Current opinion in organ transplantation
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Curr Opin Organ Transplant · Apr 2013
ReviewTime to death after withdrawal of treatment in donation after circulatory death (DCD) donors.
Controlled donation after circulatory death (DCD) donors make an important contribution to organ transplantation but there is considerable scope for further increasing the conversion of potential to actual DCD organ donors. The period between withdrawal of life-supporting treatment and death (the withdrawal period) is a major determinant of whether organ donation proceeds and it is therefore timely to review recent relevant studies in this area. ⋯ Future studies should aim to define clinical and physiological variables during the withdrawal period that can be used to maximize well tolerated use of organs from potential DCD donors; these thresholds are likely to differ according to organ type.
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Curr Opin Organ Transplant · Apr 2013
ReviewThe use of extracorporeal membranous oxygenation in donors after cardiac death.
The purpose of the present review is to describe the methods using an extracorporeal membranous oxygenation (ECMO) circuit in donors after cardiac death and to evaluate their impact on the outcome of renal transplantation. ⋯ The use of ECMO in donors after cardio-circulatory death should be encouraged and further developed. Experimental work is in progress to better define the optimal conditions of the technique, which will help to limit or even repair the injuries, induced by warm ischaemia.
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Curr Opin Organ Transplant · Apr 2013
ReviewNo-touch time in donors after cardiac death (nonheart-beating organ donation).
To evaluate arterial pulselessness and the no-touch time of 5 min in defining irreversible cessation of cardiorespiratory functions in nonheart-beating donation (NHBD). ⋯ In-situ perfusion can reverse ceased cardiac and neurological functions after arterial pulselessness and a no-touch time of 5 min in experimental models. Perfusion pressures are superior to arterial pulselessness in determining reversibility of ceased cardiac and neurological functions in circulatory arrest. Utilizing physiologically relevant circulatory and neurological parameters in NHBD protocols is essential for ascertaining irreversible cessation of vital functions in donors.
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Curr Opin Organ Transplant · Apr 2013
ReviewQuality assessment and performance improvement in transplantation: hype or hope?
Healthcare reform and the national quality strategy is increasingly impacting transplant practice, as exemplified by quality assessment and performance improvement (QAPI) regulations for pretransplant and posttransplant care. Transplant providers consider not just patient comorbidities, donor quality, and business constraints, but also regulatory mandates when deciding how to care for transplant candidates and recipients. This review describes transplant quality oversight agencies and regulations, and explores recent literature on the pros and cons of transplant QAPI. ⋯ With its focus on innovation and on clinical outcomes, transplantation is poised to continue providing outstanding clinical care and to pioneering systems that advance patient safety, satisfaction, and resource utilization, leading in the field of QAPI and healthcare reform.