Transplantation proceedings
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The concept of brain death has not been accepted by the majority of Chinese. Importantly, it is not recognized as a legal entity. We have developed a non-heart-beating donation protocol based on literature searches (Medline, Ovid, and CNKI) and issues related to Chinese customs and ethics. ⋯ We hope to find the right solutions through international debate. We believe that the use of non-heart-beating-donor organs has potential in China. We are hopeful that it will become a major organ source that is developed in such a way so as to be accepted internationally as well as in China.
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Severe sepsis in transplant recipients results in an extremely high morbidity mortality rate. Microvascular alterations play an important role in the development of sepsis-induced organ dysfunction. ⋯ Comparable trials in humans are still not available for the other coagulation, inhibitor antithrombin. We also report clinical trials discussing whether hyperimmune products reduce the infection rate during myelosuppression, but further trials are requested for the feasible evaluation of these products.
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The family advocate plays a crucial role in the organ and tissue procurement process for transplantation and research. This responsibility can weigh profoundly on the consent/conversion rates for family advocates. Some potential donor families consider time as a critical factor when deciding to donate. It was hypothesized that case time will decrease by >or=20% if family advocates were trained to become level 1 recovery coordinators and utilized during organ only cases with brain-dead donors. ⋯ The results indicate that family advocates who can function in the role of level 1 recovery coordinators may decrease donor management by hours. Incorporating family services with donor management can improve the standard in the donation process.
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Donation after cardiac death (DCD) remains controversial in some pediatric institutions. An evidence-based, consensus-building approach to setting institutional policy about DCD can address the controversy openly and identify common ground. To resolve an extended internal debate regarding DCD policy at Children's Hospital Boston, a multidisciplinary task force was commissioned to engage in fact finding and deliberations about clinical and ethical issues in pediatric DCD, and attempt to reach consensus regarding the development of a protocol for pediatric DCD. ⋯ With assistance from the local organ procurement organization (OPO), the task force developed a protocol for pediatric kidney DCD which most members believed could meet all the requirements of the foundational ethical principles. Complete consensus on the use of the protocol was not reached; however, almost all members supported initiation of kidney DCD for older pediatric patients who had wished to be organ donors. The hospital has implemented the protocol on this limited basis and established a process for considering proposals to expand the eligible donor population and include other organs.
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Chagas disease (American trypanosomiasis) is caused by the protozoan parasite Trypanosoma cruzi. Chagas disease following solid-organ transplantation has occurred in Latin America. This report presents the occurrence of Chagas disease despite negative serological tests in both the donor and the recipient, as well as the effectiveness of treatment. ⋯ At the moment of submission, the patient remains in functional class I. This case highlighted that more appropriate screening for T cruzi infection is mandatory in potential donors and recipients of solid-organ transplants in regions where Chagas disease is prevalent. Moreover, it stressed that this diagnosis should always be considered in recipients who develop cardiac complications, since negative serological tests do not completely discard the possibility of disease transmission and since good results can be achieved with prompt trypanocidal therapy.