Current status of animal-to-human transplantation

The transplantation of animal organs into humans as a way of treating organ failure has been pursued for 100 years. Clinical xenotransplantation, as such, has always failed because the transplanted organ is rejected by the recipient. Recent advances in transplant immunology have revealed some mechanisms underlying the rejection of xenografts, and these discoveries have sparked efforts to use genetic engineering of animals and therapeutics directed at the recipient to overcome this problem. This paper reviews the current understanding of the mechanisms of xenograft rejection and efforts to overcome rejection and other hurdles.     

Current status of animal-to-human transplantation

The transplantation of animal organs into humans as a way of treating organ failure has been pursued for 100 years. Clinical xenotransplantation, as such, has always failed because the transplanted organ is rejected by the recipient. Recent advances in transplant immunology have revealed some mechanisms underlying the rejection of xenografts, and these discoveries have sparked efforts to use genetic engineering of animals and therapeutics directed at the recipient to overcome this problem. This paper reviews the current understanding of the mechanisms of xenograft rejection and efforts to overcome rejection and other hurdles.     

Trauma and donation after circulatory death: a case series from a major trauma center

Even with encouraging recipient outcomes, transplantation using donation after circulatory death (DCD) is still limited. A major barrier to this type of transplantation is the consequences of warm ischemia on graft survival; however, preservation techniques may reduce the consequences of cardiac arrest and provide better organ conservation. Furthermore, DCD in trauma patients could further expand organ donation. We present five cases in which organs were retrieved and transplanted successfully using normothermic regional perfusion (NRP) in trauma patients. Prompt critical care support and surgical treatment allowed us to overcome the acute phase. Unfortunately, owing to the severity of their injuries, all of the donors died. However, the advanced and continuous organ-specific supportive treatment allowed the maintenance of general clinical stability and organ preservation. Consequently, it was possible to retrieve and transplant the donors’ organs. Death was ascertained in accordance with cardio-circulatory criteria, which was followed by NRP. We consider that DCD in trauma patients may represent an important source of organs.     

器官移植前保存的理论研究与临床应用

背景：器官移植前的活性是器官移植后功能恢复的关键,也是器官保存医学的难题之一。目的：综述了器官的保存方法、保存液以及各个器官国内外的保存现状,以便寻找不同器官的最佳保存方法和保存液,为器官保存提供理论依据。方法：应用计算机检索万方、维普数据库和PubMed数据库中1998-01/2011-09关于器官移植前保存的文章,在标题和摘要中以＂器官;移植;保存＂或＂organ;transplant;preservation＂为检索词进行检索。选择文章内容与器官移植前保存相关,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到186篇文献,根据纳入标准选择20篇文章进行综述。结果与结论：对器官保存方法的了解,有利于根据研究现状选择合适的保存方法。器官保存液是器官活性保持的关键,现存保存液较多,不同保存液对不同的器官保存效果具有一定的差异,通过选择合适的保存液使需要移植的器官保存效果达到最佳,从而使移植后的器官功能恢复的最好。通过对器官移植前保存方法和保存液的研究,了解不同器官的合适的保存方法和保存液将有利于器官保存医学的进一步发展。     

器官移植前保存的理论研究与临床应用

背景:器官移植前的活性是器官移植后功能恢复的关键,也是器官保存医学的难题之一。目的:综述了器官的保存方法、保存液以及各个器官国内外的保存现状,以便寻找不同器官的最佳保存方法和保存液,为器官保存提供理论依据。方法:应用计算机检索万方、维普数据库和PubMed数据库中1998-01/2011-09关于器官移植前保存的文章,在标题和摘要中以"器官;移植;保存"或"organ;transplant;preservation"为检索词进行检索。选择文章内容与器官移植前保存相关,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到186篇文献,根据纳入标准选择20篇文章进行综述。结果与结论:对器官保存方法的了解,有利于根据研究现状选择合适的保存方法。器官保存液是器官活性保持的关键,现存保存液较多,不同保存液对不同的器官保存效果具有一定的差异,通过选择合适的保存液使需要移植的器官保存效果达到最佳,从而使移植后的器官功能恢复的最好。通过对器官移植前保存方法和保存液的研究,了解不同器官的合适的保存方法和保存液将有利于器官保存医学的进一步发展。     

How the system functions. The roles of the United Network of Organ Sharing, the organ procurement and transplantation network, and the organ procurement organization in heart transplantation

Have the limits for suitable recipient candidates for heart transplantation been exceeded? Does the current legislation and policy instituted at all levels, from DHHS to individual transplant programs, critically address the use of a dangerously limited resource? These and other questions must be the focus of future discussions regarding equitable and efficient heart transplantation in this country. The past has shown that many individuals working cooperatively within committees at federal and organizational levels have already made great strides in making organ transplantation a successful reality. Many factors influence the broadening gap between supply and demand. Each level of the system can make contributions that bring positive and creative solutions to old and new problems. Each team and committee must continue to demand representation from diverse, yet attentive, members to ensure that the specific needs of the thoracic organ recipients are properly reviewed and addressed. UNOS and its membership must continue to work together to meet the challenges of the growing acceptance of organ transplantation and the limited supply of donor organs. Continued efforts of politicians, health care professionals, and the general public must seek newer and more creative ways to manage the critical organ shortage and the ever-growing population of patients who seek heart transplantation as the only viable treatment option for their disease process. OPOs must continue their efforts to educate and promote organ donation and continue to work diligently toward increasing the pool of acceptable organ donors through improved patient management and the development of improved preservation and transport techniques. The transplant community must take the initiative to modify current legislation and to author new legislation to serve as better representors for the transplant patient population that desperately needs it.     

Knowledge and attitudes of medical, nursing, dentistry and health technician students towards organ donation: a pilot study

Aim. This pilot study assesses the knowledge and attitudes of medicine, nursing, dentistry and health technical students toward organ donation. Background. Medicine, nursing, dentistry and health technical students’ knowledge of and attitudes towards organ donation may be a factor in organ procurement rates. There is a lack of information about how Turkish medicine, nursing, dentistry and health technical students perceive organ donation, and what they know about it. Method. Students completed a self‐administered questionnaire after a lecture. The questionnaire included a test that was used to assess knowledge of and attitudes about organ donation. Results. Of the students, 56·8% were men, 91·4% were 18–24‐year old and 89·4% from east region of Turkey. Of students, 65·5% were willing, 9% were not willing, 25·5% were hesitant about organ donation and 6% of willing students reported carrying a signed card. The most common reason for unwillingness to organ donation was worries about illegal behaviours (2·4%). There was a statistical relationship between willingness of students for organ donation and gender but were not any statistical relationship between willingness of students for organ donation and age, school, region and recognizing relatives whose need organ transplantation. Majority of the students listed transplantable organs truly but 63·1% were had no idea about organ donation process. Conclusion. Students’ had a lack of information about organ donation. The results of this study support a greater emphasis on providing information regarding transplantation in medicine, nursing, dentistry and health technical schools to improve the knowledge of future heath care professionals about transplantation and organ donation issues. Relevance to clinical practice. These findings highlight a need to review these schools’ curricula and emphasize the importance of organ transplantation. This strategy may be part of the solution to the chronic shortage of donor organs for transplantation.     

HLA typing and transplantation

Clinical trial of organ transplantation was renal transplantation by Voronoy at 1936. The discovery of HLA in the 1950s was one of the most important new findings in the area of transplantation. Nowadays, developing HLA genotyping methods, the serum analysis does not use for donor and recipient HLA typing but for cross-matching test. Because each of HLA genotyping methods has its merits and demerits, it is important to choice right methods for avoiding type error. PCR-Luminex method using fluorescence microsphere was developed for high-resolution HLA-A, HLA-B and HLA-DRB1 genotyping in the Japanese population. This genotyping method allows to define all the possible combinations of alleles at each loci existing in Japanese at the four-digital level. In hematopoietic stem cell transplantation, to match high resolution level of HLA between donor and recipient lead an improvement of recipient's survival. In organ transplantation, removed organ has to be so immediately transplanted into recipient that no time is left for HLA genotyping. In order to have good survival of transplanted organ, HLA, cytokine promoter lesion and immunoglobulin like receptor genotyping might be helpful. We focused on this review at HLA genotyping, especially new SSO methods.     

Pro/con ethics debate: When is dead really dead?

Contemporary intensive care unit (ICU) medicine has complicated the issue of what constitutes death in a life support environment. Not only is the distinction between sapient life and prolongation of vital signs blurred but the concept of death itself has been made more complex. The demand for organs to facilitate transplantation promotes a strong incentive to define clinical death in a manner that most effectively supplies that demand. We consider the problem of defining death in the ICU as a function of viable organ availability for transplantation     

器官获取组织质量管理的实践与思考

背景：随着人体捐献器官获取与分配相关政策的出台,器官获取、获取标准及器官如何分配都有了明确化的操作标准,但器官获取组织的工作流程、组织定位还不够精细化、规范化。目的：分析解放军广州军区广州总医院器官获取组织质量管理经验,及时审视工作进展并探讨需要改进的方面,为进一步加强器官获取组织质量管理和建立高效专业的器官获取组织提出相应对策。方法：通过关键词“器官捐献,器官移植,器官获取组织,质量管理;organdonation,organtransplantation,OrganProcurementOrganization,qualitymanagement”,在CNKI和PubMed等数据库中综合分析来源于核心期刊的文章。结果与结论：根据有关法律法规,解放军广州军区广州总医院制定了评价标准与检查标准,并成立了有关小组,实现职责与权力的统一和明确。同时,完善有关的器官捐献、获取、保存、登记等环节,根据这些不同环节制定针对性的质量管理计划。另外,定期举行协调员培训班,进行规范化培训。通过一系列质量管理措施,该院器官获取组织已逐步正规化,取得了一定成果,并且建议进一步强化科研研究,实现效率和效益的统一;提高院领导重视度,完善器官获取机制;重视人才培养,提高器官获取组织成员的专业素质;加强信息化管理,实现多学科协作;建立质量评价体系,实现全过程质量管理;重视医学伦理,实现医患和谐。     

Organ preservation

OBJECTIVES: To review organ preservation in cancer treatment within the context of organ function, treatment-related acute and late toxicities, outcome data, and quality of life. DATA SOURCES: Published review and research articles, proceedings of conferences, and oncology textbooks. CONCLUSIONS: The implementation of surgery, with sequential and/or concurrent chemoradiation, has advanced the success of organ preservation in multiple tumor types and organ systems. Integral to the discussion of organ preservation is consideration of quality of life. IMPLICATIONS FOR NURSING PRACTICE: An understanding of organ preservation in cancer treatment will allow oncology nurses to be more effective patient advocates by providing current information that can be integrated into patient care and education.     

原位心脏移植术后成活28个月

于１９９７年６月１９日为一例终末期扩张心肌病患者施行了同种原位心脏移植术,至今存活质量良好。本例有四个特点：１。供体血ＨＢｓＡｇ（＋）,ＨＢｅＡｂ（＋）,ＨＢｃＡｂ（＋）,术后病人无乙肝病毒感染征象;２．强调供心保护是手术成败的关键;３．采用国产赛斯平作为主要免疫抑制药物;４．术后小剂量免疫抑制药物联合抗排斥治疗,避免了严重并发症。     

The brain-dead patient or a flower in the vase? The emergency department approach to the preservation of the organ donor.

Transplantation has been incorporated into the treatment of patients with end-stage diseases of most major organ systems in recent years. However, organ supply is the greatest limitation to organ transplantation. Among the factors that can enhance organ supply, donor management has received the least attention. The importance of establishing an acceptable method of rapidly and accurately determining brain death in potential donors cannot be overemphasized. With an increased awareness of donor management issues and the application of a rational physiological approach, the supply of functional organs for transplantation can be increased. Rapid and continuing resuscitation of clinically brain-dead trauma victims is mandatory. This review addresses the evaluation and management of the organ donor within the emergency department. Common management problems (hypotension, arrhythmias, diabetes insipidus, oliguria, and coagulopathy) are discussed in detail. An aggressive, proactive approach to the medical management of the potential donor is recommended in order to limit the number of medical failures and maximize the number of organs donated.     

Complications of orthotopic liver transplantation: imaging findings

Orthotopic liver transplantation has become the major treatment for end-stage chronic liver disease and for severe acute liver failure. Despite the improvement in survival due to advances in organ preservation, improved immunosuppressive therapy agents, and refinement of surgical techniques, there are significant complications after liver transplantation. These complications mainly include biliary strictures, stones, and leakage; arterial and venous stenoses and thromboses; lymphoproliferative disorders; recurrent tumors; hepatitis virus C infection; liver abscesses; right adrenal gland hemorrhage; fluid collections; and hematomas. The diagnosis of acute rejection, one of the most serious complications after liver transplantation, is established with graft biopsy and histologic study. The role of imaging methods consists of excluding the other complications, which can have clinical signs and symptoms similar to those of acute rejection. This pictorial essay describes imaging findings of the various complications after liver transplantation and focuses on their radiologic diagnosis. Knowledge and early recognition of these complications with the most suitable imaging modality are crucial for graft and patient survival.     

Non-heart-beating organ donation: process and review

To combat the national shortage of donor organs and meet the needs of more than 60,000 patients awaiting transplant, many organ procurement organizations have reevaluated non-heart-beating organ donation (NHBD) as one solution. Non-heart-beating donation is the process by which organs are recovered from patients after the pronouncement of death by cardiopulmonary criteria. Recent media reports have misled health care providers to believe that this is a new donation procedure; however, NHBD provided the foundation for modern clinical transplantation. This article describes non-heart-beating donor evaluation criteria, the donation process, associated ethical considerations and the role of the advance practice nurse in assisting families with this end-of-life decision. A case study will be presented followed by a summary of transplant recipient patient and graft survival outcomes.     

Limiting care: the case of organ transplantation

The technical challenge of performing organ transplants is nearly nonexistent, and great progress has been made in understanding and overcoming the barriers associated with the immune system. The questions are no longer, "Can we perform organ transplants?" and "Which ones?". These questions have been replaced by a much more complex one. "Who should be offered the therapeutic option of transplant?". This article explores the concept of limited access to a vital care option, organ transplantation. The two major factors that limit unrestricted access are the high cost of organ transplantation to the individual and society, and the limited supply of donor organs. These issues are discussed within the framework of, and how they affect, patient selection for transplantation.     

Why families deny consent to organ donation.

Advances in medical practice and technology and the success of organ transplantation over the past 2 decades have resulted in an increased demand for organ donors. However, the health care community and organ procurement organisations (OPO) are faced with a worldwide shortage of donor organs. The non-consent of families is the most common reason that organs of medically suitable potential donors are not recovered. A review of published research post 1990 was conducted to primarily determine the major factors that influence a family's decision to deny consent to donation. Other objectives included providing suggestions for health care personnel to facilitate the donation request experience and to suggest strategies that would increase donation consent rates to benefit the organ procurement process. Databases predominately used in the review included CINAHL and Medline. The world wide web (www) was also accessed. The literature review indicates that the significant factors associated with denial of consent include: the misunderstanding of brain death; cultural beliefs; the specific timing of the request; the setting in which the request is made; the approach of the individual making the request; and characteristics of the deceased. Organ donation and transplantation rates could be increased by the joint involvement of medical, nursing and OPO personnel to enhance the quality of hospital care and to ensure that requests for donation are handled in a way that meets the family's informational and emotional needs. Increased consent rates have the potential to save lives and improve the quality of life for organ recipients.     

Nurse-focused ethical solutions to problems in organ transplantation

Technological developments in recent years have brought about a rapid increase in the number and variety of organ transplants, leading to problems in finding enough organs to meet the need. Organ transplantation has also become a particularly significant issue in medical ethics, especially regarding the question of how and from whom organs are procured. Many methods have been tried in order to solve these problems and discussed from an ethical perspective. This study investigates the Spanish, Belgian and Iranian approaches to solving the organ procurement problem. The Spanish model, which is based on persuading patients and their relatives, is ethically less problematic and is also an improved version of the model applied in Turkey. This study argues that an ideal solution can be found without disregarding ethical rules. In particular, nurses can contribute by helping to run the system more efficiently. The principal aim of this article is to demonstrate the contribution of nurses to solving the current organ procurement problem in Turkey and offer some reflections on what can be done to improve the efficiency of the system.     

Genetic therapies and xenotransplantation

The number of patients in need of an organ transplant is increasing, while the number of satisfactory sources of organs has declined in many countries [101]. The resulting shortage of human organs has spurred an urgent effort to investigate alternative therapies, including the use of animal organs, tissues and cells (i.e., xenotransplantation). Advances in genetic engineering have provided essential tools for the development of practical solutions to human disease. The area of xenotransplantation is no exception. In fact, the use of genetic therapies is especially attractive in the transplant setting as it offers an opportunity to manipulate the donor tissue rather than the recipient. This review will describe the obstacles in the clinical application of xenotransplantation and how genetic engineering might be used to address them.