scholarly journals The Gift of Life: Can the Organ Procurement Philosophies from Spain and Iran Help Eliminate the Organ Shortage in the United States?

2015 ◽  
Vol 25 (2) ◽  
pp. 311
Author(s):  
Emily Steeb
Keyword(s):  
United States ◽  
Organ Procurement ◽  
The United States ◽  
Organ Shortage ◽  
The Gift

An Adapted Process and Organ Procurement Perspective on Heart Retransplantation for a Healthy Heart’s Third Life

2021 ◽  
pp. 152692482110246
Author(s):  
Darryl C. Nethercot ◽  
Mita Shah ◽  
Lisa M. Stocks ◽  
Jeffrey M. Trageser ◽  
Victor Pretorius ◽  
...  
Keyword(s):  
United States ◽  
Organ Procurement ◽  
The United States ◽  
Matching Process ◽  
Organ Procurement Organizations ◽  
Third Person ◽  
Adapted Process ◽  
United Network ◽  
Transplanted Hearts

As organ procurement organizations nationwide see an increased opportunity to retransplant already transplanted hearts, we would like to share the overview and process of our 2 successful cases. Heart retransplantation increased our cardiac placement rates by 2.64% and 2% in 2015 and 2019, respectively. Spread across a nation that sees over 3500 heart placements annually, a 2% increase would be substantial. Since 2009, our cases stand as the only documented heart retransplantations in the United States. However, United Network for Organ Sharing data shows that potential exists. From a facilitation perspective, we have developed a protocol to ease the matching process. From a surgical perspective, these cases had no complications and saved 2 lives, with each heart now beating in a third person. We hope that by sharing our process and success, we can familiarize fellow organ procurement organizations and transplant communities with this viable opportunity.

Variability in Pediatric Brain Death Determination Protocols in the United States

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012225
Author(s):  
Conall Francoeur ◽  
Matthew J Weiss ◽  
Jennifer M Macdonald ◽  
Craig Press ◽  
David Matthew Greer ◽  
...  
Keyword(s):  
United States ◽  
Brain Injury ◽  
Organ Procurement ◽  
The United States ◽  
Cross Sectional Study ◽  
Neurologic Examination ◽  
National Guidelines ◽  
Cross Sectional ◽  
Organ Procurement Organizations ◽  
Death By Neurologic Criteria

Objective:To determine the variability in pediatric death by neurologic criteria (DNC) protocols between US pediatric institutions and compared to the 2011 DNC guidelines.Methods:Cross-sectional study of DNC protocols obtained from pediatric institutions in the United States (US) via regional organ procurement organizations. Protocols were evaluated across five domains: general DNC procedures, prerequisites, neurologic examination, apnea testing and ancillary testing. Descriptive statistics compared protocols to each other and the 2011 guidelines.Results:One hundred and thirty protocols were analyzed with 118 dated after publication of the 2011 guidelines. Of those 118 protocols, identification of a mechanism of irreversible brain injury was required in 97%, while 67% required an observation period after acute brain injury before DNC evaluation. Most protocols required guideline-based prerequisites such as exclusion of hypotension (94%), hypothermia (97%), and metabolic derangements (92%). On neurologic examination, 91% required a lack of responsiveness, 93% no response to noxious stimuli, and 99% loss of brainstem reflexes. 84% of protocols required the guideline-recommened two apnea tests. CO2 targets were consistent with guidelines in 64%. Contrary to guidelines, fifteen percent required ancillary testing for all patients and 15% permitted ancillary studies that are not validated in pediatrics.Conclusionsand Relevance: Variability exists between pediatric institutional DNC protocols in all domains of DNC determination, especially with respect to apnea and ancillary testing. Better alignment of DNC protocols with national guidelines may improve the consistency and accuracy of DNC determination.

Liver Transplantation for the Gastroenterologist

2015 ◽  
Author(s):  
Andreea M. Catana ◽  
Michael P. Curry
Keyword(s):  
United States ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Organ Procurement ◽  
The United States ◽  
Waiting Lists ◽  
Liver Graft ◽  
Term Survival ◽  
End Stage Liver Disease ◽  
End Stage

The first liver transplantation (LT) was performed in 1963, and currently more than 65,000 people in the United States are living with a transplanted liver. In 2012, the number of adults who registered on the LT waiting list decreased for the first time since 2002; 10,143 candidates were added compared with 10,359 in 2011. LT offers long-term survival for complications of end-stage liver disease and prolongs life in properly selected patients, but problems such as donor deficit, geographic disparities, and long waiting lists remain. This overview of LT for the gastroenterologist details the indications for LT and patient selection, evaluation, liver organ allocation, prioritization for transplantation, transplantation benefit by the Model for End-Stage Liver Disease (MELD), MELD limitations, sources of liver graft, strategies employed to decrease the donor deficit, complications, and outcomes. Figures include indications for LT in Europe and the United States, Organ Procurement and Transplantation Network regions in the United States, the number of transplants and size of active waiting lists, mortality by MELD, regional disparity, patient survival rates with and without hepatitis C virus, and unadjusted patient and graft survival. Tables list LT milestones, indications for LT, contraindications for LT, minimal listing criteria for LT, criteria for LT in acute liver failure, LT evaluation process, adult recipient listing status 1A, and early posttransplantation complications. This review contains 7 highly rendered figures, 8 tables, and 46 references. 

Effect of the Opioid Crisis on the Donor Pool for Kidney Transplantation: An Analysis of National Kidney Deceased Donor Trends from 2010–2016

2018 ◽  
Vol 47 (2) ◽  
pp. 84-93 ◽  
Author(s):  
Donald F. Chute ◽  
Meghan E. Sise
Keyword(s):  
United States ◽  
Kidney Transplant ◽  
Drug Overdose ◽  
Organ Procurement ◽  
Deceased Donor ◽  
The United States ◽  
Hcv Infection ◽  
Kidney Donor ◽  
Donor Pool ◽  
Opioid Crisis

Background: The opioid crisis has led to a dramatic increase in the number of drug overdose deaths in the United States. Little is known about the effect of the opioid crisis on the kidney transplant donor pool, particularly on hepatitis C virus (HCV)-infected donors. Methods: This is a retrospective analysis of the data from the Organ Procurement and Transplantation Network from 2010 to 2016. We determined the changes in characteristics of kidney transplant donors and evaluated which changes may be directly related to the opioid crisis. Results: Between 2010 and 2016, we found a 26% increase in overall donors, including a 277% increase in the number of donors who died from drug overdose. Nineteen percent of donors who died of drug overdose had HCV infection. Donors who die from drug overdose and donors with HCV infection are younger, less likely to have diabetes or hypertension, and have favorable kidney donor profile index scores compared to average donors. Despite these favorable characteristics, HCV-infected donors appear to be notably underutilized, with substantially lower kidneys per donor being transplanted compared to HCV uninfected donors. Conclusion: The opioid crisis in the United States has substantially altered the kidney donor pool. Strategies to increase utilization of all potentially viable kidneys for transplant are needed, particularly in this era of new, highly effective, direct-acting antiviral therapy for HCV infection.

scholarly journals Investigation of a Contaminated, Nationally Distributed, Organ Transplant Preservation Solution — United States, 2016–2017

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S11-S11
Author(s):  
Matthew Stuckey ◽  
Shannon Novosad ◽  
Nancy Wilde ◽  
Pallavi Annambhotla ◽  
Sridhar Basavaraju ◽  
...  
Keyword(s):  
United States ◽  
Adverse Events ◽  
Infection Control ◽  
Bacterial Contamination ◽  
Organ Procurement ◽  
The United States ◽  
Patient Harm ◽  
Preservation Solution ◽  
Public Health Action ◽  
Transplant Center

Abstract Background In December 2016, bacterial contamination of an organ preservation solution (OPS) was reported by Transplant Center A in Iowa. Annually, >20,000 abdominal organs are transplanted in the United States; OPS is used for organ storage. We investigated the scope of OPS contamination and its association with adverse events in patients. Methods We assessed infection control practices related to OPS at Transplant Centers A and B in Iowa and the local organ procurement organization (OPO). We issued national notifications about OPS contamination and requested transplant centers to report product-related concerns or potential patient harm. Among transplant recipients at Center A, we compared adverse events (fever, bacteremia, surgical site infection, peritonitis, or pyelonephritis within 14 days of transplantation) during October–December 2015 with October–December 2016, the presumed window of exposure to contaminated OPS. Isolates from OPS were characterized. Results No infection control deficiencies were identified at Transplant Centers A, B, or the OPO. In January 2017, contaminated OPS from the same manufacturer was reported by Transplant Center C in Texas. Nationally, there were no reports of patient harm definitively linked to OPS. Post-transplant adverse events at Center A did not increase between fourth quarter 2015 (5/12 [42%]) and 2016 (2/15 [13%]). Organisms recovered from OPS included Pantoea agglomerans and Enterococcus gallinarum (Center A) and Pseudomonas koreensis (Center C). Five Pantoea isolates from ≥3 opened OPS bags were indistinguishable by pulsed-field gel electrophoresis. The OPS distributor issued recalls and suspended production. The US Food and Drug Administration identified deficiencies in current good manufacturing practices at manufacturing and distribution facilities, including inadequate validation of OPS sterility. Conclusion Bacterial contamination of a nationally distributed product was identified by astute clinicians. The investigation found no illnesses were directly linked to the product. Prompt reporting of concerns about potentially contaminated healthcare products, which might put patients at risk, is critical for swift public health action. Disclosures All authors: No reported disclosures.

A Critical Review of MELD as a Reliable Tool for Transplant Prioritization

2019 ◽  
Vol 39 (04) ◽  
pp. 403-413 ◽  
Author(s):  
Sophie-Caroline Sacleux ◽  
Didier Samuel
Keyword(s):  
United States ◽  
Serum Creatinine ◽  
International Normalized Ratio ◽  
The United States ◽  
Meld Score ◽  
Waiting List ◽  
Organ Shortage ◽  
Short Term ◽  
Short Term Mortality ◽  
End Stage

AbstractIn a context of global organ shortage, the Model for End-Stage Liver Disease (MELD) score seems to be a fair prioritization tool, with a paradigm: “sickest first.” Since its introduction in the United States in 2002, it has been rapidly adopted by transplant centers and organ sharing agencies around the world. The MELD score showed its effectiveness with a 12% reduction in waiting list mortality in the United States. Its success is linked to its simplicity, the use of basic variables (serum creatinine, serum bilirubin, and international normalized ratio [INR]), and its ability to predict short-term mortality, particularly on the transplant waiting list. However, this score is not perfect: its variables may have disadvantages for some patients, especially women, with serum creatinine and interlaboratory variability of the INR. The MELD score does not take into account some variables associated with poor short-term prognosis in cirrhotic patients. In addition, it is currently capped at 40, which results in the exclusion of sicker patients who could greatly benefit from transplantation. Finally, the MELD score does not accurately reflect the prognosis of several conditions, requiring a MELD exception system. Some solutions have been suggested such as MELD-Na or MELD uncapping, but it has not yet been fully accepted by all transplant centers.

Hastening Death: Dying, Dignity and the Organ Shortage Gap

2009 ◽  
Vol 35 (4) ◽  
pp. 562-584 ◽  
Author(s):  
Wojciech Baginski
Keyword(s):  
United States ◽  
New York ◽  
Terminally Ill ◽  
New York Times ◽  
The United States ◽  
Organ Shortage ◽  
The New York Times ◽  
Life Sustaining Treatment ◽  
Imminent Death

Imagine that you are lying in a hospital: conscious, partially paralyzed, and terminally ill. Physicians predict that you will die in a couple of weeks. You have heard about the shortage of viable organs in the United States and consider consenting to transplantation of your organs after you die. Trying not to think about your imminent death, you open the New York Times brought by your family and skim the table of contents. You notice an article and slowly start to read. The headline reads “Surgeon Accused of Hurrying Death of Patient to Get Organs.” After you finish reading, you are not willing to donate your organs for transplantation. It does not matter that you are altruistic or that you want your life-sustaining treatment to be removed when your condition worsens. You do not want your death to be hastened. You do not want the physician to play God. You want to die with dignity in a peaceful and friendly environment.

scholarly journals Inter-vivos giving by older people in the United States: who received financial gifts from the childless?

2009 ◽  
Vol 29 (8) ◽  
pp. 1207-1225 ◽  
Author(s):  
MICHAEL HURD
Keyword(s):  
United States ◽  
Older People ◽  
The United States ◽  
Financial Transfers ◽  
Older Parents ◽  
The Gift ◽  
Using Data ◽  
Sense Of Obligation ◽  
Retirement Study ◽  
Inter Vivos

ABSTRACTInter-vivos financial transfers from older parents to their adult children are widespread in the United States. Childless people may simply make fewer transfers. On the other hand, because their giving is away from children, their decisions are more complex in that there are multiple potential targets of approximately equal attractiveness. Using data for 1996 to 2004 from the United States Health and Retirement Study, this article examines the differences between parents and childless older people in financial transfers to people other than their children. The results show that, overall, parents tend to give less than the childless to other people. However, some variation is found depending on the nature and target of the gift. Having children does not affect giving to charities but does reduce the prevalence of giving to parents, but not nearly as much as the reduction in giving to family and friends. It can therefore be concluded, first that there is little substitution between personal and impersonal transfers; secondly, that the sense of obligation to parents is not reduced by giving to charities or to children; and thirdly, that having children reduces the need to satisfy the desire for family and social ties by means of links to family and friends.

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