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Ethics
Medical Management of Brain-Dead Organ Donors
A.S.M. Tanim Anwar, Jae-myeong Lee
Acute Crit Care. 2019;34(1):14-29.   Published online February 28, 2019
DOI: https://doi.org/10.4266/acc.2019.00430
  • 24,564 View
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  • 32 Web of Science
  • 37 Crossref
AbstractAbstract PDF
With improving healthcare services, the demand for organ transplants has been increasing daily worldwide. Deceased organ donors serve as a good alternative option to meet this demand. The first step in this process is identifying potential organ donors. Specifically, braindead patients require aggressive and intensive care from the declaration of brain death until organ retrieval. Currently, there are no specific protocols in place for this, and there are notable variations in the management strategies implemented across different transplant centers. Some transplant centers follow their own treatment protocols, whereas other countries, such as Bangladesh, do not have any protocols for potential organ donor care. In this review, we discuss how to identify brain-dead donors and describe the physiological changes that occur following brain death. We then summarize the management of brain-dead organ donors and, on the basis of a review of the literature, we propose recommendations for a treatment protocol to be developed in the future.

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    Miguel Nunez, James Gardner, Shareef Syed, Allison Webber, Jun Shoji, Timothy P. Copeland, Charles E. McCulloch, Elaine Ku, Garrett R. Roll
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  • The Association of Donor Thyroid Hormone Supplementation on Heart Transplant Recipient Survival
    David Blitzer, David A. Baran, Seth Lirette, Matthew Kutcher, Asim Mohammed, Hannah Copeland, Berhane M. Worku
    Journal of Cardiac Surgery.2024; 2024: 1.     CrossRef
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    Ripudaman S Munjal, Jaskaran Munjal, Gagandeep Dhillon, Venkata S Buddhavarapu, Harpreet Grewal, Pranjal Sharma, Ram K Verma, Ruth Lee, Rahul Kashyap
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    Junho Hyun, Sang Eun Lee, Jae-Joong Kim
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    Prudhvi Dasari, Maheeja Reddy, Dileep Singh Parmar, Carl Britto
    BMJ Case Reports.2024; 17(4): e255348.     CrossRef
  • Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant
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  • The Clinical Outcomes of Marginal Donor Hearts: A Single Center Experience
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  • Induced Coma, Death, and Organ Transplantation: A Physiologic, Genetic, and Theological Perspective
    Cezar-Ivan Coliță, Denissa-Greta Olaru, Daniela Coliță, Dirk M. Hermann, Eugen Coliță, Daniela Glavan, Aurel Popa-Wagner
    International Journal of Molecular Sciences.2023; 24(6): 5744.     CrossRef
  • Donor Pericardial Interleukin and Apolipoprotein Levels May Predict the Outcome after Human Orthotopic Heart Transplantation
    Éva Pállinger, Andrea Székely, Evelin Töreki, Erzsébet Zsófia Bencsáth, Balázs Szécsi, Eszter Losoncz, Máté Oleszka, Tivadar Hüttl, Annamária Kosztin, Edit I. Buzas, Tamás Radovits, Béla Merkely
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  • Intervenciones de enfermería en procuración de órganos de personas adultas con muerte encefálica: Revisión sistemática
    Teresa de Jesús Solís-López , Josefina Gallegos-Martínez
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  • A Conceptual Framework for Evaluating National Organ Donation and Transplantation Programs
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  • Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study
    Seyed Mohammad Reza Nejatollahi, Yazdan Abdolmohammadi, Sepideh Ahmadi, Arman Hasanzade, Fatemeh Hosseini, Arshia Mohseni, Shadi Shafaghi, Mojtaba Mokhber Dezfuli, Fariba Ghorbani
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  • Deceased Organ Transplantation in Bangladesh: The Dynamics of Bioethics, Religion and Culture
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  • Specialized Donor Care Facility Model and Advances in Management of Thoracic Organ Donors
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  • Proteomics, brain death, and organ transplantation
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  • Evaluation of donor heart for transplantation
    Robert Tatum, Alexandros Briasoulis, Vakhtang Tchantchaleishvili, H. Todd Massey
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  • Evaluación de la Terapia de Preservación de los Donadores en Muerte Encefálica guiada por Metas Terapéuticas de donadores en el Hospital de Especialidades ''Dr. Antonio Fraga Mouret'' del Centro Médico Nacional ''La Raza''
    José Enrique Abarca-Romero, Bertha Angélica García-García, Andrea Lucía Maya-Rivera
    Revista Mexicana de Trasplantes.2022; 11(1): 20.     CrossRef
  • Centralized Organ Recovery and Reconditioning Centers
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    Thoracic Surgery Clinics.2022; 32(2): 167.     CrossRef
  • Organ donation and the medicolegal aspects: A process analysis study of the Indian States - Observational study
    Ishwarya Thyagarajan, Hemal Kanvinde, Sunil Shroff, MuneetKaur Sahi
    Indian Journal of Transplantation.2022; 16(2): 184.     CrossRef
  • Costs related to obtaining organs for transplantation: A systematic review
    Aline Moraes da Silva, Marcos Antonio Ferreira Júnior, Andréia Insabralde de Queiroz Cardoso, Maria Lucia Ivo, Jéssica Prince Fontes Almeida, Rayane Dayara Souza Melo
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  • Peritransplant Cardiometabolic and Mitochondrial Function: The Missing Piece in Donor Heart Dysfunction and Graft Failure
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  • Hormones to the Rescue: Ameliorating Acute Lung Inflammation After Donor Brain Death
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  • 17β-Estradiol Treatment Protects Lungs Against Brain Death Effects in Female Rat Donor
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  • Inflammatory responses in lungs from donation after brain death: Mechanisms and potential therapeutic targets
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    The Journal of Heart and Lung Transplantation.2021; 40(9): 890.     CrossRef
  • Hypothalamic-pituitary axis disorder – “the puppet master” of multiple organ dysfunction in brain-dead patients
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  • Kadavra Donörden Organ Nakli Oranlarını Arttırmada Hemşirenin Sorumlukları: Sahada Neler Yapabiliriz?
    Tuğba Nur ÖDEN, Fatma DEMİR KORKMAZ
    Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi.2021; 8(3): 558.     CrossRef
  • A translational rat model for ex vivo lung perfusion of pre-injured lungs after brain death
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  • Public opinion and legislations related to brain death, circulatory death and organ donation
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    Journal of the Neurological Sciences.2020; 413: 116800.     CrossRef
  • Donor Heart Utilization in Korea
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    International Journal of Heart Failure.2020; 2(4): 254.     CrossRef
  • Effects of Gut Metabolites and Microbiota in Healthy and Marginal Livers Submitted to Surgery
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    International Journal of Molecular Sciences.2020; 22(1): 44.     CrossRef
  • Brain Death and Management of Potential Organ Donor: An Indian Perspective

    Indian Journal of Critical Care Medicine.2019; 23(S2): 151.     CrossRef
Case Reports
Neurology/Cardiology
Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination
Sung Wook Chang, Sun Han, Jung Ho Ko, Jae-Wook Ryu
Korean J Crit Care Med. 2016;31(2):169-172.   Published online May 31, 2016
DOI: https://doi.org/10.4266/kjccm.2016.31.2.169
  • 6,200 View
  • 109 Download
  • 1 Crossref
AbstractAbstract PDF
The shortage of available organ donors is a significant problem and various efforts have been made to avoid the loss of organ donors. Among these, extracorporeal membrane oxygenation (ECMO) has been introduced to help support and manage potential donors. Many traumatic brain injury patients have healthy organs that might be eligible for donation for transplantation. However, the condition of a donor with a fatal brain injury may rapidly deteriorate prior to brain death determination; this frequently results in the loss of eligible donors. Here, we report the use of venoarterial ECMO to support a potential donor with a fatal brain injury before brain death determination, and thereby preserve donor organs. The patient successfully donated his liver and kidneys after brain death determination.

Citations

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  • Outcomes of Extracorporeal Membrane Oxygenation in Children: An 11-Year Single-Center Experience in Korea
    Hongsun Kim, Ji-Hyuk Yang, Yang Hyun Cho, Tae-Gook Jun, Kiick Sung, Woosik Han
    The Korean Journal of Thoracic and Cardiovascular Surgery.2017; 50(5): 317.     CrossRef
Toxicology
Management of Cyanide Intoxication with Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy
Jin Park, Seung-Yeob Lee, Hyun-Sik Choi, Yoon Hee Choi, Young-Joo Lee
Korean J Crit Care Med. 2015;30(3):218-221.   Published online August 31, 2015
DOI: https://doi.org/10.4266/kjccm.2015.30.3.218
  • 7,502 View
  • 88 Download
  • 1 Crossref
AbstractAbstract PDF
Cyanide intoxication results in severe metabolic acidosis and catastrophic prognosis with conventional treatment. Indications of extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are expanding to poisoning cases. A 50-year-old male patient arrived in the emergency room due to mental change after ingestion of cyanide as a suicide attempt 30 minutes prior. He was comatose, and brain stem reflexes were absent. Initial laboratory analysis demonstrated severe metabolic acidosis with increased lactic acid of 25 mM/L. Shock and acidosis were not corrected despite a large amount of fluid resuscitation with high-dose norepinephrine and continuous renal replacement therapy. We decided to apply ECMO and CRRT to allow time for stabilization of hemodynamic status. After administration of antidote infusion, although the patient had the potential to progress to brain death status, vital signs were improved with correction of acidosis. We considered the evaluation for organ donation. We report a male patient who showed typical cyanide intoxication as lethal metabolic acidosis and cardiac impairment, and the patient recovered after antidote administration during vital organ support through ECMO and CRRT.

Citations

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  • Cyanogenic glycoside amygdalin influences functions of human osteoblasts in vitro
    Radoslav Omelka, Veronika Kovacova, Vladimira Mondockova, Birgit Grosskopf, Adriana Kolesarova, Monika Martiniakova
    Journal of Environmental Science and Health, Part B.2021; 56(2): 109.     CrossRef
Cardiology
Use of Extracorporeal Membrane Oxygenation for Optimal Organ Donation
Jeong Hoon Yang, Yang Hyun Cho, Chi Ryang Chung, Kyeongman Jeon, Chi Min Park, Gee Young Suh
Korean J Crit Care Med. 2014;29(3):194-196.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.194
  • 5,025 View
  • 64 Download
  • 2 Crossref
AbstractAbstract PDF
We report a case of extracorporeal membrane oxygenation (ECMO) support for donor organ preservation in a brain-dead patient following out-of-hospital cardiac arrest. A 43-year-old male patient was referred to the emergency department after an out-of-hospital cardiac arrest caused by ventricular fibrillation. Spontaneous circulation was restored after 8 minutes of cardiopulmonary resuscitation. ECMO was implemented because of hemodynamic deterioration. The patient then underwent coronary angiography and was implanted with a drug-eluting stent because of occlusion at the proximal portion of the right coronary artery. After 144 hours, brain death was established, and ECMO support for optimal oxygen delivery was sustained until organ retrieval after consent for donation was received from the family. Liver and kidneys were successfully transplanted to three recipients, respectively.

Citations

Citations to this article as recorded by  
  • Extracorporeal Membrane Oxygenation for the Support of a Potential Organ Donor with a Fatal Brain Injury before Brain Death Determination
    Sung Wook Chang, Sun Han, Jung Ho Ko, Jae-Wook Ryu
    Korean Journal of Critical Care Medicine.2016; 31(2): 169.     CrossRef
  • The Use of Extracorporeal Circulation in Suspected Brain Dead Organ Donors with Cardiopulmonary Collapse
    Hyun Lee, Yang Hyun Cho, Kiick Sung, Jeong Hoon Yang, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh
    Journal of Korean Medical Science.2015; 30(12): 1911.     CrossRef
Successful Management of Potential Non-Heart-Beating Donor with Extracorporeal Membrane Oxygenation: A Case Report
Young Hwan Kim, Gui Yun Sohn, Yooun Joong Jung, Kyu Hyouck Kyoung, Suk Kyung Hong
Korean J Crit Care Med. 2012;27(4):279-282.
DOI: https://doi.org/10.4266/kjccm.2012.27.4.279
  • 2,915 View
  • 24 Download
  • 3 Crossref
AbstractAbstract PDF
Hemodynamics of a brain-dead donor can change rapidly during management. It frequently leads to loss of the donor or deterioration of organ functions. Various efforts have been made not to lose potential donors. Extracorporeal membrane oxygenation (ECMO) and non-heart-beating donation (NHBD) are good examples of such efforts. A 47 year-old woman with a history of hypertension, diabetes mellitus and atrial fibrillation was diagnosed with cerebral infarction and hemorrhage. Cardiopulmonary resuscitation was performed three times before transfer to our hospital. Her family agreed to organ donation. ECMO was applied due to her unstable vital signs, which made the first declaration of brain death possible. However, considering the deteriorating vital signs and expected cardiac arrest, it was decided to switch to NHBD under the family's consent. All life-support devices including ECMO were turned off in the operation room. After cardiac death was declared, the harvesting of liver and kidneys was performed with perfusion through an ECMO catheter. The liver and kidneys were successfully transplanted to three recipients.

Citations

Citations to this article as recorded by  
  • Extra-Corporeal Membrane Oxygenation Cadaver Donors: What about Tissues Used as Allografts?
    Gregorio Marchiori, Matteo Berni, Giorgio Cassiolas, Leonardo Vivarelli, Nicola Francesco Lopomo, Milena Fini, Dante Dallari, Marco Govoni
    Membranes.2021; 11(7): 545.     CrossRef
  • The Use of Extracorporeal Circulation in Suspected Brain Dead Organ Donors with Cardiopulmonary Collapse
    Hyun Lee, Yang Hyun Cho, Kiick Sung, Jeong Hoon Yang, Chi Ryang Chung, Kyeongman Jeon, Gee Young Suh
    Journal of Korean Medical Science.2015; 30(12): 1911.     CrossRef
  • Successful Transplantation of Organs from a Donor with Bacterial Meningitis Caused byStreptococcus pneumonia- A Case Report -
    Eunjung Park, Sang-Cheon Choi, Youngjoo Lee, Yoonseok Jung, Younggi Min
    Korean Journal of Critical Care Medicine.2013; 28(2): 115.     CrossRef
Original Article
Thyroid Hormonal Changes in Brain Death Donors
Jae Myeong Lee, Young Joo Lee
Korean J Crit Care Med. 2011;26(3):157-161.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.157
  • 2,932 View
  • 17 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
We analyzed thyroid hormone values in brain death patients to determine the need for thyroid hormone replacement therapy.
METHODS
We analyzed 111 brain death donors (77 males and 34 females, mean age, 41.1 years (range; 8 months -72 years) in Ajou University Hospital from 2000 to 2010.
RESULTS
The mean values of thyroid hormones were T3; 72.5 ng/dl (normal range [NR] 60-181 ng/dl), T4; 5.0 microg/dl (NR 4.5-10.9 microg/dl), free T4 1.0 ng/dl (NR 0.8-1.5 ng/dl), and TSH 1.5 microIU/ml (NR 0.35-5.5 microIU/ml), respectively. However, the values of T4 (correlation coefficient -0.264, p = 0.005), free T4 (correlation coefficient -0.305, p = 0.001) and TSH (correlation -0.206, p = 0.031) significantly decreased based on the increase of interval from the brain death-inducing event to the evaluation time (hereafter, interval). The patients with greater than 8 days of interval (N = 30) showed significantly low thyroid hormone values compared to patients with less than 8 days of interval (N = 81); T3 (70.3 ng/dl vs. 77.0 ng/dl, p = 0.242), T4 (4.7 ng/dl vs. 5.3 ng/dl, p = 0.015), free T4 (0.8 ng/dl vs. 1.2 ng/dl, p = 0.006) and TSH (1.0 microIU/ml vs. 2.0 microIU/ml, p = 0.000), respectively.
CONCLUSIONS
As the intervals from the brain death-inducing events increased, all thyroid hormone values of brain death donors except T3 significantly decreased. Therefore, we recommend that careful consideration should be given to the interval from brain death-inducing event for the evaluation of thyroid hormone status of brain death patients.

Citations

Citations to this article as recorded by  
  • Identification of Hemodynamic Risk Factors for Apnea Test Failure During Brain Death Determination
    Jin Joo Kim, Eun Young Kim
    Transplantation Proceedings.2019; 51(6): 1655.     CrossRef
Case Report
Successful Heart Transplantation after Dobutamine, Glucose-insulin-potassium, and Hormone Therapy in a Hemodynamically Unstable Cadaveric Heart Donor: A Case Report
So Yeon Kim, Shin Ok Koh, Young Chul Yoo, Ha Kyoung Kim, Tae Jin Yun, Eun Ji Chang, Sungwon Na
Korean J Crit Care Med. 2010;25(2):89-92.
DOI: https://doi.org/10.4266/kjccm.2010.25.2.89
  • 2,663 View
  • 18 Download
  • 1 Crossref
AbstractAbstract PDF
The major limitation to heart transplantation is the shortage of donor organs. In order to increase the cardiac donor pool, it is important to maintain stable hemodynamics and closely monitor cardiac function in cadaveric organ donors or potent donors. Recently, management of a potential cardiac donor pool has focused on aggressive hemodynamic management protocols and dobutamine stress echocardiography. In our case, management with low dose dobutamine, glucose-insulin-potassium (GIK), and hormone therapy reversed heart failure following brain death and the heart was successfully transplanted. We suggest that aggressive hemodynamic management with low-dose dobutamine, GIK, and hormone therapy can result in the recruitment of more cadaveric hearts in marginal conditions.

Citations

Citations to this article as recorded by  
  • Predisposing Hemodynamic Factors Associated with a Failed Apnea Test during Brain Death Determination
    Eun Young Kim, Ji Hyun Kim
    The Korean Journal of Critical Care Medicine.2016; 31(3): 236.     CrossRef
Original Article
A Survey of Patients Who Were Admitted for Life-Sustaining Therapy in Nationwide Medical Institutions
Jong Myon Bae, Joo Young Gong, Jae Ran Lee, Dae Seog Heo, Younsuck Koh
Korean J Crit Care Med. 2010;25(1):16-20.
DOI: https://doi.org/10.4266/kjccm.2010.25.1.16
  • 3,183 View
  • 59 Download
  • 16 Crossref
AbstractAbstract PDF
BACKGROUND
The study focused on figuring out the present status and distribution of the underlying diseases of Korean terminally ill patients (TIP) who were on life-support care (LSC) by conducting a nationwide health care survey.
METHODS
The authors of this study requested that the 308 nationwide hospitals that operate intensive care units answer a questionnaire that asked about the number of admitted TIPs and their underlying diseases at 12 Am, 22 July, 2009. The proportion of TIPs among all the admitted patients and the percentages of the TIP's underlying diseases were calculated.
RESULTS
In a total of 83.1% of the eligible hospitals responded, the proportion of TIP was 1.6 of 100 admitted patients. Terminal cancer was the leading underlying disease in the TIPs (42.4%). Five % of the patients on LSC were brain dead. More TIPs were admitted in the national/public or university hospitals than in the private or non-university hospitals.
CONCLUSIONS
Futile treatment seems to be administered to the TIPs in Korean hospitals. The quality of terminal care in Korean hospitals should be improved by the application of socially acceptable LSC guidelines. Timely government health plans, including hospice care, to improve the quality of palliative care should be launched and maintained.

Citations

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  • Attitudes, Perceptions, and Experiences toward End-of-Life Care Decision-Making among Intensive Care Unit Nurses in Korea : An Integrative Review
    JiYeon Choi, Youn-Jung Son, Kyounghoon Lee
    Journal of Korean Critical Care Nursing.2020; 13(1): 27.     CrossRef
  • Transcultural Adaptation and Validation of Quality of Dying and Death Questionnaire in Medical Intensive Care Units in South Korea
    Jun Yeun Cho, Jinwoo Lee, Sang-Min Lee, Ju-Hee Park, Junghyun Kim, Youlim Kim, Sang Hoon Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Yeon Joo Lee
    Acute and Critical Care.2018; 33(2): 95.     CrossRef
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    Hye-young K Park, Cristina C Hendrix
    International Journal of Palliative Nursing.2018; 24(9): 452.     CrossRef
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    Su Jeong Lee, Hye Young Kim
    Korean Journal of Adult Nursing.2017; 29(2): 131.     CrossRef
  • End‐of‐life communication in Korean older adults: With focus on advance care planning and advance directives
    Dong Wook Shin, Ji Eun Lee, BeLong Cho, Sang Ho Yoo, SangYun Kim, Jun‐Hyun Yoo
    Geriatrics & Gerontology International.2016; 16(4): 407.     CrossRef
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    Ji Eun Lee, Ae Jin Goo, Be Long Cho
    Journal of the Korean Geriatrics Society.2016; 20(2): 65.     CrossRef
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    Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
    Korean Journal of Critical Care Medicine.2014; 29(3): 160.     CrossRef
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    Dong Soon Kim, AeYoung So, Kyung-Sook Lee, Jung Sook Choi
    Journal of muscle and joint health.2013; 20(3): 214.     CrossRef
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    Dae Seog Heo
    Journal of Korean Medical Science.2013; 28(1): 1.     CrossRef
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    Jae Young Moon, Yong Sup Shin
    Korean Journal of Critical Care Medicine.2013; 28(3): 163.     CrossRef
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    Jo Kae-Hwa, An Gyeong-Ju
    Holistic Nursing Practice.2013; 27(6): 329.     CrossRef
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    Yoon-seong Lee
    Journal of the Korean Medical Association.2012; 55(12): 1161.     CrossRef
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    Younsuck Koh
    Journal of the Korean Medical Association.2012; 55(12): 1171.     CrossRef
  • Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy
    Jae Young Moon, Hee Young Lee, Chae-Man Lim, Younsuck Koh
    Korean Journal of Critical Care Medicine.2012; 27(1): 16.     CrossRef
  • Predictive Factor s for City Dweller s’ Attitudes toward Death with Dignity
    Kae Hwa Jo, Gyeong Ju An, Gyun Moo Kim, Yeon Ja Kim
    The Korean Journal of Hospice and Palliative Care.2012; 15(4): 193.     CrossRef
  • Charactersitics and issues of guideline to withdrawal of a life-sustaining therapy
    Younsuck Koh, Dae-Seog Heo, Young Ho Yun, Jeong-Lim Moon, Hyoung Wook Park, Ji Tae Choung, Hyo Sung Jung, Bark Jang Byun, Yoon-Seong Lee
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ACC : Acute and Critical Care