Elective ventilation describes the procedure of transferring selected patients dying from rapidly progressive intracranial haemorrhage from general medical wards to intensive care units for a brief period of ventilation before confirmation of brain stem death and harvesting of organs. This approach in Exeter has led to a rate of kidney retrieval and transplant higher than has been achieved elsewhere in the United Kingdom, with a stabilisation of numbers on patients on dialysis. Recently doubt has been cast on the legality of our practice of elective ventilation on the grounds that relatives are not permitted to consent to treatment of an incompetent person when that treatment is not in the patient's best interests. We are thus faced with the dilemma of a protocol that is ethical, practical, and operates for the greater good but which may be illegal. This article explores various objections to the protocol and calls for public, medical, and legal debate on the issues.
HighlightsA growing amount of experience and research evidence from across the world has shown that the role of faith is known to play an important part in the decision to donate organs. National Health Service Blood and Transplant seeks to work in partnership with faith leaders, and this culminated in a Faith and Organ Donation Summit held on May 9, 2013. The independent comments and recommendations of the summit attendees were collated into an action plan, with consensus at the summit that there needs to be sustained engagement with the issue of organ donation among faith communities and by faith communities. All faith leaders value the importance of organ donation as an issue that needs to be acknowledged and debated within their faith communities. Faith leaders highlight that there is a need for engagement at both national and local levels concerning organ donation as well as diagnosis and definition of death. Role of Religion in
Summary A 15-year-old girl who presented with a bilateral sixth nerve palsy caused by infectious mononucleosis is described. The neurological presentation of infectious mononucleosis is discussed.
Introduction: Double kidney transplantation from very marginal donors can increase the number of recipients who benefit from transplantation utilizing otherwise discarded kidneys. However, refusals by multiple transplant centers/recipients and more detailed assessments (e.g. pre-implantation histology) can prolong cold ischemia time (CIT). Methods: To assess the impact of prolonged CIT, we retrospectively evaluated 72 consecutive recipients (Dec. 2004 to Dec. 2008) who received double kidney grafts that were deemed to be not suitable for single kidney transplantation. Two groups with long CIT (L-CIT: > 36 hr, n=24) and short CIT (S-CIT: ≤ 36 hr, n=48) were compared. All grafts were evaluated by histology and preserved on pulsatile machine perfusion (PP). T-cell depleting antibody induction and tacrolimus and mycophenolate (± steroids) based maintenance immunosuppressant were used. Results: Overall, CIT was relatively long (median 33.0 hr [15.8 -51.7 hr]); 63 patients (87.5%) had CIT > 24 hr and 5 patients (6.9%) had CIT > 48 hr. Baseline characteristics were similar with regard to donor age, history of hypertension, terminal creatinine, PP flow, PP resistance, and percent glomerulosclerosis. As expected, total CIT (pre-PP time + PP time) was longer in the L-CIT group than in the S-CIT group (43.2 ± 4.7 hr vs. 28.8 ± 5.0 hr, p < 0.0001); however, pre-PP (simple storage) time was similar (6.0 ± 2.5 hr vs. 5.7 ± 2.1 hr, p=0.658). The incidence of delayed graft function (requiring dialysis within 1 week post-transplant) was numerically (but not statistically) higher in the L-CIT group (4.2% vs. 2.1%, p=1.00), which did not lead to any adverse outcomes thereafter. Two-year death-censored graft survival was not different (L-CIT: 91.5% vs. S-CIT: 93.2%, p=0.696). Estimated GFR at 1 year post-transplant was similar (L-CIT: 68.7 ± 34.5 vs. S-CIT: 59.0 ± 27.0 mL/min/1.73 m 2 , p=0.235), and the percentage of patients with poor graft function (estimated GFR < 30 mL/min/1.73 m 2 ) at 1 year was also similar (12.5% vs. 10.4%). Conclusion: Despite prolonged CIT (up to 48 hours), double kidney transplantation can provide reasonable graft survival and renal graft function when preserved by PP. These grafts should not be discarded based on merely prolonged ischemia time.
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