Geographic disparities in liver supply/demand ratio within fixed‐distance and fixed‐population circles

Recent OPTN proposals to address geographic disparity in liver allocation have involved circular boundaries: the policy selected 12/17 allocated to 150‐mile circles in addition to DSAs/regions, and the policy selected 12/18 allocated to 150‐mile circles eliminating DSA/region boundaries. However, methods to reduce geographic disparity remain controversial, within the OPTN and the transplant community. To inform ongoing discussions, we studied center‐level supply/demand ratios using SRTR data (07/2013‐06/2017) for 27 334 transplanted deceased donor livers and 44 652 incident waitlist candidates. Supply was the number of donors from an allocation unit (DSA or circle), allocated proportionally (by waitlist size) to the centers drawing on these donors. We measured geographic disparity as variance in log‐transformed supply/demand ratio, comparing allocation based on DSAs, fixed‐distance circles (150‐ or 400‐mile radius), and fixed‐population (12‐ or 50‐million) circles. The recently proposed 150‐mile radius circles (variance = 0.11, P = .9) or 12‐million‐population circles (variance = 0.08, P = .1) did not reduce the geographic disparity compared to DSA‐based allocation (variance = 0.11). However, geographic disparity decreased substantially to 0.02 in both larger fixed‐distance (400‐mile, P < .001) and larger fixed‐population (50‐million, P < .001) circles (P = .9 comparing fixed distance and fixed population). For allocation circles to reduce geographic disparities, they must be larger than a 150‐mile radius; additionally, fixed‐population circles are not superior to fixed‐distance circles.     

Impact of the 2016 revision of US Pediatric Heart Allocation Policy on waitlist characteristics and outcomes

US Pediatric Heart Allocation Policy was recently revised, deprioritizing candidates with cardiomyopathy while maintaining status 1A eligibility for congenital heart disease (CHD) candidates on “high‐dose” inotropes. We compared waitlist characteristics and mortality around this change. Status 1A listings decreased (70% to 56%, P < .001) and CHD representation increased among status 1A listings (48% vs 64%, P < .001). Waitlist mortality overall (subdistribution hazard ratio [SHR] 0.96, P = .63) and among status 1A candidates (SHR 1.16, P = .14) were unchanged. CHD waitlist mortality trended better (SHR 0.82, P = .06) but was unchanged for CHD candidates listed status 1A (SHR 0.92, P = .47). Status 1A listing exceptions increased 2‐ to 3‐fold among hypertrophic and restrictive cardiomyopathy candidates and 13.5‐fold among dilated cardiomyopathy (DCM) candidates. Hypertrophic (SHR 6.25, P = .004) and restrictive (SHR 3.87, P = .03) cardiomyopathy candidates without status 1A exception had increased waitlist mortality, but those with DCM did not (SHR 1.26, P = .32). Ventricular assist device (VAD) use increased only among DCM candidates ≥1 years old (26% vs 38%, P < .001). Current allocation policy has increased CHD status 1A representation but has not improved their waitlist mortality. Excessive DCM status 1A listing exceptions and continued status 1A prioritization of children on stable VADs potentially diminish the intended benefits of policy revision.     

基本药物带量采购分析

本文对基本药物集中招标采购的带量采购进行了探讨,分析带量采购在基本药物集中招标采购中应用的优势,通过＂量价挂钩＂等方式,达到合理降低药品价格的目的;并分析了＂一品三剂型两规格＂和＂单一货源承诺制＂可能导致货源过于集中,难以满足多样用药需求等问题。并针对问题提出改善思路及相关建议。认为带量采购整体上利大于弊,对于完善基本药物采购机制有积极作用。     

猪原位肝移植快速供肝切取方法与修整技术研究

目的总结肝脏移植供肝的快速切取和修整经验．方法分析2008年1～6月快速26例供肝的切取和修整的资料．快速切取技术采用原位腹主动脉、肠系膜上静脉灌注附加下腔静脉引流,快速切取供肝,4℃UW液中保存和修整肝脏．结果供肝切取时间平均为10min,无热缺血时间;冷缺血时间（2．11±0．26）h;供肝的修整时间为26～90min,平均46min．结论快速供肝切取法要求术者技术娴熟、动作迅速和准确,可最大限度地减少供肝热缺血时间．快速切取法能保证供肝的质量和确保供肝切取的成功．     

Trends in Deceased Organ Donation and Utilization in Korea: 2000-2009

Continuous efforts have been made by the organ donation and transplantation community in Korea to increase organ donation by the deceased. The authors detailed trends of organ donation and utilization over the past 10 yr using data provided by the KONOS. The yearly number of deceased donors has grown gradually since 2003. The number and percentage of old donors (≥50 yr) and donors dying from intracranial hemorrhage has increased continuously. Therefore, the percentage of standard criteria donors (SCD) has been declining significantly, from 94% in 2000 to 79.2% in 2009. The number of organs transplanted per donor (OTPD) has also declined slightly since 2007, from 3.28 in 2007 to 2.95 in 2009. This decline may be attributable to increases in the number and percentage of extended criteria donors (ECD) and donors after cardiac death (DCD), since the OTPD was 2.25 for DCD, 2.5 for ECD, and 3.09 for SCD in 2009. In summary, the makeup of donors has changed significantly. There is an urgent need for establishment of an institutional framework including an independent organ procurement organization and for improvement for the National Transplant Act to increase deceased donor pool and to optimize management of ECD and DCD.     

浅谈呼吸机采购中需注意的几个问题

本文介绍了呼吸机作为专用医疗设备在采购过程中的特殊性。应根据不同需求层次侧重选择相应技术指标,并通过第三方机构检测的方式对拟采购产品进行性能测试并对照厂家参数进行比较,最终以性能价格比最优原则进行采购。     

Effect of Recipient Hepatitis C Status on Outcomes of Deceased Donor Kidney Transplantation

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