Organ Procurement

2015 ◽  
Author(s):  
Prosanto Chaudhury ◽  
Talia B. Baker ◽  
Anton I. Skaro ◽  
Paul Alvord
Keyword(s):  
Perioperative Management ◽  
Organ Procurement ◽  
Therapeutic Option ◽  
Organ Shortage ◽  
Donor Pool ◽  
Current State ◽  
Heart Beating ◽  
Donor Evaluation ◽  
Living Donor Transplantation ◽  
End Stage

Improvements in immunosuppression, organ preservation, surgical technique, and recipient management have led to the widespread adoption of transplantation as a viable therapeutic option for end-stage organ disease. Consequently, more patients than ever are benefiting from organ transplantation. Unfortunately, the rate of organ donation has not kept pace with the increase in the number of recipients awaiting transplantation. The relative shortage of organs has necessitated an increasing reliance on creative strategies aimed at broadening or expanding the limits of the donor pool. For instance, organs now are frequently obtained from so-called extended-criteria donors (i.e., donors who are elderly or who have significant comorbid conditions) or from non-heart-beating donors. A particularly important strategy for alleviating the organ shortage has been the broader application of living donor transplantation. The authors outline the current state of organ procurement from both cadaveric and living donors, including donor evaluation, perioperative management, and the various donor procedures. This review contains 14 figures, 1 table, and 63 references.

scholarly journals Lung transplantation program for Hungarian patients

2013 ◽  
Vol 154 (22) ◽  
pp. 868-871 ◽  
Author(s):  
György Lang ◽  
Krisztina Czebe ◽  
Balázs Gieszer ◽  
Ferenc Rényi-Vámos
Keyword(s):  
Lung Transplantation ◽  
Organ Procurement ◽  
Therapeutic Option ◽  
Policy Decision ◽  
Technical Requirements ◽  
Health Policy Decision ◽  
Long Term Follow Up ◽  
End Stage ◽  
The University ◽  
Transplantation Procedures

When conservative treatment fails, lung transplantation often remains the only therapeutic option for patients with end stage parenchymal or vascular lung diseases. According to the statistics of the International Society for Heart and Lung Transplantation, in 2010 more than 3500 lung transplantations have been performed worldwide. The Department of Thoracic Surgery at the University of Vienna is considered to be one of the world’s leading lung transplantation centres; in the last year 115, since 1989 more than 1500 lung transplantation procedures under the supervision of Prof. Dr. Walter Klepetko. Similar to other Central-European countries, lung transplantation procedures of Hungarian patients have also been performed in Vienna whithin the framework of a twinning aggreement. However, many crucial tasks in the process, such indication and patient selection preoperative rehabilitation organ procurement and long term follow-up care have been stepwise taken over by the Hungarian team. Although the surgery itself is still preformed in Vienna, professional experience is already available in Hungary, since the majority of Hungarian recipients have been transplanted by hungarian surgeons who are authors of this article the professional and personal requirements of performing lung transplantations are already available in Hungary. The demand of performing lung transplantation in Hungary has been raising since 1999 and it soon reaches the extent which justifies launching of an individual national program. Providing the technical requirements is a financial an organisational issue. In order to proceed, a health policy decision has to be made. Orv. Hetil., 2013, 154, 868–871.

scholarly journals An Update on Usage of High-Risk Donors in Liver Transplantation

2021 ◽  
Vol 11 (1) ◽  
pp. 215
Author(s):  
Haris Muhammad ◽  
Duha Zaffar ◽  
Aniqa Tehreem ◽  
Peng-Sheng Ting ◽  
Cem Simsek ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Steady Increase ◽  
Organ Shortage ◽  
Donor Pool ◽  
End Stage Liver Disease ◽  
Split Liver ◽  
End Stage ◽  
Marginal Donors ◽  
Waitlist Mortality ◽  
The Ideal

The ideal management for end stage liver disease, acute liver failure, and hepatocellular carcinoma (HCC), within specific criteria, is liver transplantation (LT). Over the years, there has been a steady increase in the candidates listed for LT, without a corresponding increase in the donor pool. Therefore, due to organ shortage, it has been substantially difficult to reduce waitlist mortality among patients awaiting LT. Thus, marginal donors such as elderly donors, steatotic donors, split liver, and donors after cardiac death (DCD), which were once not commonly used, are now considered. Furthermore, it is encouraging to see the passing of Acts, such as the HIV Organ Policy Equity (HOPE) Act, enabling further research and development in utilizing HIV grafts. Subsequently, the newer antivirals have aided in successful post-transplant period, especially for hepatitis C positive grafts. However, currently, there is no standardization, and protocols are center specific in the usage of marginal donors. Therefore, studies with longer follow ups are required to standardize its use.

scholarly journals Review: Transplanting kidneys from donors with small renal masses — a strategy to expand the donor pool

2019 ◽  
Vol 14 (2) ◽  
Author(s):  
Octav Cristea ◽  
Jeff Warren ◽  
Brian Blew ◽  
Neal Rowe
Keyword(s):  
Data Sets ◽  
Organ Shortage ◽  
Post Transplantation ◽  
Small Renal Masses ◽  
Donor Pool ◽  
Renal Masses ◽  
The Mean ◽  
Allograft Nephrectomy ◽  
Stage Renal Disease ◽  
End Stage

Introduction: Renal transplantation is the optimal treatment for end-stage renal disease, but organ demand continues to outstrip supply. The transplantation of kidneys from donors with small renal masses (SRMs) represents a potential avenue to expand the donor pool. We reviewed all published cases of transplants from donors with SRMs and we present followup data, best practices, and outline an actionable series of steps to guide the implementation of such transplants at individual centres. Methods: A detailed literature search of the MEDLINE/PubMed and SCOPUS databases was performed. Thirty unique data sets met inclusion criteria and described the transplantation of tumorectomized kidneys; nine data sets described the transplantation of contralateral kidneys from donors with SRMs. Results: A total of 147 tumorectomized kidneys have been transplanted. Pathology revealed 120 to be renal cell carcinomas (RCCs), of which 116 were stage T1a (0.3–4 cm). The mean followup time was 44.2 months (1‒200 months). A single suspected tumor recurrence occurred in one patient nine years post-transplantation and it was managed with active surveillance. Twenty-seven kidneys have been transplanted from deceased donors with contralateral renal masses. Pathology revealed 25 to be RCCs, of which 19 were confirmed to be stage T1 (<7 cm). The mean followup time was 46.7 months (0.5‒155 months). One recipient developed an RCC and underwent curative allograft nephrectomy. Conclusions: Careful use of kidneys from donors with SRMs is feasible and safe, with an overall recurrence rate of less than 1.5%. The utilization of such kidneys could help alleviate the organ shortage crisis.

Addressing organ shortage: An automatic organ procurement model as a proposal

2021 ◽  
pp. 147775092110114
Author(s):  
Marina Morla-González ◽  
Clara Moya-Guillem ◽  
David Rodríguez-Arias ◽  
Íñigo de Miguel Beriain ◽  
Alberto Molina-Pérez ◽  
...  
Keyword(s):  
Healthcare Professionals ◽  
Unsolved Problem ◽  
Positive Impact ◽  
Organ Procurement ◽  
Therapeutic Option ◽  
Market Model ◽  
Organ Shortage ◽  
Universal Health Care System ◽  
The Right ◽  
Universal Health

Organ shortage constitutes an unsolved problem for every country that offers transplantation as a therapeutic option. Besides the largely implemented donation model and the eventually implemented market model, a theorized automatic organ procurement model has raised a rich debate in the legal, medical and bioethical community, since it could show a higher potential to solve organ shortage. In this paper, we study the main arguments for and against this model. We show how, in the light of empirical data extracted from countries with a universal health care system, its implementation could lead to a positive impact on organ procurement rates. Three factors are envisioned as fundamental in the comprehension and a possible regulation of the automatic organ procurement model: the lack of recognition of the conscientious objection, the preservation of the right to choose end of life conditions, and the need to avoid incentives for families or healthcare professionals.

scholarly journals Current Practice of Heart Donor Evaluation in Germany: Multivariable Risk Factor Analysis Confirms Practicability of Guidelines

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Sylke Ruth Zeissig ◽  
Carl-Ludwig Fischer-Froehlich ◽  
Frank Polster ◽  
Nils R. Fruehauf ◽  
Guenter Kirste ◽  
...  
Keyword(s):  
Organ Procurement ◽  
Left Ventricular ◽  
Organ Shortage ◽  
Logistic Regression Models ◽  
Donor Evaluation ◽  
Heart Donor ◽  
Severe Coronary Artery ◽  
Artery Disease ◽  
Donor Characteristics ◽  
First Time

Background. Organ shortage has liberalised the acceptance criteria of grafts for heart transplantation, but which donor characteristics ultimately influence the decision to perform transplantation? For the first time this was evaluated using real-time donor data from the German organ procurement organization (DSO). Observed associations are discussed with regard to international recommendations and guidelines.Methods. 5291 German donors (2006–2010) were formally eligible for heart donation. In logistic regression models 160 donor parameters were evaluated to assess their influence on using grafts for transplantation (random split of cases: 2/3 study sample, 1/3 validation sample).Results. Successful procurement was determined by low donor age (OR 0.87 per year; 95% CI [0.85–0.89],P<0.0001), large donor height (OR 1.04 per cm; 95% CI [1.02–1.06],P<0.0001), exclusion of impaired left ventricular function or wall motion (OR 0.01; 95% CI [0.002–0.036],P<0.0001), arrhythmia (OR 0.05; 95% CI [0.009–0.260],P=0.0004), and of severe coronary artery disease (OR 0.003; 95% CI [<0.001–0.01],P<0.0001). Donor characteristics differed between cases where the procedure was aborted without and with allocation initiated via Eurotransplant.

scholarly journals Organ transplantation and chronic disturbances in the health condition of the population – challenges and perspectives

2020 ◽  
Vol 5 (4) ◽  
pp. 82-88
Author(s):  
Arzu Kader Harmanci Seren ◽  
Keyword(s):  
Health Care Professionals ◽  
Medical Technology ◽  
Health Resources ◽  
Organ Donor ◽  
Chronic Kidney Failure ◽  
Health Condition ◽  
Organ Shortage ◽  
Donor Pool ◽  
Organ Failures ◽  
End Stage

End-stage organ failure cases are increasing around the World. Especially chronic kidney failure has been becoming a worldwide epidemic. Although available medical technology and human health resources capacity is enough to transplant organs and tissues to patients diagnosed with end-stage organ fail-ure, many people cannot access the transplantation services because of eco-nomic reasons and organ shortage. Thus, health care professionals should fo-cus on preventing chronic organ failures besides increasing the organ donor pool.

scholarly journals Impact of Melatonin in Solid Organ Transplantation—Is It Time for Clinical Trials? A Comprehensive Review

2018 ◽  
Vol 19 (11) ◽  
pp. 3509 ◽  
Author(s):  
Philipp Stiegler ◽  
Augustinas Bausys ◽  
Bettina Leber ◽  
Kestutis Strupas ◽  
Peter Schemmer
Keyword(s):  
Organ Transplantation ◽  
Solid Organ Transplantation ◽  
Experimental Studies ◽  
Organ Shortage ◽  
Solid Organ ◽  
Comprehensive Overview ◽  
Donor Pool ◽  
End Stage ◽  
New Strategies ◽  
Significant Mortality

Solid organ transplantation is the “gold standard” for patients with end-stage organ disease. However, the supply of donor organs is critical, with an increased organ shortage over the last few years resulting in a significant mortality of patients on waiting lists. New strategies to overcome the shortage of organs are urgently needed. Some experimental studies focus on melatonin to improve the donor pool and to protect the graft; however, current research has not reached the clinical level. Therefore, this review provides a comprehensive overview of the data available, indicating that clinical evaluation is warranted.

Rewarming Machine Perfusion System for Liver Transplantation

2013 ◽  
Vol 7 (4) ◽  
Author(s):  
Hiromichi Obara ◽  
Naoto Matsuno ◽  
Takanobu Shigeta ◽  
Shin Enosawa ◽  
Toshihiko Hirano ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Organ Donor ◽  
Liver Graft ◽  
Donation After Cardiac Death ◽  
Organ Shortage ◽  
Machine Perfusion ◽  
Porcine Liver ◽  
Donor Pool ◽  
Liver Preservation ◽  
End Stage

The liver is one of the most essential organs, and transplantation is an established treatment for patients with end-stage disease who have lost their liver function. However, organ shortage is a critical problem in transplantation; thus, the development of an innovative preservation system to adopt critical grafts obtained from extended criteria donors or donation after cardiac death donors as viable organs for transplantation is necessary. We recently developed a novel rewarming machine perfusion preservation system for liver transplantation, and herein discuss this system, which allows the perfusion temperature to be controlled during the transition from hypothermic to subnormothermic conditions. This system has two functions: (1) the preservation and recovery of organ function and (2) screening the organ for viability. To achieve these functions, this system has three features: (1) temperature control of the preservation perfusate and liver graft, (2) dual-controlled perfusion of the portal vein and hepatic artery, and (3) real-time monitoring of the perfusion conditions, including the flow rate, perfusion pressure and temperature. This system was useful for liver preservation and for evaluating the graft viability and recovery of functions during machine perfusion before transplantation. This novel rewarming machine preservation system was tested in an experimental model using porcine liver grafts. We report that this system has certain advantages in liver preservation, and believe that this system will positively contribute to the expansion of the organ donor pool.

Adult-to-Adult Living-Donor Liver Transplantation

Swiss Surgery ◽  
2003 ◽  
Vol 9 (5) ◽  
pp. 227-236 ◽  
Author(s):  
Majno ◽  
Mentha ◽  
Berney ◽  
Bühler ◽  
Giostra ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Therapeutic Option ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Multidisciplinary Program ◽  
First Case ◽  
Living Donor Transplantation ◽  
The Right

Living donor liver transplantation is a relatively new procedure in which the right side of the liver is harvested in a healthy donor and transplanted into a recipient. After the first case in 1994, over 3000 cases have been done worldwide. This review summarizes the reasons why the procedure is needed, describes its main technical aspects, highlights the boundaries in which it can be done safely, summarizes the current experience worldwide and describes the main points of the program in our unit. We argue that living-donor transplantation is a viable alternative to a long time on the waiting list for several patients, and it can be performed safely and successfully provided that all precautions are undertaken to minimize the risks in the donor and to increase the chances of a good outcome in the recipients. If these prerequisites are met, and within the framework of a structured multidisciplinary program, we believe that living-donor liver transplantation should be funded by health insurances as a recognized therapeutic option.

Coronary sinus catalase and ceruloplasmin levels predict all-cause mortality in patients with end-stage heart failure awaiting heart transplantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Szczurek ◽  
M Gasior ◽  
M Skrzypek ◽  
G Kubiak ◽  
A Kuczaj ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Coronary Sinus ◽  
Public Institution ◽  
Funding Source ◽  
Organ Shortage ◽  
Number Of Patients ◽  
End Stage ◽  
Medical University

Abstract   Background, As a consequence of the worldwide increase in life expectancy and due to significant progress in the pharmacological and interventional treatment of heart failure (HF), the proportion of patients that reach an advanced phase of disease is steadily growing. Hence, more and more numerous group of patients is qualified to the heart transplantation (HT), whereas the number of potential heart donors has remained invariable since years. It contributes to deepening in disproportion between the demand for organs which can possibly be transplanted and number of patients awaiting on the HT list. Therefore, accurate identification of patients who are most likely to benefit from HT is imperative due to an organ shortage and perioperative complications. Purpose The aim of this study was to identify the factors associated with reduced survival during a 1.5-year follow-up in patients with end-stage HF awating HT. Method We propectively analysed 85 adult patients with end-stage HF, who were accepted for HT at our institution between 2015 and 2016. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine the panel of oxidative stress markers. Oxidative-antioxidant balance markers included glutathione reductase (GR), glutathione peroxidase (GPx), glutathione transferase (GST), superoxide dismutase (SOD) and its mitochondrial isoenzyme (MnSOD) and cytoplasmic (Cu/ZnSOD), catalase (CAT), malondialdehyde (MDA), hydroperoxides lipid (LPH), lipofuscin (LPS), sulfhydryl groups (SH-), ceruloplasmin (CR). The study protocol was approved by the ethics committee of the Medical University of Silesia in Katowice. The endpoint of the study was mortality from any cause during a 1.5 years follow-up. Results The median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. All included patients were treated optimally in accordance with the guidelines of the European Society of Cardiology. Mortality rate during the follow-up period was 40%. Multivariate logistic regression analysis showed that ceruloplasmin (odds ratio [OR] = 0.745 [0.565–0.981], p=0.0363), catalase (OR = 0.950 [0.915–0.98], p=0.0076), as well as high creatinine levels (OR = 1.071 [1.002–1.144], p=0.0422) were risk factors for death during 1.5 year follow-up. Conclusions Coronary sinus lower ceruloplasmin and catalase levels, as well as higher creatinine level are independently associated with death during 1.5 year follow-up. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Medical University of SIlesia, Katowice, POland

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