Advanced practice organ procurement techniques: insertion of thoracic catheters

Advanced practice coordinators who perform procedures that may be associated with complications must be proficient at treating those untoward events. This discussion reviews the diagnosis of a pneumothorax as a complication of insertion of a central venous catheter and mechanical ventilation. The method for inserting the Wayne Pneumothorax Set thoracic catheter is presented. This and similar commercially available catheters may also be used to evacuate a pleural effusion or nonclotted blood from the thorax for diagnostic purposes or when treating hypoxemia. It is essential for organ procurement organizations to provide appropriate training and quality assurance programs to ensure safe practice.     

Advanced practice organ procurement techniques: insertion of arterial catheters

Placement of arterial catheters by organ procurement coordinators is becoming more common. Classroom and clinical training in this technique and provision of appropriate quality assurance and supportive policies/procedures by organ procurement programs will ensure the coordinators' success. This discussion reviews technical aspects of insertion of catheters into the radial, femoral, and axillary arteries, potential complications, and alternative noninvasive methods of measuring blood pressure.     

心脏死亡器官捐赠中器官切取的手术方法与技巧总结

目的 对心脏死亡器官捐赠(DCD)中供者器官切取手术方法的特点与技巧进行总结,观察器官移植后移植物的功能.方法 回顾性分析26例DCD供者器官切取的临床资料,分别采用上腹部多器官联合切取法和肝肾分别切取法切取供者器官.结果 26例供者器官的平均热缺血时间为4 min(1～10 min),器官切取手术操作顺利,器官切取手术平均耗时为27min(20～45min).共获得供肝22个,供肾44个,上腹部多器官(包括肝脏、胰腺和十二指肠)2个;所获取器官进行肝移植24例(其中2例供肝进行劈离式肝移植供给4例受者),肾移植42例(其中2例供者的双肾进行双肾移植),上腹部多器官移植2例.所有移植手术均顺利,移植器官的功能恢复良好,未出现原发性移植物无功能等并发症.结论 在DCD器官切取手术中,上腹部多器官联合切取法和肝肾分别切取法的手术步骤简捷、安全可靠,要求术者掌握熟练的外科技巧,动作迅速准确,能最大限度减少供者器官的热缺血时间,以保证获取高质量的供者器官.     

Advanced practice organ procurement techniques: placement of pulmonary artery catheters

Insertion of pulmonary artery catheters by organ procurement coordinators may be incorporated into donor management to optimize organ perfusion. As invasive procedures are added to coordinator roles, the organ procurement organization must include didactic instruction and supervised clinical experience as part of any training program. Policies and procedures guiding the use of the pulmonary artery catheter and the measurements obtained must be provided by the organization to guide practitioners. This article focuses on methods for insertion and basic troubleshooting of a pulmonary artery catheter.     

Advanced practice organ procurement techniques: insertion of central venous catheters

Placement of central venous catheters by organ procurement coordinators to assist in obtaining blood samples or for measuring intravascular pressure is appropriate. Preparation for this role should include appropriate didactic instruction and supervised clinical experience. The organ procurement organization must ensure that such training occurs and must support a continuing quality assurance program for such providers. Policies and procedures must be provided to guide practitioners in site selection, timing of implementation, and titration of measurements obtained. Also, resources must be readily available to treat any complications. This discussion reviews methods for insertion of venous catheters placed in the femoral, internal jugular, or subclavian veins.     

Standards of visceral organ procurement

Due to poor willingness in the population to donate organs and increasing number of patients on the waiting list for organ transplantation there is an imminent need on cadaveric organs. Although efforts have been to optimize the prerequisites for organ donation, less than 50% of possible organ harvesting procedures take place. In our country, only 13.1 organ donations .per 1 million inhabitants were realized in 2001. These data force the medical community to maximize the utility of the donor pool. A refined surgical technique, increased efficacy of solutions for graft conservation, an advanced perioperative management and new potent immunosuppressive drugs contributed to a post-transplant 1-year graft and patient survival of up to 80 to 90%. The quality of a graft has a significant impact on the outcome of transplantation. An optimal graft function will not only be achieved with an adequate surgical and preservation technique but also with an appropriate management of the brain-dead donor on the intensive care unit. Basic knowledge of brain death definition, insight into the organization of organ donation, management of the donor, and modern surgical harvesting techniques are presented.     

Technical complications in organ procurement

It is of crucial importance that harvested organs are not discarded because of lesions inflicted during the procurement operation. From January 2005 to January 2006, a total of 395 organs were procured: 266 kidneys, 102 livers, and 27 pancreate. Two kidneys were lost due to vascular lesions, and 1 liver could not be transplanted because of a severe parenchymal injury (0.75% total organ losses). In 33 of 198 cases (16.7%) despite lesions to renal vessels or to the ureter, the kidneys were transplanted after back-table repair procedures. Vascular lesions were observed in 10% of the evaluated livers (8 of 102) and in 3 of 18 pancreatic grafts. In the literature, a total organ loss of 0.75% because of technical problems demonstrates a high standard of visceral organ procurement in our region. Hence, reparable vascular and ureteral lesions in 10% to 16.4% indicated the need for better surgical training and standardization in procurement techniques. We believe that double-checking both the organ and quality reports and giving immediate feedback to the procurement surgeons in cases of technical problems are effective ways to perform quality control. It must be our goal to increase the response rate of the quality forms.     

Efficiency of organ procurement and transplantation programs

Abstract The number of donations per million population (pmp) per year and the number of transplants pmp/year enables one to compare donation or transplant programs made in different years in the same area or made the same year in different areas. These pmp indexes may be integrated with an evaluation system by which each organ is evaluated separately in terms of the efficiency of its procurement and transplant systems using the procurement index (percentage in terms of number of organs utilized/number of organs procurable from donors utilized in a single area during 1 year) and the transplant index (percentage in terms of number of transplants performed/number of organs harvested in a single area during 1 year). We have called them Caldes I (procurement) and Caldes II (transplant) indexes. The harvest index evaluates the efficiency of utilization of organs retrieved from suitable donors. It usually ranges between 80‐90% for the kidney, 70‐95 % for the liver, 40‐50 % for the heart, and 5‐15 % for the lungs. The transplant index evaluates for each organ the transplant team capacity to use available organs which can be harvested locally or in different areas. It usually ranges between 60‐120%. Index determination did not require information different from the standard data available. Both the harvest and transplant indexes could be used to compare the efficiency of donation and transplant programs and policies in the same area during different years or at the same time in different areas. They can be critical in evaluating: (a) marginal donor utilization, (b) marginal organ utilization, and (c) dishomogeneity of organ retrieval and organ transplantation in different regions belonging to the same area. They also enable to evaluate if organs considered not available in a single area are offered to other areas or are not retrieved at all from available donors.     

Ethics and regulation in organ procurement research

This article explores the role of ethics and regulation in human research conducted by organ procurement agencies; basic ethical principles for human research are outlined. Organ procurement agencies are not required to observe federal regulations; however, voluntary adherence will ensure that procurement research is conducted according to current standards of ethical practice. Although most organ procurement research will qualify for exempt status, this determination should be made by an institutional review board. Even if studies qualify for exempt status, there is a moral presumption that informed consent should be sought, unless certain narrow conditions for waiver of consent are satisfied. Finally, when future research utilizing organ procurement records is anticipated, procurement coordinators should provide sufficiently detailed information to families about such plans to permit their advance informed consent to research activities.     

Solid organ procurement from burned children

BACKGROUND: Burns have constituted a traditional contraindication to solid organ procurement because of concerns that such organs may be damaged by burn shock associated splanchnic ischemia and contaminated by burn wound manipulation associated bacteremia. METHODS: Over a 5-year period, we attempted solid organ procurement from five burned children who had suffered concurrent anoxic brain injury. RESULTS: These four boys and one girl had an average age of 8.1 years (range, 2.5-12 years) and burn size of 29% (range, 4-70%). All were injured in house fires and four of five (80%) required prehospital external cardiac compressions. Brain death was declared an average of 35 hours (range, 2.75-77 hours) after injury. Solid organs procured and successfully transplanted from this group were 4 livers, 10 kidneys, and 2 hearts. Two of the livers and one heart were placed into pediatric recipients. Procured tissues included three sets of cardiac valves, and two corneas. All solid organs transplanted were functional at 6 months, although longer follow-up is not available. CONCLUSION: Early identification and diagnosis of brain death during resuscitation of burn patients with anoxic brain injury, combined with careful resuscitation and support of the brain dead potential organ donor, can result in the recovery of suitable solid organs and tissues for transplantation.     

History of deceased organ donation, transplantation, and organ procurement organizations

The historical development of deceased organ donation, transplantation, and organ procurement organizations is reviewed. The concept of transplantation, taking parts from one animal or person and putting them into another animal or person, is ancient. The development of organ transplantation brought on the need for a source of organs. Although many early kidney transplants used kidneys from living donors, these donors could not satisfy the ever-growing need for organs, and extrarenal organs were recovered only from deceased donors. This need for organs to satisfy the great demand led to specialized organizations to identify deceased donors, manage them until recovery occurred, and to notify transplant centers that organs were available for their patients. The functions of these organ procurement organizations expanded to include other required functions such as education, accounting, and compliance with state and federal requirements. Because of the shortage of organs relative to the demand, lack of a unified organ allocation system, the perception that organs are a national resource and should be governed by national regulations, and to improve results of organ procurement organizations and transplant centers, the federal government has regulated virtually all phases of organ procurement and transplantation.