array:3 [
                  "comentario" => "Available in&#58; <span class="elsevierStyleInterRef" id="intr0010" href="http://www.ont.es/infesp/Paginas/DocumentosdeConsenso.aspx">http&#58;&#47;&#47;www&#46;ont&#46;es&#47;infesp&#47;Paginas&#47;DocumentosdeConsenso&#46;aspx</span> &#91;reviewed 30&#46;05&#46;15&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Documento de Consenso Nacional sobre donaci&#243;n en asistolia &#91;Online&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Organizaci&#243;n Nacional de Trasplantes"
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                      ]
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                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2012"
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Guidelines for the determination of death&#46; Report of the medical consultants on the diagnosis of death to the President&#39;s Commission for the Study of Ethical Problems in Mecicine and Biomedical and Behavioral Research"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "1981"
                        "volumen" => "246"
                        "paginaInicial" => "2184"
                        "paginaFinal" => "2186"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7289009"
                            "web" => "Medline"
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                0 => array:1 [
                  "referenciaCompleta" => "Gobierno de Espa&#241;a&#46; Real Decreto 2070&#47;1999 del 30 de diciembre por el que se regula las actividades de obtenci&#243;n y utilizaci&#243;n cl&#237;nica de &#243;rganos humanos&#46;"
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                      "titulo" => "Statements on non-heart-beating donor programs"
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                        "tituloSerie" => "Transplant Proc"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7482979"
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                        "tituloSerie" => "Nefrolog&#237;a"
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