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© 2017 Wolters Kluwer
Results of Kidney Transplant From Donors With Sepsis-Induced
Acute Kidney Injury
Knowledge & Attitude of Health Staff on Deceased Donor Organ
Donation & Transplantation in a Sri Lankan Tertiary Care Setting
Agnieszka Wieczorek1, Małgorzata Lipińska-Gediga1,
Agnieszka Siebert1, Dariusz Patrzałek2
Anesthesia and Intensive Care, 4th Military Hospital, Wrocław, Poland;
Physiotherapy, Medical University Wroclaw, Wrocław, Poland.
Prasad Herath1, M.H.P. Godakandage1, W.A.N.N. Peries1,
L.P. Dilrukshi1, T.D.S. Gunasekera1, A.R.S. Fernando1,
N.H.E. Hareendra De Silva1, M.N. Danansuriya2, K.K.C. De Silva1,
Ruwan Dissanayake1
Transplant Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka;
Public Health Complex, Ministry of Health, Colombo, Sri Lanka.
Introduction: Acute kidney injury (AKI) is a syndrome comprising multiple
clinical conditions and the most common cause of AKI in critically ill patients
is sepsis. The pathophysiology of sepsis-induced AKI is complex and multifactorial. The functional consequences during sepsis-induced AKI are dramatic, the histological changes are moderate and do not entirely explain the
clinical status. Resolved septicemia is a relative contraindication to organ
Methods: Two young patients with brain injury were hospitalized on ICU and
both developed sepsis due to aspiration pneumonia. These patients were
around 30 years old and had no medical history before this hospitalization.
The antibiotic treatment was in accordance with microbiological results of
BAL and blood cultures. Both patients developed sepsis-induced AKI and
were treated with CRRT. Bood microbiological test were negative in third
day of antibiotic therapy. After diagnosis of brain death they were classified
as marginal donors with diagnosis of resolved septicemia. We decided to
transplant the organs after the optimistic histological results of biopsy taken
from retrieved kidneys.
Results: The histological exam showed focal and mild acute tubular necrosis
without inflammation and four kidneys were transplant. None of the organ recipient developed any inflammatory complications and their transplant kidney
function one year after transplant procedure remains stabile.
Conclusion: The pathomechanism of sepsis related AKI is complex and
patient with sepsis related AKI may become a kidney donor in particular
1. Zarbock A, Gomez H, Kellum JA. Sepsis-induced acute kidney injury
revisited: pathophysiology, prevention and future therapies. Curr Opin Crit
Care 2014, 20:588-595.
2. Ronco C, Kellum J, Bellomo R, House AA. Potential Interventions in
Sepsis-Related Acute Kidney Injury. Clin J Am Soc Nephro 3: 531-544, 2008.
Introduction: Deceased donor organ donation and transplantation in Sri
Lanka is still in its early stages. Lack of organs is a significant problem at present. Further, availability of deceased donors lags behind those of live. One of
the presumed reasons for this is poor knowledge and attitude among the
health care staff and general public. The present study aimed to assess the
knowledge and attitude of medical and nursing staff in surgical and medical
intensive care units (ICU) in the National Hospital of Sri Lanka (NHSL) on deceased organ donation.
Method: A pre-tested, self-administered questionnaire on knowledge and attitude was used. Sample contained doctors and nursing officers of the ICUs of
NHSL where potential donors are common. A percentage score was calculated with regard to knowledge and attitude. Ethical approval was obtained
from the ethical committee of National Hospital of Sri Lanka.
Results: Sample contained 167 subjects; 110 (65.9%) nursing officers
and 57 (34.1%) doctors. Majority were females (87.4%) and were in the
31-40-year age group (90, 53.9%). Of the sample, 110 (65.9%) had studied
up to diploma, 44 (26.3%) up to basic degree and 13 (7.8%) were undergoing
postgraduate training. Majority were Buddhists (102, 61.1%) followed by
Muslims (20,12%) and Catholics (19,11.4%). About 40% (68) had ICU work
experience of 1-5 years with the mean experience being 6.9 years (range
1-24) and 74.3% (124) were involved in the deceased organ donation process either in preparation or coordination. Of the sample, 87.4% (146) had
a knowledge score of more than 50% with 4 (2.3%) achieving 100%. Nearly
75% (n, 127) acknowledged that they have adequate knowledge to address
the public, however only 46.7% (78) were aware about the related legal procedures on deceased donor organ donation and transplantation in Sri Lanka.
Majority (153,91.6%) possessed a positive attitude on organ donation while
admitting the need for better awareness. There were no statistically significant
associations between the age, designation, sex, level of education, religion or
work experience with regard to knowledge and attitude (p>0.05).
Conclusion: There is a satisfactory knowledge and positive attitude among
the medical and nursing staff in ICUs of NHSL on deceased organ donation
and transplantation. However, knowledge on certain aspects need to be further improved specially on procedural and legal aspects, which may increase
deceased organ donations in Sri Lanka.
Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
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