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Organ Shortage (organ + shortage)
Kinds of Organ Shortage Selected AbstractsLiver transplantation for alcoholic liver diseaseADDICTION BIOLOGY, Issue 4 2001Georges-Philippe Pageaux Although increasing numbers of alcoholic patients are being referred to liver transplant centres, liver transplantation for alcoholic liver disease still remains controversial, essentially because we are in an era of organ shortage. In fact, the main issue is the likelihood of relapse and its influence on outcome, because it is the possibility of returning to alcohol use that separates patients with alcoholic liver disease from those with other forms of chronic liver disease. In all proposed clinical guidelines of indications for referral and assessment for liver transplantation for alcoholic liver disease, the authors emphasize the risk of alcoholism recurrence and, thus, a multidisciplinary approach is required to select patients who are likely to comply with follow-up and not return to a damaging pattern of alcohol consumption after transplantation. It emerges from all clinical studies that when we take into account the usual criteria of success for liver transplantation, i.e. patient and graft survival, rejection rate and infection rate, alcoholic liver disease is a good indication for liver transplantation. Predictive factors for alcoholic relapse after liver transplantation have been assessed in numerous studies, often with contradictory results making these difficult to analyse and compare. Several predictive factors for alcoholic relapse have been studied: length of abstinence before transplantation, associated psychiatric problems, social conditions, associated drug addiction, age. Abstinence after transplantation is the goal, but the necessary treatment for alcoholic disease can result in considerable improvement, even when complete abstinence is not achieved. Finally, the good results obtained with liver transplantation for alcoholic liver disease should help us to educate the general population about alcoholic disease. [source] Immune tolerance: mechanisms and application in clinical transplantationJOURNAL OF INTERNAL MEDICINE, Issue 3 2007M. Sykes Abstract. The achievement of immune tolerance, a state of specific unresponsiveness to the donor graft, has the potential to overcome the current major limitations to progress in organ transplantation, namely late graft loss, organ shortage and the toxicities of chronic nonspecific immumnosuppressive therapy. Advances in our understanding of immunological processes, mechanisms of rejection and tolerance have led to encouraging developments in animal models, which are just beginning to be translated into clinical pilot studies. These advances are reviewed here and the appropriate timing for clinical trials is discussed. [source] Liver transplantation in the era of model for end-stage liver diseaseLIVER INTERNATIONAL, Issue 1 2004Victor S. Wang Abstract: Liver transplantation is challenged by organ shortage and prolonged waiting list time. The goal of the ideal organ allocation system is to transplant individuals least likely to survive without a liver transplantation, and maintain appropriate rates of postoperative survival. Currently, liver allocation in the United States is based on the model for end-stage liver disease (MELD). Studies have shown MELD to be objective and accurate in predicting short-term survival in patients with cirrhosis. [source] Living donor liver transplantation in high-risk vs. low-risk patients: Optimization using statistical modelsLIVER TRANSPLANTATION, Issue 2 2006François Durand Living donors represent a recognized alternative for facilitating the access to transplantation in a period of organ shortage. However, which candidates should be preferentially considered for living-donor liver transplantation (LDLT) is debated. The aim of this study was to create statistical models to determine which strategies of selection for LDLT provide the most efficient contribution. The study included 331 patients listed for deceased-donor transplantation (DDLT) and 128 transplanted with living donors. Statistical models predicting the events following listing were created and combined in a multistate model allowing the testing of different strategies of selection for LDLT and to compare their results. Taking 3-yr survival after listing as the principal end-point, selecting the 20% patients at highest risk of death on the waiting list gave better results than selecting the 20% patients at lowest risk of death after LDLT (70% vs. 64%, respectively). These strategies resulted in waiting list mortality rates of 17% and 8%, respectively. One-year survival after LDLT was lower in high-risk patients (85%) than in low-risk patients (91%). However, the 1-yr survival benefit derived from LDLT was 75% in high-risk patients while it was nil in low-risk patients. In conclusion, LDLT is more effective for overcoming the consequences of organ shortage when performed in patients at high risk of death on the waiting list. On an individual basis, the sickest patients are those who derive the most important benefit from LDLT. This study provides incentives for considering LDLT in high-risk patients. Liver Transpl 12:231,239, 2006. © 2006 AASLD. [source] AASLD/ILTS transplant course: Is there an extended donor suitable for everyone?LIVER TRANSPLANTATION, Issue S2 2005Andrew Cameron Key Points 1The clinical success of liver transplantation coupled with the current era of organ shortage has caused many centers to expand their criteria for acceptable donors. 2The definition of "Extended Criteria Donor" (ECD) is becoming better understood and quantified. 3Recipient factors that portend poor outcome must be recognized and factored in as well. Grafts and recipients must be "matched" to manage and minimize the risk from ECDs. 4Maintaining acceptable outcomes as ECD concepts evolve is paramount. 5Absolute risk factors for poor graft function still exist and must be respected, but relative risk factors are now well identified, quantified, accepted, and managed as an alternative to high waiting list mortality. (Liver Transpl 2005;11:S2,S5.) [source] Liver transplantation from non,heart-beating donors: Current status and future prospectsLIVER TRANSPLANTATION, Issue 10 2004Srikanth Reddy Liver transplantation is the treatment of choice for many patients with acute and chronic liver failure, but its application is limited by a shortage of donor organs. Donor organ shortage is the principal cause of increasing waiting lists, and a number of patients die while awaiting transplantation. Non,heart-beating donor (NHBD) livers are a potential means of expanding the donor pool. This is not a new concept. Prior to the recognition of brainstem death, organs were retrieved from deceased donors only after cardiac arrest. Given the preservation techniques available at that time, this restricted the use of extrarenal organs for transplantation. In conclusion, after establishment of brain death criteria, deceased donor organs were almost exclusively from heart-beating donors (HBDs). To increase organ availability, there is now a resurgence of interest in NHBD liver transplantation. This review explores the basis for this and considers some of the published results. (Liver Transpl 2004;10:1223,1232.) [source] Retransplantation for late liver graft failure: Predictors of mortalityLIVER TRANSPLANTATION, Issue 2 2000Marcelo Facciuto As patient survival after orthotopic liver transplantation (OLT) improves, late complications, including late graft failure, more commonly occur and retransplantation (re-OLT) is required more often. Survival after re-OLT is poorer than after primary OLT, and given the organ shortage, it is essential that we optimize our use of scarce donor livers. We sought to identify variables that predict poor outcome after late re-OLT. Among adults who underwent OLT between September 1989 and October 1997, we identified transplant recipients who survived greater than 6 months (n = 964) and analyzed those who required late re-OLT (,6 months after primary OLT). We recorded the indication for the initial OLT and interval from OLT to re-OLT. We also analyzed data collected at the time of re-OLT, including age, sex, indications for primary OLT and re-OLT, United Network for Organ Sharing status, preoperative laboratory values (white blood cells, platelets, hemoglobin, albumin, bilirubin, creatinine, and prothrombin time), Child-Pugh-Turcotte score, number of rejection episodes before re-OLT, and interval between OLT and re-OLT. In addition, we analyzed surgical factors (including procedure performed and use of packed red blood cells, fresh frozen plasma, and platelets), postoperative immunosuppression, and donor factors (age, ischemic time). Forty-eight patients (5%) underwent late re-OLT at a median of 557 days (range, 195 to 2,559 days) post-OLT. Survival rates after re-OLT at 90 days, 1 year, and 5 years were 71%, 60%, and 42%, respectively. Patients surviving 90 days or greater after re-OLT had an 85% chance of surviving to 1 year. Sepsis was the leading cause of death (15 of 25 deaths; 60%). Recipient age older than 50 years (P = .04), preoperative creatinine level greater than 2 mg/dL (P = .004), and use of intraoperative blood products (packed red blood cells, P = .001; fresh frozen plasma, P = .002; platelets, P = .004) had significant impacts on survival. Late re-OLT was associated with increased mortality. Careful patient selection, with particular attention to recipient age and renal function, may help improve results and optimize our use of scarce donor livers. [source] Low donor-to-recipient weight ratio does not negatively impact survival of pediatric heart transplant patientsPEDIATRIC TRANSPLANTATION, Issue 6 2010Liwen Tang Tang L, Du W, Delius RE, L'Ecuyer TJ, Zilberman MV. Low donor-to-recipient weight ratio does not negatively impact survival of pediatric heart transplant patients. Pediatr Transplantation 2010: 14:741,745. © 2010 John Wiley & Sons A/S. Abstract:, A major limitation to success in pediatric heart transplantation is donor organ shortage. While the use of allografts from donors larger than the recipient is accepted, the use of undersized donor grafts is generally discouraged. Using the UNOS database, we wanted to evaluate whether using smaller donor hearts affects the short- and long-term survival of pediatric heart transplant patients. A retrospective analysis of data entered into the UNOS database from April 1994 to May 2008 was performed. Pediatric heart transplant recipients (ages 0,18 yr) with DRWR <2.0 were identified and divided into two groups: Low-DRWR (<0.8) and Ideal-DRWR (0.8,2.0). Patients' demographics, pretransplant diagnoses, age at transplantation, severity of pretransplant condition, and rate of complications prior to hospital discharge after transplantation were noted. Fisher's exact, chi-square, and Wilcoxon rank sum tests were used to compare patients' baseline characteristics. Kaplan,Meier curves and Cox proportional hazard regression were used to compare patients' survival and to identify independent risk factors for outcomes. There were 3048 patients (204 with Low- and 2844 with Ideal-DRWR). The Low-ratio group patients were older (8.3 vs. 6.9 yr; p = 0.001), there was a slight male predominance in the Low-DRWR group (p = 0.055). The Low-DRWR group had longer transplant wait time than the Ideal-DRWR group (97 vs. 85 days; p = 0.04). The groups did not differ in race, primary diagnoses, severity of pretransplant condition (medical urgency status, need for ventilation, inotropic support, ECMO, nitric oxide, or dialysis, the PVR for those with bi-ventricular anatomy), or post-transplant complications (length of stay, need for inotropic support, dialysis, and rate of infections). The Low-DRWR patients had less episodes of acute rejection during the first-post-transplant month. Infants with DRWR 0.5,0.59 had lower 30-day survival rate (p = 0.045). There was no difference in short- and long-term survival between the patients with DRWR 0.6,0.79 and DRWR 0.8,2.0. Use of smaller allografts (DRWR 0.6,0.8) has no negative impact on the short- and long-term survival of pediatric heart transplant patients. [source] Hepatic Resection in Liver Transplant Recipients: Single Center Experience and Review of the LiteratureAMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2005Olaf Guckelberger Biliary complications such as ischemic (type) biliary lesions frequently develop following liver transplantation, requiring costly medical and endoscopic treatment. If conservative approaches fail, re-transplantation is most often an inevitable sequel. Because of an increasing donor organ shortage and unfavorable outcomes in hepatic re-transplantation, efforts to prolong graft survival become of particular interest. From a series of 1685 liver transplants, we herein report on three patients who underwent partial hepatic graft resection for (ischemic type) biliary lesions. In all cases, left hepatectomy (Couinaud's segments II, III and IV) was performed without Pringle maneuver or mobilization of the right liver. All patients fully recovered postoperatively, but biliary leakage required surgical revision twice in one patient. At last follow-up, two patients presented alive and well. The other patient with persistent hepatic artery thrombosis (HAT), however, demonstrated progression of disease in the right liver remnant and required re-transplantation 13 months after hepatic graft resection. Including our own patients, review of the literature identified 24 adult patients who underwent hepatic graft resection. In conclusion, partial graft hepatectomy can be considered a safe and beneficial procedure in selected liver transplant recipients with anatomical limited biliary injury, thereby, preserving scarce donor organs. [source] Le don d'organes au Canada: I'urgence d'agirCANADIAN PUBLIC ADMINISTRATION/ADMINISTRATION PUBLIQUE DU CANADA, Issue 2 2007René Dussault Sommaire: Le taux de dons d'organes au Canada est l'un des plus faibles parmi tous les pays industrialisés. En 2004, il était de 13 donneurs par million alors qu'on peut espérer, en prenant les mesures appropriées, atteindre dans l'avenir près de 30 donneurs par million. Dans un contexte où la rareté des donneurs potentiels, c'est-à-dire des personnes en état de décès neurologique, est la cause principale d'insuffisance d'organes, il est essentiel que des mesures soient prises pour réduire le plus possible la perte de ces donneurs. Trois raisons expliquent cette perte: les donneurs éventuels ne sont pas bien identifiés, leur famille n'a pas été approchée ou bien elle a refusé le don. Bien que cause importante de la perte de donneurs, le refus des familles n'explique cette situation qu'en partie. Elle découle tout autant d'un manque de formation des professionnels de la santé et de coordination des activités reliées au don et à la transplantation des organes qui présentent un caractère fortement multidisciplinaire et ont un impact important sur la disponibilité des lits de soins intensifs et des salles d'opération. Pourtant, au Canada comme dans tout autre pays, le meilleur moyen de lutter contre le commerce d'organes est d'organiser un système efficace permettant d'augmenter le taux de donneurs effectifs pour répondre à la demande. Nous devons donc porter nos efforts sur l'organisation plus efficace du système de don et de transplantation des organes et travailler sans relâche à réduire la perte de donneurs potentiels, en agissant de manière concertée sur chacune de ses causes. L'adoption du principe du consentement présumé, qui implique de renverser la présomption de droit civil selon laquelle une personne doit donner un consentement éclairé au don de ses organes, ne peut servir de substitut à ce travail d'organisation et de coordination et doit être vue comme un dernier recours. Abstract: The organ donor rate in Canada is one of the lowest among industrialized countries. In 2004, there were thirteen donors per million population; however, if the appropriate measures are taken, this rate may one day reach close to thirty donors per million. In a context where the scarcity of potential donors - persons in a state of neurological death - is without a doubt the major reason for organ shortage, it is essential that measures be taken to minimize the loss of such donors. The three main causes for the loss of donors are the failure to identify potential donors, the failure to approach the family, or the family's refusal to consent to organ donation. Although it is a major reason for the loss of donors, refusal by families to consent to organ donation represents only a small part of the overall picture. Other equally significant factors are the lack of training for health professionals and the lack of coordination with respect to organ donation and organ transplant activities, both of which are highly multidisciplinary in nature and have a considerable impact on the availability of icu beds and operating rooms. In Canada, however, as in any other country, the best way to fight against the trade in human organs is to organize an efficient system to increase the actual donor rate to meet the demand. Therefore, our efforts must focus first and foremost on improving the organization of the organ donation and organ transplant system. We must also work tirelessly to reduce the loss of potential donors through concerted action on each of these issues. Adopting the principle of presumed consent, which implies the overturning of the presumption of civil rights according to which an individual must give his or her informed consent to donate his or her organs, cannot be a substitute for implementing an organized and coordinated system and must be viewed as a last resort under the circumstances. [source] Examining the association between media coverage of organ donation and organ transplantation ratesCLINICAL TRANSPLANTATION, Issue 2 2007Brian L. Quick Abstract:, Research addressing the organ shortage in the USA has examined multiple factors influencing one's decision to become an organ donor. One of these research lines addresses media coverage of organ donation. The present investigation seeks to advance this research line by examining the association between organ donation media coverage and organ transplantation rates. A content analysis spanning January 1990 to December 2005 of three television networks reveals an overall positive association between coverage and transplantation rates. The implications of our findings are discussed along with recommendations for practitioners and advocates alike. [source] The cadaveric kidney and the organ shortage , a perspective reviewCLINICAL TRANSPLANTATION, Issue 6 2001L Brasile Despite the technical and logistical hurdles that must be overcome with the reintroduction of non-heartbeating donor kidneys, the potential of these organs represents the only near-term solution for effectively alleviating the growing disparity between demand and supply. This review provides an argumentative overview of the history of cadaveric kidney transplantation. During the early years of transplantation retrieval of kidneys from non-heartbeating donors necessitated a prolonged period of warm ischemic exposure, with a corresponding minimal ex vivo period since organ preservation was in its infancy. Today we have the inverse situation where warm ischemic times are quite limited and hypothermic preservation times average 24 h because organs are shipped to remote centers due to mandated organ sharing algorithms. The recent experience with the reintroduction of non-heartbeating donors has necessitated combining the worst aspects from both eras: substantial warm ischemia with prolonged hypothermic preservation. Nevertheless, recent results from several transplant groups poignantly highlight the potential of this approach in expanding the organ donor pool. [source] Experimental study of a type 3 phosphodiesterase inhibitor on liver graft functionBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2001T. Ikegami Background: The number of liver transplant recipients is increasing but donor organ shortages have become more severe. The effect of milrinone, a type 3 phosphodiesterase inhibitor (PDEI), on non-heart-beating donor grafts was evaluated using an orthotopic liver transplantation model in rats. Methods: Type 3 PDEI or normal saline (control group) was given intravenously to the donor animals for 60 min continuously (50 µg kg,1 min,1 ) before 60 min of warm ischaemia followed by cold preservation and subsequent transplantation. Survival, serum chemistry, bile output, histopathological findings and tissue cyclic 3,,5,-adenosine monophosphate (cAMP) concentrations were then compared. Results: Five of seven animals in the PDEI group were alive at 7 days, compared with only one of seven rats in the control group (P < 0·01). Serum levels of alanine aminotransferase 2 and 6 h after reperfusion, and hyaluronic acid levels 6 h after reperfusion, were significantly lower in the PDEI group than in the control group. Bile output from the transplanted graft was significantly greater in the PDEI group than in controls 2 h after reperfusion (P < 0·01). The mean necrotic area 6 h after reperfusion was also reduced in the PDEI-treated grafts (P < 0·01). cAMP levels in liver tissue at the end of both warm and cold ischaemia, and 2 and 6 h after reperfusion, were significantly higher in the PDEI group compared with those in the control group. Conclusion: Type 3 PDEI attenuated the graft injury caused by warm and cold ischaemia and subsequent reperfusion injury via an increase in intracellular cAMP levels. This treatment may be a novel pharmacological intervention for safe and efficient usage of liver grafts from non-heart-beating donors. © 2001 British Journal of Surgery Society Ltd [source] | ||||||||||