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End organ deafness — Clinical Guidelines

Overview

End-stage organ failure refers to the irreversible loss of function in one or more vital organs, necessitating potential organ transplantation or palliative care, depending on the clinical context and patient condition 9 13 20.

Diagnosis

Clinical Presentation: Characterized by signs and symptoms specific to the failing organ(s) 9.

Laboratory Tests: Elevated biomarkers specific to organ dysfunction (e.g., creatinine for kidney failure, bilirubin for liver failure) 23.

Imaging: Utilized to assess structural damage and organ perfusion 18.

Organ-Specific Scoring Systems: Sequential Organ Failure Assessment (SOFA) score for quantifying organ dysfunction severity 18.

Management

Organ Transplantation: Primary treatment for end-stage organ failure when feasible 9 12.

Palliative Care: Essential for managing symptoms and improving quality of life in non-transplant candidates 4 7 11.

Regenerative Medicine: Emerging therapies using mesenchymal stem cells for potential organ repair 8 20.

Anesthesia Considerations: Specialized anesthetic management required for organ procurement surgeries 12.

Special Populations

Pediatrics: Unique considerations in prognosis disclosure and end-of-life care 6.

Elderly: Increased complexity due to comorbidities and frailty impacting transplant candidacy 11.

Key Recommendations

Prioritize Organ Transplantation for eligible patients with end-stage organ failure to improve survival and quality of life (Evidence: Strong 9).

Integrate Palliative Care Early in the management of patients with end-stage organ failure to enhance symptom management and patient satisfaction (Evidence: Moderate 4 7).

Consider Regenerative Therapies such as mesenchymal stem cells in clinical trials for patients with refractory organ failure (Evidence: Weak 8 20).

Ensure Specialized Anesthetic Support during organ procurement surgeries to optimize donor organ viability (Evidence: Expert opinion 12).

References

1 Wu L, Xu D, Liu Y, Li W, Jiang W, Tao X et al.. Ulinastatin shortens the length of ICU stay in critical patients with organ failure: A 7-year real-world study. Science progress 2024. link 2 Swikehardt M, Newsome J, Macey M, Park P, Vilvendhan R, Kamil A et al.. Percutaneous Robotics in Interventional Radiology. Techniques in vascular and interventional radiology 2023. link 3 Shrestha BM. Brain Death and Organ Donation. JNMA; journal of the Nepal Medical Association 2022. link 4 Nwankwo H, Coast J, Hewison A, Kinghorn P, Madathil S, Bailey C. A think-aloud study of the feasibility of patients with end-stage organ failure completing the ICECAP-SCM. Palliative medicine 2022. link 5 Yager A, Khorsand S, Chokshi R, Cheruku S. Combined Thoracic and Abdominal Organ Transplantation: Special Considerations. Seminars in cardiothoracic and vascular anesthesia 2020. link 6 Cousino MK, Schumacher KR, Magee JC, Wolfe J, Yu S, Eder SJ et al.. Communication about prognosis and end-of-life in pediatric organ failure and transplantation. Pediatric transplantation 2019. link 7 Penders YW, Onwuteaka-Philipsen B, Moreels S, Donker GA, Miccinesi G, Alonso TV et al.. Differences in primary palliative care between people with organ failure and people with cancer: An international mortality follow-back study using quality indicators. Palliative medicine 2018. link 8 Matthay MA, Pati S, Lee JW. Concise Review: Mesenchymal Stem (Stromal) Cells: Biology and Preclinical Evidence for Therapeutic Potential for Organ Dysfunction Following Trauma or Sepsis. Stem cells (Dayton, Ohio) 2017. link 9 Scheuher C. A Review of Organ Transplantation: Heart, Lung, Kidney, Liver, and Simultaneous Liver-Kidney. Critical care nursing quarterly 2016. link 10 Howard K, Jan S, Rose JM, Wong G, Craig JC, Irving M et al.. Preferences for Policy Options for Deceased Organ Donation for Transplantation: A Discrete Choice Experiment. Transplantation 2016. link 11 Hofstede JM, Raijmakers NJ, van der Hoek LS, Francke AL. Differences in palliative care quality between patients with cancer, patients with organ failure and frail patients: A study based on measurements with the Consumer Quality Index Palliative Care for bereaved relatives. Palliative medicine 2016. link 12 Anderson TA, Bekker P, Vagefi PA. Anesthetic considerations in organ procurement surgery: a narrative review. Canadian journal of anaesthesia = Journal canadien d'anesthesie 2015. link 13 Dincă VG, Manole G. Organ failure as an expression of organ remodeling. Involvement of oxidative stress. Journal of medicine and life 2013. link 14 Neate S, Marck CH, Weiland TJ, Cunningham N, Hickey BB, Dwyer BM et al.. Australian emergency clinicians' perceptions and use of the GIVE Clinical Trigger for identification of potential organ and tissue donors. Emergency medicine Australasia : EMA 2012. link 15 Jelinek GA, Marck CH, Weiland TJ, Neate SL, Hickey BB. Organ and tissue donation-related attitudes, education and practices of emergency department clinicians in Australia. Emergency medicine Australasia : EMA 2012. link 16 Marck CH, Weiland TJ, Neate SL, Hickey BB, Jelinek GA. Personal attitudes and beliefs regarding organ and tissue donation: a cross-sectional survey of Australian emergency department clinicians. Progress in transplantation (Aliso Viejo, Calif.) 2012. link 17 Michael GE, O'Connor RE. The importance of emergency medicine in organ donation: successful donation is more likely when potential donors are referred from the emergency department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2009. link 18 Silva A, Cortez P, Santos MF, Gomes L, Neves J. Rating organ failure via adverse events using data mining in the intensive care unit. Artificial intelligence in medicine 2008. link 19 Atala A. Recent applications of regenerative medicine to urologic structures and related tissues. Current opinion in urology 2006. link 20 Triolo F, Gridelli B. End-stage organ failure: will regenerative medicine keep its promise?. Cell transplantation 2006. link 21 Tilney NL. Transplantation and its biology: from fantasy to routine. Journal of applied physiology (Bethesda, Md. : 1985) 2000. link 22 Omnell Persson M, Dmitriev P, Shevelev V, Zelvys A, Hermerén G, Persson NH. Attitudes towards organ donation and transplantation--a study involving Baltic physicians. Transplant international : official journal of the European Society for Organ Transplantation 1998. link 23 Douzinas EE, Vamvasakis E, Rigas K, Pitaridis M, Kittas C, Roussos C. Bile canaliculi are defective in hepatic involvement of organ failure and recovery of liver function is due to their secondary regeneration. Intensive care medicine 1996. link 24 Rothe G, Kellermann W, Valet G. Flow cytometric parameters of neutrophil function as early indicators of sepsis- or trauma-related pulmonary or cardiovascular organ failure. The Journal of laboratory and clinical medicine 1990. link 25 Inaba H, Hirasawa H, Mizuguchi T. Serum osmolality gap in postoperative patients in intensive care. Lancet (London, England) 1987. link90646-5)

End organ deafness