With an acute shortage of donor organs, the implementation of an active donor registration system was once again an important topic of conversation in The Hague last week. Whereas before most organs came from patients who died as a result of brain death, now they are increasingly coming from people who died following cardiac or circulatory arrest. This is known as donation after circulatory death or DCD. Transplant coordinator Tineke Wind focused her doctoral research on the critical aspects of the DCD process. One of her conclusions was that relatives of organ donors perceived end-of-life care as more positive compared to those of non-donors. Wind hopes to obtain her PhD from Maastricht University on 19 February.

The number of registered organ donors in the Netherlands has increased slightly over the past few years. People can indicate their preference for organ donation in advance or leave the decision to their loved ones. While there are currently 3.5 million registered organ donors in the Netherlands, very few cases actually lead to donation. In fact, only 265 donations were performed last year. Until the Netherlands introduces an active donor registration system (ADR) that automatically registers everyone as a donor unless they object, it is extremely important for people to make their wishes known in advance.

No regrets

'It's easier for family members to make a decision about organ donation when their loved one is alive and well. Most survivors tend to turn down organ donation if they're not sure what their loved one would have wanted. That's why it's so important to explain your wishes to your family or to register as an organ donor in advance. This will help prevent your family from regretting their decision later on,' explains Tineke Wind, who speaks from experience.  As part of her PhD research, she investigated how surviving relatives experience the current donation procedure. To do so, she approached 158 emergency contacts for patients who died at the intensive care unit at Maastricht UMC+. 'I wanted to know how satisfied these family members were with the care, the decision-making process, the termination of medical treatment and the end-of-life care their loved ones received. More specifically, I wanted to know whether organ donation changed the way relatives experienced the process as a whole. Interestingly, the relatives of organ donors experienced the care process in a more positive way than the relatives of non-donors. This was particularly true for the end-of-life care these patients received.  Whether this is the result of better communication and the extra care and attention these surviving relatives received as part of the donation procedure remains unclear.'

Half of all organs from DCD donors

In recent years, organ transplantation has focused primarily on patients who died as a result of brain death, due to the quality and condition of the organs following this type of death. But thanks to improved medical interventions, fewer people are dying from this condition. Moreover, it's now possible to transplant multiple organs from people who died of circulatory arrest (DCD). At the moment, roughly half of all transplanted organs were obtained from DCD donors. 'The Netherlands is a real front-runner in this regard, as donation has been embedded in our legal system and our hospitals are equipped to handle organ donation. We also have an excellent national protocol governing organ and tissue donation, with guidelines that clearly describe the applicable procedures.'

In the Netherlands, the doctor who meets with the family to discuss the termination of medical care is also the one who raises the issue of organ donation. This only happens if the organs are viable and if the patient did not oppose organ transplantation in the donor register. If the family consents to the donation, the transplant coordinator becomes involved.

Preliminary research

'We go to the hospital to assess the donor's prior medical history. We determine which organs are suitable for donation and carry out tests to assess the quality of those organs,' explains Wind. 'Of course, everything is discussed in detail with the surviving relatives. It's important to make sure the family is informed of each step in the process. For example, why we're taking blood samples or an ultrasound or a chest X-ray. We then send the electronic patient file to Eurotransplant, which is responsible for managing the donor waiting lists and determining who is eligible for the organs. The transplant is usually carried out four to six hours later in the hospital where the donor patient was admitted.'

Some donors are deemed unsuitable before or during the donation process. 'An important transplant condition is that the patient died within two hours of terminating medical treatment. If not, the organs are likely to be damaged. This process takes longer for one in five patients, which means the transplant team and the recipient's medical team leave empty-handed. Unfortunately, the exact time of death is hard to determine, which is why we start the procedure just in case,' explains Wind. 

New protocol

During her PhD research, Wind found that medical professionals were hoping for a national protocol to help them determine death by DCD. This protocol is on its way. 'It’s currently being developed and has nothing to do with my PhD study,' Wind says. 'I was already a member of the Health Committee, which worked on revising the legislation governing organ donation at the request of the minister. As a result, the brain death protocol was revised based on recent developments and a DCD protocol was introduced. The new act will be formally implemented before the summer.'

Beneficial effect of red wine and green tea

In Body
Monday, 25 January 2016 12:55

Nutritional supplements containing ingredients found in red wine and green tea have a beneficial effect on the metabolism. People who take supplements that contain these so-called polyphenols burn more fats than sugars. 'This is a promising development for people with a metabolic imbalance, such as chronically ill or bedridden people,’ says human biologist Jasper Most. Most recently he obtained his PhD at Maastricht University for his research on the effect of nutritional supplements that contain this new combination of polyphenols.

Previous studies have already demonstrated the metabolic effect of polyphenols. However, the combination of polyphenols in red wine and green tea had never been researched. 'We wanted to develop nutritional supplements that would reduce the risk of diabetes in overweight people. Unfortunately, we did not notice any significant changes to the key factors that cause diabetes. Insulin sensitivity, for example, remained unchanged,' says the researcher.

No weight loss
Further research should reveal the long-term effects of nutritional supplements in people with a metabolic imbalance, such as elderly people, people with a sedentary lifestyle and people who are bedridden due to illness. 'The supplements do not cause weight loss. At least, we couldn't demonstrate that the test subjects, who took the supplements for twelve weeks, lost any adipose tissue. We also failed to see a reduction in the amount of fat stored by the body. What we did find is a metabolic shift from sugar-burning to fat-burning, which is a promising development. If we can improve energy production, we might be able to reduce the risk of diabetes in the long term. But this would require additional research.'

The body gets sugar from food, but these sugars are also produced by the liver or drawn from the body's own sugar stores in the form of glycogen. These sugars are a source of quick energy. Our brain, nerve cells and blood cells all convert sugar (glucose) into energy. This process is meant to peak in times of stress. Our muscles use this energy source to help us run or sprint, for example. Adipose tissue is largely a resting energy source that is tapped during sleep or periods of fasting or low-impact exercise. Weight gain is the result of more fats being stored than burned.

Insulin sensitivity unchanged
The hormone insulin ensures that glucose from food can be absorbed by the cells via the blood. Diabetics make little to no insulin, which wreaks havoc on blood glucose levels. Insulin resistance happens when the cells no longer respond to insulin. Most had hoped that his nutritional supplements based on red wine and green tea would reactivate this response or improve insulin sensitivity. Unfortunately, this was not the case. But he still considers his study a success.

'Red wine and green tea are not miracle workers and never will be, in my opinion. Those hoping to lose weight shouldn't start consuming vast amounts of these products. We used concentrated polyphenols derived from a plan known as the Japanese knotweed. Producing a single capsule would require the equivalent of the polyphenols in three cups of tea and ten to fifteen litres of red wine. Our test subjects, which included men and women who were slightly to seriously overweight, received two capsules per day over the course of twelve weeks. '
One happy coincidence of this study is that it demonstrates a relationship between the composition of intestinal flora and health. The composition of intestinal flora may provide us with new insights into insulin sensitivity. These bacteria may also influence the effectiveness of nutritional supplements, which could be used in the future to prevent insulin resistance. More targeted research on intestinal flora is required to generate more conclusive results.

Intestinal flora and energy
'Intestinal flora develops at birth and remains relatively stable throughout one's lifetime. Knowing the importance of the composition of intestinal flora gives us a new research perspective. Examining the bacteria found in faecal matter is much less invasive for test subjects, certainly compared to the current methods used to test energy use, which involve placing a hood over the participant's head to measure exhalations. These gasses and the amount of oxygen and nitrogen they contain tell us a lot about energy consumption. It tells us how much is being used and which energy sources are being tapped.' 

According to Most, extensive research is needed to determine the effect of polyphenols. Whether and when this research will begin remains unclear. If it does, the researcher will not be involved. 'I'm going to spend the next three years conducting research at the Pennington Biomedical Research Center in Louisiana, where I'll be studying nutrition and weight gain. I'm currently involved in a long-term research study on the advantages of sports and dieting. I also plan to participate in a study on the relationship between weight gain and diet during pregnancy. What is the ideal weight for pregnant women and what health implications does diet have on the baby?’

Jasper Most received his PhD from the Faculty of Health, Medicine and Life Sciences on 15 January. The full title of his dissertation is: 'Dietary polyphenols: modulators of energy and substrate metabolism in obese humans'

Parents have far more influence on the drinking behaviour of their adolescents than they realise. Setting clear boundaries and communicating well with your child can ensure that he or she does not succumb to excessive drinking behaviour. This is the conclusion reached by psychologist Astrid Jander in her thesis entitled Alcohol Alert with which she gained her doctorate on Thursday, 21 January 2016 at Maastricht University. “The majority of adolescents who took part in my research stated that outside of their homes they also took into account the agreements made with the parents.”

Using robots to humanise elderly care

In Body
Wednesday, 20 January 2016 15:28

He’s soft, he’s cute and he wants to get your attention. Cuddle him and he’ll respond by turning his head towards you, making eye contact and producing adorable little noises. He’s irresistible – and yet, he’s not alive. Meet Paro, a socially assistive robot in the form of a baby harp seal. He and robots like him represent the future of elderly care.

The right to citizenship

Wednesday, 20 January 2016 15:14

External PhD candidate Bronwen Manby, a British lawyer, visiting fellow at the London School of Economics and consultant, is committed to improving the fate of stateless persons on the African continent and ensuring the right to a nationality for all, as promised by the Universal Declaration of Human Rights. "Without proof of nationality of course you can’t vote or stand for office, but you may also not be able to access public health care or education, or even get a sim card, a bank account or a job in the formal economy."  

Maastricht still home to Yuri Michielsen

In Alumni
Thursday, 15 October 2015 14:24

Yuri Michielsen is a man of many talents. A brilliant legal scholar. Graduate of Maastricht University’s (UM) European Law School, winner of the Best Speaker Award at the European Law Moot Court, and holder of a master’s degree from Harvard and a PhD cum laude from Maastricht. Now, this champion of the Limburgish language is about to receive a second PhD, this time in clinical psychology, in San Francisco.

A meeting of minds

Thursday, 15 October 2015 14:13

“It’ll be alright.” These were the reassuring words with which Taru Spronken took over the supervision of Wouter van Ballegooij’s PhD research in 2012. She hadn’t read a single page of the book he had been working on for seven years, but she was familiar with his expertise. The past three years have been a joy for him. “My dissertation was like a flower waiting to bloom. She drew it out into the light.”

In 1987 Diana, Princess of Wales, shakes hands with a man with HIV. Click, goes the camera, and the picture is seen all over the world. At the height of the AIDS frenzy, this gesture was a huge statement. How different things are today, with HIV now a chronic rather than a deadly disease in many parts of the world. Nonetheless, people living with HIV continue to be confronted with stigma – a prejudice all of us may be guilty of.

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