Brain death and postmortem organ donation: report of a questionnaire from the CENTER-TBI study

BACKGROUND: We aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation.METHODS: Investigators from 67 Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study centers completed several questionnaires (response rate: 99%).RESULTS: Regarding practices around brain death, we found agreement on the clinical evaluation (prerequisites and neurological assessment) for brain death determination (BDD) in 100% of the centers. However, ancillary tests were required for BDD in 64% of the centers. BDD for nondonor patients was deemed mandatory in 18% of the centers before withdrawing life-sustaining measures (LSM). Also, practices around postmortem organ donation varied. Organ donation after circulatory arrest was forbidden in 45% of the centers. When withdrawal of LSM was contemplated, in 67% of centers the patients with a ventricular drain in situ had this removed, either sometimes or all of the time.CONCLUSIONS: This study showed both agreement and some regional differences regarding practices around brain death and postmortem organ donation. We hope our results help quantify and understand potential differences, and provide impetus for current dialogs toward further harmonization of practices around brain death and postmortem organ donation.</p

Bioethical implications of end-of-life decision-making in patients with dementia:a tale of two societies

End-of-life decision-making in patients with dementia is a complex topic. Belgium and the Netherlands have been at the forefront of legislative advancement and progressive societal changes concerning the perspectives toward physician-assisted death (PAD). Careful consideration of clinical and social aspects is essential during the end-of-life decision-making process in patients with dementia. Geriatric assent provides the physician, the patient and his family the opportunity to end life with dignity. Unbearable suffering, decisional competence, and awareness of memory deficits are among the clinical considerations that physicians should incorporate during the end-of-life decision-making process. However, as other societies introduce legislature granting the right of PAD, new social determinants should be considered; Mexico City is an example. Current perspectives regarding advance euthanasia directives (AED) and PAD in patients with dementia are evolving. A new perspective that hinges on the role of the family and geriatric assent should help culturally heterogeneous societies in the transition of their public health care policies regarding end-of-life choices.</p

hospital factory for manufacturing customised patient specific 3d anatomo functional models and prostheses

The fabrication of personalised prostheses tailored on each patient is one of the major needs and key issues for the future of several surgical specialties. Moreover, the production of patient-specific anatomo-functional models for preoperative planning is an important requirement in the presence of tailored prostheses, as also the surgical treatment must be optimised for each patient. The presence of a prototyping service inside the hospital would be a benefit for the clinical activity, as its location would allow a closer interaction with clinicians, leading to significant time and cost reductions. However, at present, these services are extremely rare worldwide. Based on these considerations, we investigate enhanced methods and technologies for implementing such a service. Moreover, we analyse the sustainability of the service and, thanks to the development of two prototypes, we show the feasibility of the production inside the hospital

Impact of the coronavirus disease 2019 (COVID-19) pandemic on the care of patients with acute and chronic aortic conditions

10.1093/ejcts/ezaa452European Journal of Cardio-thoracic Surgery5951096-110