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Organ donor management

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https://www.readbyqxmd.com/read/29198691/successful-liver-transplantation-from-a-donor-with-a-continuous-flow-left-ventricular-assist-device-for-9-months
#1
K Munawar, N Rajagopalan, A Grigorian, D Dennis, M Guglin
Organ donor criteria continue to be extended in an attempt to meet growing demands. Patients with continuous-flow left ventricular assist devices are one group of potential donors being considered. One concern with this group is the effect of continuous flow for a prolonged duration, as opposed to normal pulsatile flow, on end-organ function. We report the 1st case of a liver transplantation from a donor who had a continuous-flow left ventricular assist device for 9 months. The recipient was a 69-year-old woman with a history of cryptogenic cirrhosis and hepatocellular carcinoma...
December 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29198668/a-case-of-successful-simultaneous-pancreas-kidney-transplantation-using-the-injured-pancreas-graft
#2
S Miyagi, K Shimizu, K Miyazawa, W Nakanishi, Y Hara, K Tokodai, C Nakanishi, S Satomi, M Goto, M Unno, T Kamei
OBJECTIVE: Graft injuries sometimes occur and may cause complications such as the leakage of pancreatic secretions, which is often lethal. We report our experience of a case of successful simultaneous pancreas-kidney transplantation using injured pancreas graft. PATIENTS AND METHODS: The recipient was a 57-year-old woman with type 1 diabetes mellitus, and the donor was a 30-year-old man with a brain injury. In the donation, the pancreas parenchyma, splenic artery, and gastroduodenal artery were injured iatrogenically...
December 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/29194652/outcomes-of-red-blood-cell-transfusions-prescribed-in-organ-donors-by-the-digital-intern-an-electronic-decision-support-algorithm
#3
Joseph P Connor, Thomas Raife, Joshua E Medow
BACKGROUND: The Digital Intern (DI) is an electronic decision support tool for the management of organ donors. One algorithm determines the dose, in units of red blood cells to be transfused, based on hematocrit (Hct) thresholds and targets. The effectiveness of the transfusion dose calculated by the DI in terms of achieving the selected Hct target and the duration of the targeted dose is not known. STUDY DESIGN AND METHODS: This was a retrospective study to describe the outcomes of transfusions prescribed by the DI...
December 1, 2017: Transfusion
https://www.readbyqxmd.com/read/29191293/cardiac-transplantation-current-outcomes-and-contemporary-controversies
#4
REVIEW
Michelle M Kittleson, Jon A Kobashigawa
Despite advances in pharmacologic and device treatment of chronic heart failure, long-term morbidity and mortality remain high, and many patients progress to end-stage heart failure. Over the last 5 decades, heart transplantation (HTx) has become the preferred therapy for select patients with end-stage heart disease. However, although HTx has become standard of care for the management of end-stage heart failure, challenges continue to exist. The number of patients with end-stage heart failure is increasing, whereas the number of donor organs remains constant and a limiting factor in HTx...
December 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/29190374/scaling-up-newborn-care-in-afghanistan-opportunities-and-challenges-for-the-health-sector
#5
Malalai Naziri, Ariel Higgins-Steele, Zelaikha Anwari, Khaksar Yousufi, Karla Fossand, Sher Shah Amin, David B Hipgrave, Sherin Varkey
Newborn health in Afghanistan is receiving increased attention, but reduction in newborn deaths there has not kept pace with declines in maternal and child mortality. Using the continuum of care and health systems building block frameworks, this article identifies, organizes and provides a synthesis of the available evidence on and gaps in coverage of care and health systems, programmes, policies and practices related to newborn health in Afghanistan. Newborn mortality in Afghanistan is related to the nation's weak health system, itself associated with decades of conflict, low and uneven coverage of essential interventions, demand-side and cultural specificities, and compromised quality...
November 27, 2017: Health Policy and Planning
https://www.readbyqxmd.com/read/29187041/restrictive-cardiomyopathy-or-constrictive-pericarditis-an-unresolved-conundrum
#6
Gregory Ho, Ed Peng, Antony Hermuzi, Asif Hasan
Cardiomyopathy may have a variety of causes and may lead to significant morbidity. Often, there is no "perfect" treatment. New investigative techniques may add insight but retain the possibility of uncertainty. The distinction between restrictive cardiomyopathy and pericardial constriction may be challenging, particularly when considering the incidence of these entities. This distinction may significantly impact patient management and this is becoming increasingly important in the context of donor organ austerity...
January 1, 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/29174516/delayed-hemolytic-transfusion-reaction-and-hyperhemolysis-syndrome-without-detectable-alloantibodies-or-autoantibodies-in-a-patient-with-sickle-cell-disease-a-fatal-case-report-and-literature-review
#7
B Nsimba, A Habibi, F Pirenne, P Bartolucci, D Tonduangu, C Duvoux, N De Prost, M Marcandetti, A Mekontso-Dessap, F Galactéros, P Morel
Delayed hemolytic transfusion reaction is a classic and still under diagnosed complication in patients with sickle cell disease who undergo blood transfusions, and this condition may lead to hyperhemolysis syndrome which is characterized by a massive destruction of both the donor's and patient's red blood cells. We reported the clinical and biological features, treatments and prevention measures of a case of a 47-year-old man of Martinican origin, with sickle cell disease (hemoglobin SS) and no history of alloimmunization, multiply transfused, who was admitted to the Sens Medical Center in July 2015 due to a vaso-occlusive crisis...
November 22, 2017: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
https://www.readbyqxmd.com/read/29171093/government-helper-and-citizen-advocate-a-case-study-of-the-multiple-roles-and-pressures-facing-a-nongovernmental-organization-contracted-by-government-to-strengthen-community-health-in-northern-india
#8
Kerry Scott, Asha S George, Steven A Harvey, Shinjini Mondal, Gupteswar Patel, Raman Vr, Kabir Sheikh
While nongovernmental organizations (NGOs) can potentially strengthen valuable citizen political engagement, NGOs that are increasingly oriented towards donor and government contracts may instead contribute to depoliticizing development. Amidst competing pressures, NGO experiences and agency in managing multiple roles require examination. We present a qualitative case study of an NGO implementing a government-designed intervention to strengthen Village Health, Sanitation, and Nutrition Committees (VHSNCs) in rural north India...
November 24, 2017: International Journal of Health Planning and Management
https://www.readbyqxmd.com/read/29128023/evaluation-and-management-of-the-potential-lung-donor
#9
REVIEW
Andrew Courtwright, Edward Cantu
The expansion of the donor lung pool has involved an evidence-driven redefinition of acceptable donors. Proceeding with transplantation with an acceptable rather than ideal donor depends on specific patient-related and organ-related risk factors as well as the severity of recipient illness. Although the physiologic optimization of brain-dead donors has not changed significantly in recent years, the use of donor management protocols has improved procurement rates. Ex vivo lung perfusion is an increasingly viable strategy to recondition lungs that would otherwise fall below the acceptable threshold for transplant...
December 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/29127678/allogeneic-matched-related-transplantation-for-%C3%AE-thalassemia-and-sickle-cell-anemia
#10
Françoise Bernaudin, Corinne Pondarré, Claire Galambrun, Isabelle Thuret
Allogeneic hematopoietic stem cell transplantation (HSCT) can cure single gene disorders such as thalassemia and sickle cell anemia (SCA). These non-malignant diseases have in common severe hemolytic anemia and high proliferative bone marrow, requiring frequent transfusions. The risk of rejection is high and graft-vs-host disease is not desirable. Important progress has been made in the management of these diseases, including leukocyte depletion of blood products, and chelation therapy, for both diseases, and erythrocytapheresis and hydroxycarbamide for SCA...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/29115076/current-status-and-future-of-lung-donation-in-korea
#11
Hye Ju Yeo, Seong Hoon Yoon, Seung Eun Lee, Doosoo Jeon, Yun Seong Kim, Woo Hyun Cho, Do Hyung Kim
Lung transplantation is the only effective treatment option for patients with end-stage lung disease. However, donor organ shortage makes timely transplant not possible for all patients, especially in Korea. We investigated the number and utilization of donor lungs by retrospectively reviewing all donor organs registered in the Korea Network for Organ Sharing database from March 2012 to March 2016. The donors were stratified into 4 groups by donor acceptability criteria. A total of 1,304 donors were included...
December 2017: Journal of Korean Medical Science
https://www.readbyqxmd.com/read/29110798/intraoperative-anesthetic-management-of-lung-transplantation-patients
#12
REVIEW
Bessie Kachulis, Ludmil Mitrev, Desmond Jordan
Lung transplantation is a high-risk procedure that requires a highly trained cardiothoracic anesthesiologist and a considerable degree of vigilance. In the 50 years since the first lung transplantation, improvements in immunosuppression, preservation solutions, and surgical techniques and technologies have led to increased survival rates. The development of the extracorporeal circulatory membrane oxygenation allowed for bridge to transplantation and for donor organ recovery from primary graft dysfunction post transplantation [1]...
June 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29110788/worldwide-trends-in-heart-and-lung-transplantation-guarding-the-most-precious-gift-ever
#13
REVIEW
Vera von Dossow, Joseph Costa, Frank D'Ovidio, Nandor Marczin
Transplantation is sadly a therapy to die for. The survival of a recipient with end-stage heart or lung disease requires the demise of a human being through brain death or cessation of circulation, with the noblest final act of offering one's organs to another. However, transplantation is constrained by severe hemodynamic, regulatory, inflammatory, and metabolic stresses in the donor, rendering the majority of offered organs unsuitable for transplantation. Coupled with our inability to acquire exact molecular and cellular information and missed opportunities for effectively modulating deteriorations of donors and allografts, anesthesia and critical care contributes to ongoing organ shortages...
June 2017: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/29109556/management-of-mechanical-ventilation-in-patients-with-hospital-acquired-pneumonia-a-retrospective-observational-study
#14
Radovan Uvizl, Tomas Herkel, Katerina Langova, Petr Jakubec
BACKGROUND: Hospital-acquired pneumonia (HAP) in intensive care patients is a frequent reason for mechanical ventilation (MV). The management of MV and ventilator weaning vary, depending on the type of lung inflammation. This retrospective, observational study screened the data from all patients admitted to the intensive care unit (ICU) of the Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc between 2011 and 2016...
November 2, 2017: Biomedical Papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia
https://www.readbyqxmd.com/read/29108406/intracerebral-hemorrhage-in-intensive-care-unit-early-prognostication-fallacies-a-single-center-retrospective-study
#15
Stefano Spina, Chiara Marzorati, Alessia Vargiolu, Federico Magni, Matteo Riva, Matteo Rota, Carlo Giussani, Erik P Sganzerla, Giuseppe Citerio
BACKGROUND: Intracerebral hemorrhage (ICH) admitted to intensive care is deem of poor prognosis. To compare observed and predicted 30-days mortality and to evaluate long term functional outcome in a consecutive ICH cohort. METHODS: Retrospective analysis of prospectively collected data of ICH patients managed in a Neuro-ICU from 2012 to 2015. RESULTS: 136 consecutive patients; 34 (25%) had "withholding of life-sustaining treatment" (WLST) order and 102 (75%) received a "full treatment" (FT)...
November 6, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29100644/a-comprehensive-risk-score-to-predict-prolonged-hospital-length-of-stay-after-heart-transplantation
#16
Todd C Crawford, J Trent Magruder, Joshua C Grimm, Alejandro Suarez-Pierre, Nishant Patel, Christopher M Sciortino, Kenton J Zehr, Kaushik Mandal, Ryan J Tedford, Stuart D Russell, John V Conte, Robert S Higgins, Duke E Cameron, Glenn J Whitman
BACKGROUND: Prolonged hospital length of stay (PLOS) after heart transplantation increases cost and morbidity. To better inform care, we developed a risk score to identify patients at risk for PLOS after heart transplantation. METHODS: We queried the United Network for Organ Sharing Scientific Registry of Transplant Recipients database for adult patients who underwent isolated heart transplantation from 2003 to 2012. The population was randomly divided into a derivation cohort (80%) and a validation cohort (20%)...
November 1, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29021960/relapsing-ebv-encephalitis-in-a-renal-transplant-recipient
#17
Joshua A Stone, Bettina M Knoll, Dimitrios Farmakiotis
In solid organ transplant recipients, Epstein-Barr virus (EBV) can cause active central nervous system (CNS) infection or malignant transformation of latently infected cells in the CNS, known as post-transplant lymphoproliferative disease (PTLD). Reduction of T-cell immunosuppression is the cornerstone of management. The role of antivirals with in-vitro activity against herpesviruses in EBV-related CNS syndromes is controversial, as they have no effect on latent virus. We report an unusual case of relapsing EBV encephalitis in a donor-positive, EBV-negative renal transplant recipient, with response to valganciclovir...
2017: IDCases
https://www.readbyqxmd.com/read/28993303/the-lived-experience-of-being-evaluated-for-organ-donation-focus-groups-with-living-kidney-donors
#18
Camilla S Hanson, Angelique F Ralph, Karine E Manera, John S Gill, John Kanellis, Germaine Wong, Jonathan C Craig, Jeremy R Chapman, Allison Tong
BACKGROUND AND OBJECTIVES: Comprehensive evaluations are required to safeguard voluntarism and minimize harm to living kidney donors. This process is lengthy, invasive, and emotionally challenging, with up to one fifth of potential donors opting out. We aimed to describe donors' experiences of the evaluation process. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted 14 focus groups involving 123 kidney donors who completed donation from three transplant centers (Australia and Canada)...
November 7, 2017: Clinical Journal of the American Society of Nephrology: CJASN
https://www.readbyqxmd.com/read/28985863/early-declaration-of-death-by-neurologic-criteria-results-in-greater-organ-donor-potential
#19
Shelby Resnick, Mark J Seamon, Daniel Holena, Jose Pascual, Patrick M Reilly, Niels D Martin
BACKGROUND: Aggressive management of patients prior to and after determination of death by neurologic criteria (DNC) is necessary to optimize organ recovery, transplantation, and increase the number of organs transplanted per donor (OTPD). The effects of time management are understudied but potentially pivotal component. The objective of this study was to analyze specific time points (time to DNC, time to procurement) and the time intervals between them to better characterize the optimal timeline of organ donation...
October 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28975176/deformability-based-microfluidic-separation-of-pancreatic-islets-from-exocrine-acinar-tissue-for-transplant-applications
#20
Walter B Varhue, Linda Langman, Molly Kelly-Goss, Morgan Lataillade, Kenneth L Brayman, Shayn Peirce-Cottler, Nathan S Swami
The long-term management of type-1 diabetes (T1D) is currently achieved through lifelong exogenous insulin injections. Although there is no cure for T1D, transplantation of pancreatic islets of Langerhans has the potential to restore normal endocrine function versus the morbidity of hypoglycemic unawareness that is commonly associated with sudden death among fragile diabetics. However, since endocrine islet tissues form a small proportion of the pancreas, sufficient islet numbers can be reached only by combining islets from multiple organ donors and the transplant plug contains significantly high levels of exocrine acinar tissue, thereby exacerbating immune responses...
October 25, 2017: Lab on a Chip
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