Use of SARS‐CoV‐2‐infected deceased organ donors: Should we always “just say no?”

In the context of a rapidly evolving pandemic, multiple organizations have released guidelines stating that all organs from potential deceased donors with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection should be deferred, including from otherwise medically eligible donors found to have mild or asymptomatic SARS‐CoV‐2 discovered on routine donor screening. In this article, we critically examine the available data on the risk of transmission of SARS‐CoV‐2 through organ transplantation. The isolation of SARS‐CoV‐2 from nonlung clinical specimens, the detection of SARS‐CoV‐2 in autopsy specimens, previous experience with the related coronaviruses SARS‐CoV and MERS‐CoV, and the vast experience with other common RNA respiratory viruses are all addressed. Taken together, these data provide little evidence to suggest the presence of intact transmissible SARS‐CoV in organs that can potentially be transplanted, specifically liver and heart. Other considerations including ethical, financial, societal, and logistical concerns are also addressed. We conclude that, for selected patients with high waitlist mortality, transplant programs should consider accepting heart or liver transplants from deceased donors with SARS‐CoV‐2 infection.     

Engaged,Workaholic, Burned‐Out or Just 9‐to‐5? Toward a Typology of Employee Well‐being

The aim of this study was to establish a typology of employee well‐being, together with its psychosocial antecedents and consequences. Results obtained with a sample of 786 full‐time employees from different occupational sectors show four types of employee well‐being: 9‐to‐5 or relaxed, work engaged or enthusiastic, workaholic or tense, and burned‐out or fatigued, each having different relationships with job and personal characteristics. This study provides evidence of a parsimonious, theory‐based classification of employee well‐being and contributes to the existing literature about work investment because meaningful relations were found between various types of employee well‐being, and heavy and soft work investors. Copyright © 2013 John Wiley & Sons, Ltd.     

A 10 min “no‐touch” time – is it enough in DCD? A DCD Animal Study

Donation after cardiac death (DCD) is under investigation because of the lack of human donor organs. Required times of cardiac arrest vary between 75s and 27min until the declaration of the patients' death worldwide. The aim of this study was to investigate brain death in pigs after different times of cardiac arrest with subsequent cardiopulmonary resuscitation (CPR) as a DCD paradigm. DCD was simulated in 20 pigs after direct electrical induction of ventricular fibrillation. The "no-touch" time varied from 2min up to 10min; then 30min of CPR were performed. Brain death was determined by established clinical and electrophysiological criteria. In all animals with cardiac arrest of at least 6min, a persistent loss of brainstem reflexes and no reappearance of bioelectric brain activity occurred. Reappearance of EEG activity was found until 4.5min of cardiac arrest and subsequent CPR. Brainstem reflexes were detectable until 5min of cardiac arrest and subsequent CPR. According to our experiments, the suggestion of 10min of cardiac arrest being equivalent to brain death exceeds the minimum time after which clinical and electrophysiological criteria of brain death are fulfilled. Therefore shorter "no-touch" times might be ethically acceptable to reduce warm ischemia time.     

‘Insignificant’ prostate cancer on prostatectomy and cystoprostatectomy: variation on a theme ‘low‐volume/ low‐grade’ prostate cancer?

Although ‘insignificant’ prostate cancer has been examined separately in radical prostatectomy (RP) and radical cystoprostatectomy (RCP) studies, it is not entirely clear whether cancers designated as ‘insignificant’ on RP and RCP represent the same, similar or different forms of prostate cancer. Insignificant prostate cancer has been traditionally defined based on the pathological findings in the whole prostate gland. In addition to the pathological determinants of ‘insignificant’ prostate cancer, it is also important to account for the biological and the clinical context of the disease, as well as patient age and health status to designate a prostate cancer ‘insignificant’. This review examines and compares prostate cancers described as ‘insignificant’ on RP and RCP. We conclude that in most cases these low‐volume/low‐grade prostate cancers represent an early stage and clinically ‘silent’ disease, which are only detected in different clinical settings.     

Implications for the usage of the left lateral liver graft for infants ≤10 kg,irrespective of a large‐for‐size situation – are monosegmental grafts redundant?

Organ donor shortage for infant liver transplant recipients has lead to an increase in splitting and living donation. For cases in which even transplantation of the left lateral graft (Couinaud’s segments II + III) results in a “large for size situation” with an estimated graft body weight ratio (GBWR) of >4%, monosegmental liver transplantation was developed. This, however, bears complications because of greater parenchymal surface and suboptimal vascular flow. We exclusively use the left lateral graft from living donors or split grafts. Temporary abdominal closure is attempted in cases of increased pressure. We report of 41 pediatric transplants in 38 children ≤10 kg. Within this group, there were 23 cases with a GBWR of ≥4, and 15 cases with a GBWR <4. There was no statistical difference in vascular or biliary complications. Despite a more frequent rate of temporary abdominal closure, we did not find a higher rate of intra‐abdominal infections. Overall, patient and graft survival was excellent in both groups (one death, three re‐transplants). We noticed, however, that the ventro–dorsal diameter of the graft appears to be more relevant to potential graft necrosis than the actual graft size. In conclusion, the usage of monosegmental grafts seems unnecessary if transplantation of left lateral grafts is performed by an experienced multidisciplinary team, and temporary abdominal closure is favored in cases of increased abdominal pressure.