Personal experience with the procurement of 132 liver allografts

Abstract. A single donor surgeon's experience procuring the livers from 132 donors is described. Thirty-seven grafts (28. 9%) had hepatic arterial anomalies, 19 (14. 4%) of which required arterial reconstruction prior to transplantation. Of the 121 grafts evaluated for early function, 103 grafts (85. 2%) functioned well, whereas 14 grafts (11. 6%) functioned poorly and 4 grafts (3. 3%) failed to function at all. The variables associated with less than optimal function of the graft consisted of donor age ( P <0. 05), duration of donor's stay in the intensive care unit ( P < 0. 005), abnormal graft appearance ( P < 0. 05), and such recipient problems as vascular thromboses during or immediately following transplantation ( P < 0. 005). A new preservation fluid, University of Wisconsin solution, allowed safe and longer cold storage of the liver allograft than did Euro-Collins' solution ( P < 0. 0001). A parameter of liver allograft viability, which is simple and predictive of allograft function prior to the actual transplant procedure, is urgently needed.     

Histidine–Tryptophan–Ketoglutarate (HTK) Is Associated with Reduced Graft Survival in Deceased Donor Livers, Especially Those Donated After Cardiac Death

Single-center studies have reported that liver allograft survival is not affected by preservation in histidine–tryptophan–ketoglutarate (HTK) versus University of Wisconsin (UW) solution. We analyzed the UNOS database of liver transplants performed from July, 2004, through February, 2008, to determine if preservation with HTK (n = 4755) versus UW (n = 12 673) impacted graft survival. HTK preservation of allografts increased from 16.8% in 2004 to 26.9% in 2008; this was particularly striking among donor after cardiac death (DCD) allografts, rising from 20.7% in 2004 to 40.9% in 2008. After adjusting for donor, recipient and graft factors that affect graft survival, HTK preservation was associated with an increased risk of graft loss (HR 1.14, p = 0.002), especially with DCD allografts (HR 1.44, P = 0.025) and those with cold ischemia time over 8 h (HR 1.16, P = 0.009). Furthermore, HTK preservation was associated with a 1.2-fold higher odds of early (< 30 days) graft loss as compared to UW preservation (OR 1.20, p = 0.012), with a more pronounced effect on allografts with cold ischemia time over 8 h (OR 1.31, p = 0.007), DCD allografts (OR 1.63, p = 0.09) and donors over 70 years (OR 1.67, p = 0.081). These results suggest that the increasing use of HTK for abdominal organ preservation should be reexamined.     

Absence of significant dissent should be sufficient for deceased donor organ procurement in New Zealand

Objective: New Zealand's organ donation rates are among the lowest in the OECD. In a bid to increase organ availability, the New Zealand Human Tissue Act 2008 introduces new consent arrangements for deceased donor organ procurement. This article assesses these new arrangements and presents the case for further reform.
Approach: Our assessment and arguments are based on philosophical analysis informed by empirical data on the effectiveness of alternative consent systems. We: 1) Identify widely held ethical judgments about policies and practices relevant to organ donation (e.g. those relating to coronial post-mortems), 2) Assess the implications of these judgments for the Human Tissue Act and the assumptions that underpin it, and 3) Derive policy recommendations that are consistent with the judgments.
Conclusion: The Human Tissue Act 2008 retains a strong consent requirement for organ procurement: organs may not be transplanted unless either the deceased or the family consents. We argue that organ availability could and should be increased by shifting from a model that requires consent to one that requires the absence of significant dissent.
Implications: We recommend that New Zealand adopt either 1) an organ donation system similar to the existing system for ordering coronial post-mortems, or 2) a variant of the 'opt-out' system already in place in several other countries.     

国家药品集中采购政策对天津市北辰医院门诊降压药使用情况的影响

目的 分析国家药品集中采购对天津市北辰医院门诊降压药使用情况的影响。方法 提取国家药品集中采购政策实施前后门诊降压药的用药数据,采用药物经济学方法回顾性分析药品价格、数量、金额、用药频度（DDDs）、日均费用（DDC）和换药率等变化情况。结果 2018—2022年天津市北辰医院门诊降压药共涉及9个品种,集采药较原用药相比,降价幅度均在50%以上,销售金额减少132.48万元,同比降低54.26%,DDDs同比升高29.01%,DDC均有不同程度的降低。70.71%～100.00%患者将非集采药更换成集采药使用。结论 国家药品集中采购政策切实降低了天津市北辰医院高血压患者用药负担,提高了医保资金使用效率,同时医生和患者越来越倾向于使用集采药,集采药逐步得到大众认可。     

我国药物招标采购制度分析

通过对我国现有的药物招标和采购制度的探讨,并运用制度理论以图示形式罗列、推导我国药品招标和采购工作中存在的主要问题,借鉴国外发达国家在制定药品招标和采购制度方面的先进经验,提出构建和完善我国药物招标和采购制度的方案,方案主要包括:实现制度设置公平性的具体措施、建立具有约束性的规则,以及建立政府监管和协调机制等。     

医疗设备预算管理存在的问题与对策

医疗设备的引进和更新要通过设备预算实现,然而,医疗卫生单位在设备预算管理中,还存在重视不够、体制不健全、预算完成质量不高、应变能力差、资金不能得到有效利用等问题。本文探讨通过制度建设,信息公开,建立“精算”意识,充分做好设备预算的论证工作,及时调整预算,以达到设备预算的预期目的。     

浅析医用耗材网上集中招标采购

扩大医用耗材招标范围,将常用的低值医用耗材和高值医用耗材全部纳入集中招标采购,有效提高了投标人的积极性;医用耗材集中配送模式减少了流通环节,降低了各医疗机构的采购成本,为实现医用耗材价格透明创造了有利条件。     

药品带量采购的政策路径分析及思考

上海从2015年开始,陆续开展了3批次的药品带量采购试点,形成了较完整的制度框架和操作规范,为国家组织药品集中采购和使用(国家集采)工作提供了上海经验。本文在总结上海药品带量采购试点和国家集采工作实践经验的基础上,分析当前药品带量采购工作面临的问题和挑战,为进一步完善相关政策,促进带量采购工作的健康可持续发展提供新思路。     

基于药品采购金额分析我省第一批国家重点监控药品的监管效果

目的从药品采购金额角度探讨实施国家监管对我省第一批国家重点监控药品临床应用的影响。方法统计广东省二、三级医疗机构2018年上半年、2018年下半年、2019年上半年和2019年下半年第一批国家重点监控药品的采购金额,并计算采购金额占比。结果加强重点监控药品监管显著降低了我省二、三级医疗机构第一批国家重点监控药品采购金额占比,其中神经节苷脂等10个品种采购金额占比呈明显下降趋势,小牛血清去蛋白等5个品种采购金额占比呈一定程度的下降趋势,而脑蛋白水解物、长春西汀和马来酸桂哌齐特3个品种采购金额占比则变化不大。结论实施国家监管能显著降低第一批国家重点监控药品的采购金额占比,从而促进其临床合理应用,但目前仍有必要进一步强化管理。     

The pancreas allograft donor: current status,controversies, and challenges for the future

Fridell JA, Rogers J, Stratta RJ. The pancreas allograft donor: current status, controversies, and challenges for the future.
Clin Transplant 2010: 24: 433–449.
© 2010 John Wiley & Sons A/S. Abstract: The pancreas allograft is a scarce resource that is currently underutilized. The selection of appropriate deceased donors for pancreas procurement is of paramount importance for minimizing technical failure and optimizing long‐term outcomes in pancreas transplantation. Despite the increasing demand for pancreas transplantation, increases in overall organ donation rates and the evolution of criteria that constitute an “acceptable” pancreas donor, the number of deceased donor pancreas transplants being performed in the United States has actually declined in recent years. Although there are many factors that must be considered during evaluation of the potential pancreas allograft donor to minimize morbidity and graft loss, it is evident that there are transplantable organs that are not used. In this review, deceased donor pancreas identification, management, selection, allocation, assessment, preservation, and the problem of pancreas underutilization will be discussed.