Donor Management and Matching

Frist, William H.; Fanning, William J.

doi:10.1016/s0733-8651(18)30383-7

Cited by 18 publications

(7 citation statements)

References 45 publications

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“…BDOD is frequently the subject of less than meticulous management after the declaration of brain death [2]. This is unfortunate in light of the fact that a single donor can benefit as many as 5-15 recipients [1,2]. The care of these patients is often left to persons who follow standardized protocols in their management.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Hemodynamic Heterogeneity of Brain Dead Organ Donors

Duke

Ramsay

Paulsen

et al. 1992

Survey of Anesthesiology

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Brain death is accompanied by a loss of homeostatic mechanisms leading to physiologic changes which have been shown to be detrimental to donor organs prior to procurement [2,4]. The management of the brain dead organ donor (BDOD) is frequently left to transplant coordinators, often registered nurses, who follow standardized protocols for that management. The use of a standardized protocol assumes that these donors display homogeneity. To investigate this assumption, the anesthesiology fellows and faculty involved in multiorgan transplantation at the Baylor University Medical Center/UTSWMC conducted a study into the perioperative hemodynamics ofthe BDOD.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Hemodynamic Heterogeneity of Brain Dead Organ Donors

Duke

Ramsay

Paulsen

et al. 1992

Survey of Anesthesiology

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“…[12][13][14] The type of cardioplegic solution used in heart preservation has been the only varying method throughout the years: between January 1988 and October 1991 St. Thomas' 1 solution was used (31 cases; 15.0%), between January 1991 and June 1996, Wisconsin solution (96 cases; 46.6%), and between June 1996 and June 1999, Celsior solution (80 cases; 38.6%). In the first part of this study the rate of hospital mortality for graft failure was assessed.…”

Section: Methodsmentioning

confidence: 99%

Determinants and prognostic value of ischemic necrosis in early biopsies following heart transplant

et al. 2000

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To evaluate the impact of early ischemic necrosis (IN) on the early and late outcome of heart transplantation, we reviewed our 11-year experience. Between January 1988 and June 1999, 207 heart transplants were performed in 205 patients (174 male and 31 female). Criteria for donor and recipient selection, and protocols for postoperative immunosuppression and rejection monitoring have remained unchanged over this period. Three different cardioplegic solutions were employed in graft preservation: St. Thomas Hospital solution in the earliest 31 cases (15%), University of Wisconsin solution in 96 cases (46.4%), and Celsior solution in the last 80 cases (38.6%). All patients who underwent at least one endomyocardial biopsy (176 patients) were divided into two groups according to the findings of IN within the early 3 postoperative months (group A, 49 patients with IN; group B, 127 patients without IN). The following variables were estimated in each group: donor and recipient age, ischemic time, type of cardioplegia, late mortality for cardiac causes, incidence of grade >2 rejection within the first 6 postoperative months, late incidence of grade >2 rejection, late incidence of NYHA class >II. No significant difference was found in any parameter between the two groups, except for the type of cardioplegic solution. A significantly higher incidence of ischemic necrosis in hearts preserved with St. Thomas solution was found (P < 0.001). Although pathology findings show that extracellular solutions carried a higher risk of early IN, no associated significant impairment in terms of late survival and event-free rate was observed in recipients with early IN.

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“…It has been recognized that the loss of brain stem function can lead to marked autonomic and endocrine dysfunction that may impact at least on early graft function (53,94,268). Determination of death as complete cessation of cardiorespiratory function [so-called donation after cardiac death (DCD)] was used in early solid-organ cadaveric transplantation (334).…”

Section: Technical Aspects Of Transplantation Donorsmentioning

confidence: 99%

Exercise Limitation Following Transplantation

Williams

McKenna

2012

Comprehensive Physiology

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Organ transplantation is one of the medical miracles or the 20th century. It has the capacity to substantially improve exercise performance and quality of life in patients who are severely limited with chronic organ failure. We focus on the most commonly performed solid‐organ transplants and describe peak exercise performance following recovery from transplantation. Across all of the common transplants, evaluated significant reduction in o 2 peak is seen (typically renal and liver 65%‐80% with heart and/or lung 50%‐60% of predicted). Those with the lowest o 2 peak pretransplant have the lowest o 2 peak posttransplant. Overall very few patients have a o 2 peak in the normal range. Investigation of the cause of the reduction of o 2 peak has identified many factors pre‐ and posttransplant that may contribute. These include organ‐specific factors in the otherwise well‐functioning allograft (e.g., chronotropic incompetence in heart transplantation) as well as allograft dysfunction itself (e.g., chronic lung allograft dysfunction). However, looking across all transplants, a pattern emerges. A low muscle mass with qualitative change in large exercising skeletal muscle groups is seen pretransplant. Many factor posttransplant aggravate these changes or prevent them recovering, especially calcineurin antagonist drugs which are key immunosuppressing agents. This results in the reduction of o 2 peak despite restoration of near normal function of the initially failing organ system. As such organ transplantation has provided an experiment of nature that has focused our attention on an important confounder of chronic organ failure‐skeletal muscle dysfunction. © 2012 American Physiological Society. Compr Physiol 2:1937‐1979, 2012.

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Donor Management and Matching

Cited by 18 publications

References 45 publications

Intraoperative Hemodynamic Heterogeneity of Brain Dead Organ Donors

Intraoperative Hemodynamic Heterogeneity of Brain Dead Organ Donors

Determinants and prognostic value of ischemic necrosis in early biopsies following heart transplant

Exercise Limitation Following Transplantation

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