Donation and transplantation among personnel in the hospital emergency department: a multicenter study conducted in Spain and Mexico

Introduction

The promotion of different means of procureming both deceased and living organs (kidney and liver) is a necessity given the current organ shortage. Emergency department personnel are involved in the donation and transplantation process. Our objective was to analyze the attitude to the different kinds of organ donation of emergency services personnel in hospital centers in Spain and Mexico.

Materials and Methods

A randomized sample was obtained from the “International Collaborative Donor Project” and was stratified according to emergency services and job category in nine hospitals, in Spain and in Mexico (n = 22). Attitude was evaluated using a validated survey.

Results

Of the respondents, 76% were in favor of deceased organ donation and 24% were not in favor. This attitude toward deceased donation was associated with the respondent's country of origin, age, and job category; Mexicans (P = .036), younger respondents (P = .023), and physicians were most in favor (P < .001). With regard to attitude toward living kidney donation, 89% were in favor of related donation. Regarding living liver donation, 85% were in favor of related donation. In attitude toward living kidney and liver donation, relevant factors were related to donation and transplantation.

Conclusions

Professionals in emergency departments in hospital centers in Spain and Mexico had a favorable attitude toward the different kinds of donation, although it was less favorable than the attitude reported in other professional hospital groups.     

Attitudes toward organ donation: a survey on Iranian teachers

Background

Organs from brain dead patients are the main source for transplantation. However, in most societies, including Iran, the family consent rate for organ donation is low necessitating improvements in public knowledge. Because teachers' knowledge has an important role to educate the next generations, this study assessed their knowledge and attitudes about brain death and organ donation.

Methods

The present cross-sectional study included, 93 teachers selected from eight schools in Tehran, Iran, in 2009. We used a standardized questionnaire containing items which inquired about knowledge and attitudes of the participants regarding brain death and organ donation.

Results

The mean age of the participants was 37 years and 48 (52%) were males. Eighty-seven (94%) of them had heard or read about organ donation, among whom 91% favored organ donation. The main sources of their information were television, radio, and newspapers. Sixty-five (70%) were willing to donate their own organs after death. Those with lower organ donation desire were in contact with a small number of patients who have chronic diseases, had less trust in organ donation networks and brain death diagnostic tools, expressed less desire to receive an organ, and had a low record of blood donation (P < 0.05).

Conclusion

Our findings show that although most teachers had heard or read about brain death and organ donation, and approved of organ donation after death, a lack of exposure to patients with chronic diseases and a distrust of organ donation networks were greater among teachers with a lower desire to participate in this effort. Therefore, building trust in brain death diagnostic systems is necessary together with relevant educational programs.     

A National Program Toward Improving Renal Health: Advancing Organ Donation Awareness

Background

Despite the national advocacy campaign for kidney transplantation from deceased donors in the Philippines 96% of kidneys transplanted into 721 kidney transplants from 1999 to 2001 came from living donors. A national survey on the knowledge, attitudes and perceptions of Filipinos on organ donation in 2001 showed factors that disadvantaged deceased organ donation to be poor understanding of “brain death,” religion, and fear of the operation. These concerns were addressed and another survey was conducted in 2005.

Objectives

To compare knowledge, attitudes, and perceptions of Filipinos on organ donation between 2001 and 2005, and compare the number of kidney transplants from deceased donors between 2001 until 2008.

Methods

Two surveys in 15 regions of the Philippines were conducted using multistage sampling. Using a structured questionnaire there were 2000 respondents in 2001, and 2140 in 2005. Analysis was performed using chi-square analysis.

Results

The majority of respondents knew about kidney donation. Between 2001 and 2005, there was increased awareness that transplants came from both living and deceased donors (37% to 41%) and a decline in those believing transplants came only from deceased donors (14% to 9%). Willingness to become a living (59% to 87%) or a deceased donor (35% to 49%) increased. The increase in transplantation from deceased donors from an average of 10 per year from 1999 to 2001 to 31 per year from 2006 to 2008.

Conclusion

Increased awareness about kidney donation among Filipinos, improved consent to become an organ donor, and an increase in kidney transplantation from deceased donors occurred from 2001 to 2008.     

Attitudes of Spanish and Mexican Resident Physicians Faced With Solid Organ Donation and Transplantation

Introduction

The attitudes of specialist physicians toward organ donation and transplantation are of great interest because promotion of this activity depends on them. Our objective was to analyze the attitudes of residents in health centers in Spain (MIR) and in Mexico (ENARM).

Materials and methods

A random stratified sample was obtained in six teaching hospitals: two in Spain (n = 246) and four in Mexico (n = 139) as part of the International Collaborative Program “Proyecto Donante, Murcia.” The sample consisting of 385 trainee physicians completed a psychosocial questionnaire as the instrument to test their opinions.

Results

Most residents (93%; n = 359), were in favor of deceased organ donation with 90% (n = 348) in favor of living kidney donation and 87% (n = 335) in favor of liver donation. Attitudes toward donation were similar among Spanish and Mexican residents regarding deceased donation (93% vs 94%; P > .05), living kidney donation (88% vs 94%; P > .05), and living liver donation (86% vs 89%; P > .05). None of the attitudes toward donation was associated with the classic psychosocial factors related to attitudes toward donation or job factors. Discussion within the family was associated with more positive attitudes toward deceased donation (P < .001), living donation of the kidney (P = .01), and of the liver (P = .019).

Conclusion

Attitudes toward various types of donation were favorable among both Spanish and Mexican trainee physicians, so that they could potentially act as a group to promote this activity, raising hopes for increased donation rates in the future.     

Acute kidney injury before organ procurement is associated with worse long-term kidney graft outcome

Background

As the disparity between the numbers of available organ donors and patients awaiting transplantation increases, different strategies have been proposed to extend the donor pool. Patients with acute kidney injury (AKI) developing during an intensive care unit (ICU) stay are often considered to be donors, but the long-term outcomes of such high-risk kidney transplantations is unknown. We analyzed the renal function and outcomes over 5 years of kidney grafts recovered from deceased donors diagnosed with AKI.

Materials and Methods

We collected data from 61 deceased kidney donors, identified in 1 ICU, and 120 kidney graft recipients who underwent transplantation between January 1999 and December 2006. Donors were stratified according to the RIFLE classification, based on their creatinine and urine output change from admission to the ICU and organ procurement. Recipient kidney graft function (eGFR) calculated according to the MDRD (Modification of Diet in Renal Disease) equation was estimated every 6 months.

Results

Among 61 donors, 10 (16.4%) developed AKI, including 7 classified as “risk”, 2 as “injury,” and 1 as “failure.” The mean follow-up of kidney graft recipients was 49 ± 18 months. The long-term risk for graft loss was significantly higher among the group of kidneys recovered from donors with AKI (27.8% vs 7.1%; P = .02; log-rank = 0.07). Their excretory function was worse over the whole follow-up period.

Conclusion

Patients with kidney grafts obtained from the donors with AKI showed a higher risk for graft loss and worse excretory function upon long-term follow-up.     

National survey of Filipinos on acceptance of incentivized organ donation

Background

The increasing number of patients requiring transplantation has brought about a shortage of donor kidneys. Incentives can potentially improve organ donation. There is a need to know if the public can accept incentivized organ donation.

Objectives

To evaluate knowledge and opinions on organ donation and compensating the donor/donor family and to determine factors affecting consent.

Methods

The third survey in 2009 covered 15 regions, 29 provinces, and 14 cities in the National Capital Region. There were 1500 respondents interviewed using a structured questionnaire. Analysis used Statistical Package for Social Science and chi-square.

Results

Of the respondents, 63% were females and 74% were married. Nearly half were between 26 and 45 years old. Fewer than 5% were unschooled. Monthly household income was less than USD$222.00 in 70% of respondents. A majority knew about donation from 2001 to 2009. Fewer than 20% knew about deceased donors. Those who wanted to become donors decreased. Sixty-five percent were willing to donate a brain-dead relative's organs. Respondents felt that kidney donors deserve a token of gratitude. Options included livelihood (32%), cash (31%), and educational assistance (26%). Sixty percent wanted the donor assistance termed a “token of gratitude.” Consent for donation was positively correlated (P < .05) with higher education and monthly income.

Conclusion

Awareness on organ transplantation and donation increased. Factors that promote organ donation are higher education and monthly income. A majority of Filipinos felt that the donor deserves a token of gratitude. Public acceptance of incentivized organ donation may be pursued. Strategies to improve the national advocacy campaign for deceased donation are needed.     

International multicenter opinion study: administrative personnel from Spanish and Mexican health centers faced with human organ donation for transplantation

Introduction

Administrative personnel from healthcare centers are an important opinion group given their direct relationship to patients and the general public.

Objective

The objective of this study was to analyze the attitudes of administrative personnel in Spanish and Mexican healthcare centers toward various kinds of donation.

Material and Methods

A random selection of 418 administrative staff from 32 primary care centers and 9 hospitals in Spain and Mexico (“Proyecto Donante, Murcia”) used a validated questionnaire to explore attitudes.

Results

Most (76%) respondents favored deceased donation. Mexican workers had the most favorable attitude (P < .001). Factors influencing this attitude (P < .05) were as follows: type of healthcare center, clinical service, personal experience of organ donation and transplantation (ODT), attitude toward living donation, attitude toward the donation of a family member's organs, discussion of ODT, partner's attitude toward ODT, participation in pro-social activities, and variables related to attitudes toward the body. Most respondents (89%) favored related living kidney donation (LKD) and 87% favored living liver donation (LLD). Mexican respondents showed the most favorable attitudes (P < .05). Factors influencing this attitude (P < .05) were as follows: personal experience of ODT, belief that a transplant is needed, willingness to accept a living organ, family discussion about ODT, partner's attitude about the matter, and respondent's awareness of the view of his or her religion toward ODT.

Conclusion

Attitudes toward deceased organ donation were not favorable among administrative personnel from Spanish compared with Mexican centers, although attitudes toward LKD and LLD were favorable in both countries.     

Effects of an Education Program on Intensive Care Unit Nurses' Attitudes and Behavioral Intentions to Advocate Deceased Donor Organ Donation

Introduction

Organ shortage limits the application of organ transplantation. The attitudes of intensive care unit (ICU) staff play an important role in organ advocating. The effects of an education program for ICU nurses on organ advocating were uncertain. The purpose of this study was to explore the effects of an education program based on the Theory of Planned Behavior (TPB) on ICU nurses' attitudes and behavioral intentions to advocate deceased organ donation.

Methods

Participants were recruited from 3 different ICU units in medical centers and were randomly assigned to either an experimental group (n = 61) or a control group (n = 62). The nurses in the experimental group received comprehensive education programs, and the control groups received a brochure only. The outcome parameters were measured by questionnaires at 3 different time points of pretest, posttests immediately after education, and 2 months later.

Results

Before education, there was no difference in attitude and behavior intentions between the control and experimental groups. After TPB training, the nurses significantly changed their attitudes and behavior intentions on organ advocating, both immediately (P < .01) and 2 months after the education program (P < .01). In addition, multivariate analysis indicated that TPB training is significantly associated with the change of attitude (P < .01) and behavior intention (P < .05) of organ donation advocacy.

Conclusions

TPB education programs enhanced the ICU nurses' attitudes and behavioral intentions on advocating organ donation. Repeated education is advised to increase the participation of ICU nurses on organ advocacy.     

Spanish and Latin American Nursing Personnel and Deceased Organ Donation: A Study of Attitude

Objective

To analyze the attitude of nursing personnel about organ donation and transplantation in hospitals in Spain and Latin America, and factors that affect this attitude.

Methods

Data were selected from 12 hospitals and 32 primary care centers participating in an international study (Proyecto Donante, Murcia) in 4 countries including Spain (n = 650), Mexico (n = 428), Cuba (n = 89), and Costa Rica (n = 27). The sample was random and stratified by type of service among nursing personnel (n = 1194). Attitude was evaluated using a psychosocial questionnaire.

Results

Of nursing personnel surveyed, 77% (n = 922) were in favor of organ donation. No differences were found according to whether they were directly involved in transplantation-related services (P < .05). Attitude in favor of organ donation varied between countries: 92% in Cuba, 85% in Costa Rica, 80% in Mexico, and 73% in Spain (P < .001) This attitude was also related to donation of a family member's organs (P < .001), having discussed organ donation and transplantation within the family (P < .001), the concept of brain death (P < .001), fear of body mutilation (P < .001), and manipulation of the body after death (P = .001).

Conclusion

Attitude toward deceased organ donation among nurses varies between countries. There is a discrepancy between those in favor vs actual donation rates in countries and work centers. These fears may become worse when donation is seen as common in daily clinical practice.     

Stem cell factor, interleukin-16, and interleukin-2 receptor alpha are predictive biomarkers for delayed and slow graft function

Introduction

Delayed graft function (DGF) and slow graft function (SGF) due to ischemic and reperfusion injury (IRI) are common complications of deceased donor kidney transplantation. We tested whether a panel of serum and urine cytokines represent early biomarkers for DGF and SGF.

Methods

We collected serum and urine samples from 61 patients 48 hours posttransplantation and used a multiplex enzyme-linked immunosorbent assay (ELISA) technique to measure levels of 23 cytokines. Fourteen patients developed poor graft function (PGF), with 6 having DGF and 8 with SGF.

Results

Area under receiver operation characteristics curve (AUC) demonstrated the following: serum levels of SCF (0.88) and interleukin (IL) 16 (0.74).

Conclusions

This study showed that a select panel of cytokines measured early post kidney transplantation may predict poor graft function.     

Organ Transplant Education: The Way to Form Altruistic Behaviors Among Secondary School Students Toward Organ Donation

Background

Organ shortage for transplantation is a crucial problem all over the world. Educational intervention may appeal to young people's altruism, increasing organ donation and decreasing the opposition.

Aim

This study assessed the influence of an educational program, including organ donation and transplantation, to forming students' altruistic behaviors.

Methods

A total 680 students of 25 secondary schools were asked about their attitudes, intentions, and knowledge about organ donation and transplantation from September 2008 to June 2009 during a 45-minute lesson.

Results

In this study, altruistic attitudes were measured through questions about the expression of will to give organs away after death; to give one kidney to relatives; to use the bone marrow from a foreign person; and to sign a donor card. Attitudes were assessed by questions about conversations with relatives, an evaluation of the educational project. More than 1500 donor card were distributed and more than 90% of students wanted to sign them; 73.6% agreed to sign a donor card with the ID card. Before the project, only 8% of students had a signed donor card. Almost everybody is ready to agree to give their organs after death (80.6% male; 92.2% female), or to relatives (100% male; 90.38% female), or bone marrow (80% male; 55.7% female). The students talked to their family, informing them about their decision (36.9% male; 45.9% female).

Conclusions

The proposed educational project successfully encouraged teenagers to make well-considered choices with regard to organ donation and created altruistic behaviors.     

Survey of First-Year Medical Students to Assess Their Knowledge and Attitudes Toward Organ Transplantation and Donation

Background

The important shortage of organ donors is still a fundamental public health problem in France. Improving the knowledge and attitudes of health care professionals could help to promote organ donation. The aim of this survey was to evaluate the level of knowledge of medical students and their gaps about organ donation prior to any medical course.

Materials and Methods

A survey was conducted among 571 first-year medical students at a medical faculty in Lyon. Their knowledge, attitudes, personal views, and perceptions toward organ donation and transplantation were investigated prior to any medical course. A 31-item anonymous questionnaire including queries about personal views of organ donation, factual knowledge, and awareness of French law was distributed to the students.

Results

To “willingness to donate a kidney to a relative,” 97.7% of respondents consented, 0.9% objected, and 1.4% did not answer. Their attitudes toward cadaveric organ donation were different: 81.1% agreed, 13.5% refused, and 5.4% did not answer. Regarding their knowledge about which organs could be transplanted, 95% of the respondents were aware of the possibility to transplant a face and 14% thought that xenotransplantation was performed nowadays.

Conclusions

First-year medical students have a good knowledge level regarding the organ donation and transplantation system prior to their medical course. Some gaps remain which could be improved. The results of this study supported a greater emphasis on providing information regarding transplantation in medical schools to improve the knowledge of future health care professionals. A follow-up survey of the participants at the end of their medical course will be interesting to assess the progress of their attitudes.     

Attitude and Behavior Related to Organ Donation and Affecting Factors: A Study of Last-Term Students at a University

Aim

The aim of this study was to detect the behavior and attitude of our last-term students.

Methods

The study group for this cross-sectional research consisted of 1690 last-term students. We applied a questionnare about sociodemographic features, behaviors, and attitudes about organ donation. Data were evaluated with SPSS 11.0.

Results

We accessed 1287 students among whom 1.3% stated that they would donate their organs. Among students who did not agree, 58.7% were considering donation. The main reasons for not agreeing to donation were fear of commercial use (45.7%) and the belief of inappropriateness related to religion (25.7%). In contrast, 62.3% stated that they would donate their organ when needed for their relatives. Also, 50.6% indicated that if one of their relatives died, they would donate their relative's organs; there was no significant difference based on gender. In addition, favorable thoughts about donation were significantly more prevalent for female subjects (P = .001). Organ donation behavior and thoughts were significantly higher among the group with better economic position (P = .001, .018); and for students whose mother had an education higher than high school (P = .003, .004). Higher donation ratios were observed for students who had a relative working in the medical field (P = .04) and the group who stated they were well informed about organ donation (P < .001).

Conclusion

When we take into account that our study group consisted of university students, organ donation rates were low. To overcome the difficulties, we have to inform the community and collaborate with religious organizations. To prevent fear that organs will be used commercially we must prove confidence in the system.     

Knowledge and Attitude of Donor Cardholders Toward Organ and Tissue Donation and Transplantation in an Iranian Tissue Bank: A Case-Control Study

Background

Cadaveric organ shortage is the most important obstacle to more widespread provision of transplants. Many factors influence the donation rate: social factors, religion, familial relations, and especially knowledge and attitudes toward organ and tissue donation and transplantation. Increasing public awareness can reform the incorrect beliefs and myths about donation and transplantation. This study investigated knowledge and attitudes of donor cardholders toward organ and tissue donation as well as transplantation.

Methods

This case-control study was performed in 2006 among 178 donor cardholders and the same number of a control group who completed a questionnaire including 23 questions and demographic information.

Findings

Knowledge and attitude among the cardholder was significantly greater than the control group (P < .05). We observed a inverse correlation between age and a positive attitude toward donation and transplantation among cardholders.

Conclusion

This study suggested that the main reasons for refusal to donate organ and tissue were insufficient knowledge and negative attitudes due to misinformation regarding donation and transplantation. We believe that educating and motivating the public via the mass media can increase the rate of consent for organ and tissue donation and transplantation.     

Comparison of anxious and depressive symptomatology among pretransplant hepatic patients and their relatives

Objective

We sought to compare the anxiety and depressive symptoms of patients undergoing pretransplant evaluation with those of their closest relatives.

Materials and Methods

We assessed 51 patients with hepatic cirrhosis and 51 relatives who were the main care giver for each patient. All subjects were assessed during the interval when the patients were hospitalized to undergo the medical assessment to determine their inclusion on the waiting list for liver transplantation. In both groups, we used a “Psychosocial Survey” and the “Hospital Anxiety and Depression Scale.”

Results

Significant differences were observed in anxiety (P = .001), but not in depression (P = .820). Specifically, relatives presented higher levels of anxiety compared with the hepatic patients.

Conclusion

The relatives were worse off psychologically than the patients.     

Preincisional local infiltration of tramadol at the trocar site versus intravenous tramadol for pain control after laparoscopic cholecystectomy

Study Objective

To compare the effects of preoperative intravenous (IV) tramadol and preoperative tramadol infiltration of trocar sites on postoperative pain and postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy.

Design

Prospective, randomized study.

Setting

Operating room, recovery room, and surgical ward.

Patients

70 ASA physical status 1 and 2 patients, aged 20-70 years, scheduled for elective laparoscopic cholecystectomy.

Interventions

In Group I, patients received IV 2.0 mg/kg of tramadol; in Group II, trocar insertion points were infiltrated with 2.0 mg/kg of tramadol in 20 mL of 0.9% NaCl.

Measurements

Pain scores, sedation scores, postoperative analgesic requirement, and PONV were recorded at 0 and 30 minutes and one, three, 6, 12, and 24 hours. At 30 minutes and one hour, pain localization (incisional or diffuse abdominal) was also recorded.

Main Results

Visual analog scale scores at 30 minutes were significantly lower in Group II [3 (0-7)] than Group I [6 (3-8)] (P < 0.001). In Group I, 91.4% of patients received sodium diclofenac, while 68.6% of Group II patients received sodium diclofenac (P = 0.002). The time to first analgesic requirement was significantly lower in Group II (P = 0.004). At the 30-minute measurement time, a significant difference was recorded between the groups in incisional pain (P < 0.001). There was also a significant difference between groups in the frequency of PONV.

Conclusions

Trocar site infiltration of tramadol improves early postoperative pain and decreases PONV.     

Attitudes Toward Living Kidney Donation in Transplant Hospitals: A Spanish, Mexican, and Cuban Multicenter Study

Introduction

Living donor kidney (LKD) transplantation provides better results than deceased donor donation, involving minimum risk for the donor. However, LKD donation rates are low in most countries. We analyzed attitudes toward LKD in transplant hospitals in Spain, Mexico, and Cuba.

Materials and methods

Data were obtained from five transplant hospitals through the International Collaborative Program “Proyecto Donante Vivo, Murcia” in three countries: Spain (n = 1168), Mexico (n = 903), and Cuba (n = 202). The random sample (2273 employees) was stratified according to job category. The instrument used to evaluate attitude was a validated questionnaire. Statistical analysis included Student t test, the χ² test, and multivariate analysis.

Results

Eighty eight percent (n = 2002) of Spanish, Mexican, and Cuban transplant hospital personnel were in favor of related LKD and 24% nonrelated LKD (n = 555). Attitudes were more favorable among centers in Cuba 97% (n = 195), followed by Mexico 88% (n = 793) and by Spain 87% (n = 1014; P < .001). According to job category, 91% (n = 617) of physicians were in favor, 88% (n = 543) of nurses, 85% (n = 198) of health care assistants, and 85% (n = 198) of auxiliary personnel. Attitudes were related to variables of: attitude toward deceased donation (P < .001), discussion about organ donation and transplantation (P < .001), concern about body mutilation after donation (P = .001), a possible need for a transplant in the future (P < .001), and attitude toward living liver donation (P < .001).

Conclusions

Attitudes toward LKD in Hispanic/Latin Transplant Hospitals were favorable and could encourage an increase in LKD in the coming years assuming suitable sociopolitical and economic condition, as well as support from nephrologists.     

A study on knowledge and attitude toward brain death and organ retrieval among health care professionals in Korea

Purpose

The practice of retrieving vital organs from brain-dead donors is legally and medically accepted in Korea, but health care professionals' beliefs and opinions regarding these matters have not been sufficiently explored. The purpose of this study was to evaluate the knowledge and attitudes of health care professionals to the concepts of brain death and organ retrieval.

Methods

Data were collected using a 41-item questionnaire during a week in June 2011. Sixty-one doctors and 109 nurses from five hospitals with more than 2000 beds in Seoul, Korea, participated in the survey. The data was analyzed using SPSS version 17.0 (SPSS Inc. Chicago, Illinois, USA).

Results

There were statistically significant differences in the scores on knowledge according to marital status (P = .001) education level (P = .019), whether the participants were informed about organ donation from a brain-dead donor (P = .002), and the participant's experience managing potential brain-dead patients (P = .037). There were statistically significant differences in the scores on the attitude according to gender (P < .001), age (P < .001), marital status (P < .001), education level (P = .003), job position (P < .001), and the participant's experience referring brain-dead patients to the hospital-based organ procurement organization (P = .001). Significantly, attitude's positively correlated with knowledge about brain-dead organ donation (P < .001).

Conclusion

Compared with previous studies, the knowledge and attitudes of health care professionals' regarding brain death and organ retrieval were not improved. There are passive attitudes to brain death and organ retrieval. More research must be performed to promote knowledge and understanding toward brain death and organ retrieval among health care professionals.     

A novel corrective pullthrough surgery in a mouse model of Hirschsprung's disease

Background/Purpose

The study aimed to develop a mouse model of post-pullthrough Hirschsprung's disease that will allow investigation of mechanisms that cause postoperative complications.

Methods

We developed a novel microsurgical pullthrough operation on Balb/C mice and evaluated its effect on growth rate and stooling pattern. Histologic assessment of the pullthrough colon was performed. The pullthrough operation was then performed on Ednrb−/− mice that have aganglionic megacolon and Ednrb+/+ littermate controls, and the outcomes compared.

Results

The Balb/C pullthrough group had 97% survival at 1 week and 70% survival at 2 weeks. Body weight of the pullthrough animals declined 15% in the first week after surgery and subsequently normalized. The stooling pattern showed consistently softer stools in the pullthrough group, but no difference in frequency compared to controls. Histopathologic analyses 4 weeks postoperatively showed well-healed coloanal anastomoses. Two-week survival after pullthrough surgery in Ednrb−/− and Ednrb+/+ mice was 50.0%, and 69.2%, respectively (P = NS). Increased mortality in the Ednrb−/− mice was related to the technical challenge of performing microsurgery on smaller-sized mice with poor baseline health status.

Conclusions

Our microsurgical pullthrough operation in mice is feasible and allows systematic investigations into potential mechanisms mediating post-pullthrough complications and poor long-term results in mouse models of Hirschsprung's disease.