Laparoscopic Living Donor Nephrectomy: Low Surgical Risk for High-quality Grafts

Renal transplantation is most important for patients with end-stage renal disease to preserve their survival and quality of life. Living donation has decisive advantages over deceased donor kidney transplantation, and with the continuing organ shortage, it also can reduce the number of patients waiting for an organ. The major problem with living kidney donation is that a healthy person has to undergo a substantial surgical procedure to provide the organ for transplantation; therefore, a nephrectomy technique that is associated with the lowest surgical risk for the donor and the best organ quality for the recipient should be used. Since its introduction by Ratner and colleagues in 1995, laparoscopic donor nephrectomy has become the technique of choice at many major transplant centres. The aim is to achieve less postoperative pain, shorter hospitalisation time, more rapid return to normal activities, a more cosmetically acceptable incision, and, in particular, a greater patient acceptance. All techniques for living donor nephrectomy (open donor nephrectomy, “pure” laparoscopic donor nephrectomy, hand-assisted laparoscopic donor nephrectomy, robot-assisted laparoscopic donor nephrectomy, laparoscopic donor nephrectomy via natural orifice transluminal endoscopic surgery or laparoendoscopic single-site surgery, and retroperitoneoscopic donor nephrectomy) achieve good results, in so far as they are performed at specialised centres. Perioperative complications are rare, and the quality of the grafts is excellent. Renal graft function is specified at up to 96% at 1 yr and 85% at 5 yr after living donor kidney transplantation.Patient summaryLiving donation has decisive advantages over deceased donor kidney transplantation. When performed at specialised centres, living donor nephrectomy achieves good results, with few perioperative complications and excellent graft quality.     

Outcomes of Donation After Circulatory Death Heart Transplantation in Australia

Background

Transplantation of hearts retrieved from donation after circulatory death (DCD) donors is an evolving clinical practice.

造血干细胞移植无关供者真实感受的质性研究

目的了解和探讨造血干细胞移植无关供者的真实心理感受,为捐献工作提供参考。方法选取10例造血干细胞移植无关供者进行面对面深度访谈,采用现象学分析法对结果进行分析。结果提炼出加入中华骨髓库时无明确认知、配型成功后高兴与担忧并存、自我价值认可、主动了解骨髓捐献知识及承受术后不适、不希望被媒体报道及关心受者6个主题。结论供者骨髓捐献知识缺乏,配型成功即无偿履行捐献义务,认知正向,关心受者。相关部门应加强捐献骨髓的宣传与保障,让更多的人参与捐献。     

Hemagglutination of preoperative blood donation in patients with rheumatoid arthritis

Abstract

We gave preoperative blood transfusions to 37 patients with rheumatoid arthritis (RA) and 35 patients with osteoarthritis (OA), including some whose baseline hemoglobin level was less than 10?g/dl. Transfusion packs can preserve whole blood containing citrate phosphate dextrose (CPD) for 3 weeks. The baseline hemoglobin level of RA cases was 10.4?g/dl (range 8.4–13.1?g/dl), and that of OA cases was 11.9?g/dl (range 10.4–15.0?g/dl). By collecting 200–400?g every week before the operation, the total was 800–1200?g. Erythropoietin was given to patients intramuscularly when their hemoglobin was less than 13?g/dl after blood had been collected. Hemagglutination, with diameters of more than 1?cm, made filter occlusions in 11 RA cases (30%) and one OA case (3%) (P < 0.0031) after retransfusion. There were no differences between hemagglutination patients (agglutination group) and nonhemagglutination patients (nonagglutination group) regarding baseline C-reactive protein (CRP), white blood cells, platelets, or fibrinogen. We could not predict the formation of macrohemagglutination in the packs collected during the clinical course. In RA cases, allogenic transfusions were performed for four cases (36%) in the agglutination group and for one case (12%) in the nonagglutination group. Preoperative transfusion for the RA patients showed hemagglutination in some cases, and highlighted the need for modifications to reduce these hemagglutinations.     

腹主动脉联合门静脉快速灌注法在器官捐献供体肝肾联合获取中的应用

目的总结腹主动脉联合门静脉快速灌注法在器官捐献供体肝肾联合获取中的可行性和安全性。方法回顾性分析2011年9月至2014年6月在佛山市第一人民医院完成的43例中国心脏死亡供体器官捐献肝肾联合获取的临床资料。43例供体中,中国心脏死亡供体分类一类(脑死亡供体)(C-Ⅰ类)15例,中国二类(心脏死亡供体)(C-Ⅱ类)1例,中国三类(脑-心双死亡捐献供体)(C-Ⅲ类)27例。器官灌注采用腹主动脉、门静脉快速插管联合灌注法。结果开腹至腹主动脉插管时间约1.5~2.0 min,43例供体共获得肝脏43个,肾脏86个。C-Ⅰ类供体热缺血时间全部为0,其余供体热缺血时间范围为3~21 min,平均10 min。2例供肝分别因肝门部严重损伤和重度脂肪肝弃用,18例供肾分别因肾结石、肾萎缩、术前血清肌酐水平较高、肾动脉粥样硬化严重、肾微小血管血栓、多发肾囊肿、外伤性肾破裂等原因弃用,供体器官总弃用率为16%。结论腹主动脉联合门静脉快速灌注法是器官捐献供体肝肾联合获取的简单、安全的方法。     

‘To donate or not to donate? that is the question!’: an organ and body donation comic

Abstract

Conversations surrounding end of life and death can be difficult or taboo for some, meaning that matters of organ and body donation are not widely discussed. To Donate or Not to Donate? That is the Question! is a comic developed to raise awareness and challenge common misconceptions about donation by encouraging the publics to engage in informed discussions about the different options available. This case study proposes graphic medicine as an alternative method of presenting donation information to a public audience, and illustrates how the comic medium can communicate body donation information in an accessible and engaging way.