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To develop the deceased donor (DD) program was the most crucial strategy to against the organ trafficking transplant (Tx) in Vietnam (VN). In 2007, VN published the donation, removal and transplantation Law. Cho Ray Hospital (CRH) is a 3200 bed, special ranked, public hospital of the Ministry of Health. CRH has proceeded the living related donor kidney Tx since 1992, liver Tx since 2012 and heart Tx in 2017. CRH was the first hospital of VN proceeded the brain death DD kidney Tx from the son to his mother in 2008. A neurosurgical ICU of CRH was the most crowded department with mean of 2000-2500 admission cases per year, mainly head trauma due to vehicle accident. In 2014, the allocation unit (AU) of CRH was established and led the DD program through multiple activities with the media to the public. A hot line 24/7, table phone, webpage, fanpage and email of AU were set up to receive any call from the public. The aim of our study was to review the activities of AU in the DD organ-tissue donation, and transplantation at CRH.
A retrospective study was conducted at the AU of CRH. We reviewed all calls related to DD organ donation to the AU from June 2015 to August 2023. We reported the activities of AU via the number of potential donors, the real number DD, of organ donation, of organ transplanted at CRH or transferred to other hospitals.
Over 8 years, we received 179 calls related to organ donation (Table). Among 179 potential donors, mean age was 39 ±15 (min 15 yo, max 84 yo), mainly male 147/179 (82,12%). The majority of calls (114/179, 63,69%) originated from the Neurosurgical ICU of CRH. The rest was from other hospitals (6 inside HCMC in which 3 could performed kidney Tx and 3 outside HCMC) (figure). Through AU approaching, 140 (78.9%) refused, 39 (21.8%) accepted for tissue or organ donation.
Of 140 refused donation, 106/140 (75.7%) calls originated from health care providers (HCP), the rest (34, 24.3%) from the family potential donors. The reasons of refusing donation from HCP were (1) family refusion (88 cases), (2) medical problems (7 cases uncontrolled infections, 4 cases circulatory collapse), (3) inaccordance to VN law (1 too young to donate, 2 no brain death diagnosed by EEG, 3 recovered). Of 34 calls from the family, the causes of refusing donation were (1) medical problems (6 uncontrolled infections, 4 circulatory collapses, 2 cancers, 1 death on arrival of hospital, 1 severe multiple organ damage), (2) family refusion later (10 cases), (3) inaccordance to VN law (6 no brain death diagnosed by EEG, 3 too young to donate, 1 recovered).
Only 39 calls related to real DD donation (31 from family, 8 from HCP). The number of organ donation were 58 kidneys, 13 livers, 13 hearts, 1 heart-lungs block, 48 corneas, 2 skins. One kidney from an adult DD was allocated to one child. CRH transplanted 72 organs (58 kidneys, 7 livers, 7 hearts, 23 corneas). We transferred 13 organs (6 livers, 6 hearts, 1 heart-lungs block) to 4 other hospitals in the North and Middle of VN as CRH didn’t has the suitable recipients in our waitlist.
The development of the DD program attracted the progression of multiple organ transplantation at CRH. Family agreement is the opening key for the success of DD organ donation. A training program about organ donation could be concentrated to the health care providers in the ICU for early detection the potential donor, organ resuscitation, infection prevention, and timely informed the AU. The VN law should be considered to accept the brain cortex or brainstem death determination for donation, besides the recent full brain death with electrocerebral inactivity in EEG.