Pub Date : 1999-09-01DOI: 10.7182/prtr.1.9.3.fk25r1452l1460g2
K A Evers, D D Lewis
The number of people awaiting a life-saving transplant far outweighs the number of organs available for transplantation. Our organ procurement organization sought to identify the non-heart-beating donor potential at a large urban level 1 trauma center. We modified the death-record reviews for a 2-year period and determined that a total of 23 patients who expired were suitable for non-heart-beating donation. Therefore, it can be hypothesized that if all large urban level 1 trauma centers participated in non-heart-beating donation, more organs would be available for transplantation.
{"title":"Estimating the non-heart-beating donor potential at a trauma center.","authors":"K A Evers, D D Lewis","doi":"10.7182/prtr.1.9.3.fk25r1452l1460g2","DOIUrl":"https://doi.org/10.7182/prtr.1.9.3.fk25r1452l1460g2","url":null,"abstract":"<p><p>The number of people awaiting a life-saving transplant far outweighs the number of organs available for transplantation. Our organ procurement organization sought to identify the non-heart-beating donor potential at a large urban level 1 trauma center. We modified the death-record reviews for a 2-year period and determined that a total of 23 patients who expired were suitable for non-heart-beating donation. Therefore, it can be hypothesized that if all large urban level 1 trauma centers participated in non-heart-beating donation, more organs would be available for transplantation.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 3","pages":"186-8"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21555264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-09-01DOI: 10.1177/090591999900900307
K. Scholz, K. L. Turrisi
Journal of Transplant Coordination, Vol. 9, Number 3, September 1999 The desire to reduce the costs of this transplant center’s organ transplant programs prompted a review of major factors influencing expenditures in 1995. Each transplant program, including bone marrow, heart, kidney, liver, lung, and pancreas, was evaluated. Outcomes, costs (mean and median), and LOS were benchmarked with other university hospitals, with the use of University Health System Consortium (UHC) data and Medicare data where applicable. The clinical outcomes of all organ transplant programs at this center met or exceeded national averages.1 Based on the use of UHC data, the costs of providing care were consistently below other university programs reporting data in the survey in all programs except bone marrow transplantation. Each program’s LOS was compared to data received from communication with other transplant centers. Although most of the center’s organ transplant programs compared favorably with other centers in the UHC, the reported LOS at this center for both kidney and bone marrow transplant patients was highly variable and often longer than at other centers.
{"title":"Outpatient Housing following Kidney Transplantation","authors":"K. Scholz, K. L. Turrisi","doi":"10.1177/090591999900900307","DOIUrl":"https://doi.org/10.1177/090591999900900307","url":null,"abstract":"Journal of Transplant Coordination, Vol. 9, Number 3, September 1999 The desire to reduce the costs of this transplant center’s organ transplant programs prompted a review of major factors influencing expenditures in 1995. Each transplant program, including bone marrow, heart, kidney, liver, lung, and pancreas, was evaluated. Outcomes, costs (mean and median), and LOS were benchmarked with other university hospitals, with the use of University Health System Consortium (UHC) data and Medicare data where applicable. The clinical outcomes of all organ transplant programs at this center met or exceeded national averages.1 Based on the use of UHC data, the costs of providing care were consistently below other university programs reporting data in the survey in all programs except bone marrow transplantation. Each program’s LOS was compared to data received from communication with other transplant centers. Although most of the center’s organ transplant programs compared favorably with other centers in the UHC, the reported LOS at this center for both kidney and bone marrow transplant patients was highly variable and often longer than at other centers.","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"161 - 164"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900307","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65465709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-09-01DOI: 10.1177/090591999900900302
M. Bartucci
Journal of Transplant Coordination, Vol. 9, Number 3, September 1999 survival rates have also improved in the past decade. Between 1986 and 1993, median cadaveric graft survival increased from 5.4 years to 8.5 years, whereas median live donor graft survival increased from 9.7 years to 14.7 years.3 Excluding death with a functioning graft, chronic rejection accounts for the majority of late graft losses.4 Risk factors for chronic rejection include history of acute rejection, inadequate immunosuppression, delayed graft function, acute tubular necrosis, donor organ characteristics (eg, age >60 years and cadaveric vs live donor), recipient characteristics (eg, gender and age), pretransplantation diseases (eg, diabetes and hypertension), and infection.5 Clinical management of the transplant recipient should therefore include strategies to prevent the development of chronic rejection, thereby improving long-term graft survival. As more options for immunotherapy become available, transplant recipients will continue to experience better short-term and long-term outcomes. The list of available immmunosuppressants continues to expand (Table 1) and several other promising new agents are under investigation. Although new combinations are being tested, the current optimal immunosuppressive regimen remains predominantly calcineurin-inhibitor based. Issues in cyclosporine drug substitution: implications for patient management
{"title":"Issues in Cyclosporine Drug Substitution: Implications for Patient Management","authors":"M. Bartucci","doi":"10.1177/090591999900900302","DOIUrl":"https://doi.org/10.1177/090591999900900302","url":null,"abstract":"Journal of Transplant Coordination, Vol. 9, Number 3, September 1999 survival rates have also improved in the past decade. Between 1986 and 1993, median cadaveric graft survival increased from 5.4 years to 8.5 years, whereas median live donor graft survival increased from 9.7 years to 14.7 years.3 Excluding death with a functioning graft, chronic rejection accounts for the majority of late graft losses.4 Risk factors for chronic rejection include history of acute rejection, inadequate immunosuppression, delayed graft function, acute tubular necrosis, donor organ characteristics (eg, age >60 years and cadaveric vs live donor), recipient characteristics (eg, gender and age), pretransplantation diseases (eg, diabetes and hypertension), and infection.5 Clinical management of the transplant recipient should therefore include strategies to prevent the development of chronic rejection, thereby improving long-term graft survival. As more options for immunotherapy become available, transplant recipients will continue to experience better short-term and long-term outcomes. The list of available immmunosuppressants continues to expand (Table 1) and several other promising new agents are under investigation. Although new combinations are being tested, the current optimal immunosuppressive regimen remains predominantly calcineurin-inhibitor based. Issues in cyclosporine drug substitution: implications for patient management","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"137 - 144"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900302","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65465899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-09-01DOI: 10.7182/prtr.1.9.3.b7845470197n7513
M Kraljevich
Currently, more than 64,000 people are awaiting transplants in the United States. Transplant coordinators must do everything possible to ensure that viable organs from consented donors are transplanted. To evaluate donors and organ function, transplant coordinators rely on a multitude of diagnostic tests to determine donor organ suitability. How reliable are the results of these tests? The following case study presents an incident in which diagnostic test results were not accurate; as a result, transplant centers deferred what turned out to be a normal, atraumatic organ. The end result was that this organ was placed, but only after actual visualization in the operating room and the granting of full waivers to the transplanting center.
{"title":"Liver donation by a trauma patient: a case study in placement.","authors":"M Kraljevich","doi":"10.7182/prtr.1.9.3.b7845470197n7513","DOIUrl":"https://doi.org/10.7182/prtr.1.9.3.b7845470197n7513","url":null,"abstract":"<p><p>Currently, more than 64,000 people are awaiting transplants in the United States. Transplant coordinators must do everything possible to ensure that viable organs from consented donors are transplanted. To evaluate donors and organ function, transplant coordinators rely on a multitude of diagnostic tests to determine donor organ suitability. How reliable are the results of these tests? The following case study presents an incident in which diagnostic test results were not accurate; as a result, transplant centers deferred what turned out to be a normal, atraumatic organ. The end result was that this organ was placed, but only after actual visualization in the operating room and the granting of full waivers to the transplanting center.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 3","pages":"153-5"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21556013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-09-01DOI: 10.1177/090591999900900309
T. Fabián, K. Lohmann
Offering the option of organ and tissue donation to grieving families may seem stressful, but asking the question may provide a positive means to extend care to the bereaved family and help others in return. Many donor families have said donation was an opportunity to make some sense out of a senseless situation and to relieve some of the grief they experienced. This article presents a case that started with such a discussion by ICU nurses in one of our donor hospitals, and ended with successful organ and tissue recovery and transplantation. As “routine” as this may sound, it was anything but routine—it made history.
{"title":"Nerve Transplantation: A Father's Final Gift","authors":"T. Fabián, K. Lohmann","doi":"10.1177/090591999900900309","DOIUrl":"https://doi.org/10.1177/090591999900900309","url":null,"abstract":"Offering the option of organ and tissue donation to grieving families may seem stressful, but asking the question may provide a positive means to extend care to the bereaved family and help others in return. Many donor families have said donation was an opportunity to make some sense out of a senseless situation and to relieve some of the grief they experienced. This article presents a case that started with such a discussion by ICU nurses in one of our donor hospitals, and ended with successful organ and tissue recovery and transplantation. As “routine” as this may sound, it was anything but routine—it made history.","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"175 - 176"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900309","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65466197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-09-01DOI: 10.7182/prtr.1.9.3.6760485v16223542
G T Armstrong
Lung and heart-lung transplantation was first undertaken in Australia in the late 1980s and early 1990s. Although detailed data are available on Australian lung transplantation outcomes, little data are available regarding the utilization of donated lungs. This study examines donated lung utilization rates and considers various factors that may affect these rates. Australian donation and transplantation data were analyzed for the years 1989 through 1997. Results showed that 24% of overall donors were lung donors. The percentage of donors from whom at least 1 lung was transplanted increased from 6% in 1989 to 36% in 1997. Heart-lung transplantation rates changed little (2%-9%), whereas bilateral lung transplantation increased from 1% to 23% of donors. Single-lung donors accounted for 32% of lung donors in 1997. Uniform basic donor criteria and management guidelines, simple allocation mechanisms, and cooperative retrieval have evolved during this time. Close collaboration at the time of donation between units, coordinators, and ICUs has allowed early retrieval from well-managed donors.
{"title":"Utilization of donated lungs in Australia: 1989-1997.","authors":"G T Armstrong","doi":"10.7182/prtr.1.9.3.6760485v16223542","DOIUrl":"https://doi.org/10.7182/prtr.1.9.3.6760485v16223542","url":null,"abstract":"<p><p>Lung and heart-lung transplantation was first undertaken in Australia in the late 1980s and early 1990s. Although detailed data are available on Australian lung transplantation outcomes, little data are available regarding the utilization of donated lungs. This study examines donated lung utilization rates and considers various factors that may affect these rates. Australian donation and transplantation data were analyzed for the years 1989 through 1997. Results showed that 24% of overall donors were lung donors. The percentage of donors from whom at least 1 lung was transplanted increased from 6% in 1989 to 36% in 1997. Heart-lung transplantation rates changed little (2%-9%), whereas bilateral lung transplantation increased from 1% to 23% of donors. Single-lung donors accounted for 32% of lung donors in 1997. Uniform basic donor criteria and management guidelines, simple allocation mechanisms, and cooperative retrieval have evolved during this time. Close collaboration at the time of donation between units, coordinators, and ICUs has allowed early retrieval from well-managed donors.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 3","pages":"181-5"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21555263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-09-01DOI: 10.7182/prtr.1.9.3.c825131122r83203
K A Scholz, K L Turrisi
The purpose of this article is to describe the efforts of a medium-sized kidney transplant program in the southeastern United States to reduce the inpatient length of stay by moving toward the outpatient arena, thereby reducing the overall cost of the transplant experience. An outpatient transplant unit was created to house patients who were medically stable but still required further monitoring and education prior to being discharged. The development and implementation of the transplant outpatient unit significantly reduced inpatient length of stay following kidney transplantation from 14 to 5 days. The benefits and outcomes of the transplant outpatient unit were impressive.
{"title":"Outpatient housing following kidney transplantation.","authors":"K A Scholz, K L Turrisi","doi":"10.7182/prtr.1.9.3.c825131122r83203","DOIUrl":"https://doi.org/10.7182/prtr.1.9.3.c825131122r83203","url":null,"abstract":"<p><p>The purpose of this article is to describe the efforts of a medium-sized kidney transplant program in the southeastern United States to reduce the inpatient length of stay by moving toward the outpatient arena, thereby reducing the overall cost of the transplant experience. An outpatient transplant unit was created to house patients who were medically stable but still required further monitoring and education prior to being discharged. The development and implementation of the transplant outpatient unit significantly reduced inpatient length of stay following kidney transplantation from 14 to 5 days. The benefits and outcomes of the transplant outpatient unit were impressive.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 3","pages":"161-4"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21556015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-09-01DOI: 10.1177/090591999900900308
A. Linyear, A. Tartaglia
Journal of Transplant Coordination, Vol. 9, Number 3, September 1999 nically and racially diverse population. During l996 and l997, MCVH recovered organs from 36 donors, and 249 individuals received at least 1 solid organ. In l996, MCVH, in an effort to improve its performance, became a part of the collaborative project to increase organ donation by the University Health System Consortium and the Partnership for Organ Donation (Partnership). The Partnership is an independent nonprofit organization committed to improving organ donation through research and program implementation. The purpose of this article is to present findings following implementation of a systematic hospital-based program to improve organ donation.
{"title":"Family Communication Coordination: A Program to Increase Organ Donation","authors":"A. Linyear, A. Tartaglia","doi":"10.1177/090591999900900308","DOIUrl":"https://doi.org/10.1177/090591999900900308","url":null,"abstract":"Journal of Transplant Coordination, Vol. 9, Number 3, September 1999 nically and racially diverse population. During l996 and l997, MCVH recovered organs from 36 donors, and 249 individuals received at least 1 solid organ. In l996, MCVH, in an effort to improve its performance, became a part of the collaborative project to increase organ donation by the University Health System Consortium and the Partnership for Organ Donation (Partnership). The Partnership is an independent nonprofit organization committed to improving organ donation through research and program implementation. The purpose of this article is to present findings following implementation of a systematic hospital-based program to improve organ donation.","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"165 - 174"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900308","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65466121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-09-01DOI: 10.1177/090591999900900311
G. T. Armstrong
Journal of Transplant Coordination, Vol. 9, Number 3, September 1999 ber of studies have been done to determine either the potential for donation or overall donation and transplantation rates. Roels and De Meester1 showed higher rates of thoracic transplantation in the Eurotransplant (the exchange organization that coordinates organ procurement, allocation, and exchange in and between Austria, Belgium, Luxembourg, Germany, and the Netherlands) countries with presumed consent than those with explicit consent legislation. Data are reported in this study as donors and donated lungs per million population per year. A calculation based on their reported populations shows a rate of 25 available lungs per 100 donors for the presumed consent countries compared with a rate of 13 per 100 donors for the nonpresumed consent Eurotransplant countries. The investigators concluded that presumed consent legislation accounted for this discrepancy. A similar calculation based on population applied to a study by Colpitts and Freitag2 shows an overall lung utilization rate of 15 lung transplants per 100 donors in Canada for the same years as reported by Roels and De Meester1 (1992-1994). The United Network for Organ Sharing (UNOS)3 and United Kingdom Transplant Support Service Authority (UKTSSA)4 data for these years show rates of 13 to 15 and 14 to 18 lung transplants per 100 donors, Utilization of donated lungs in Australia: 1989-1997
{"title":"Utilization of Donated Lungs in Australia: 1989–1997","authors":"G. T. Armstrong","doi":"10.1177/090591999900900311","DOIUrl":"https://doi.org/10.1177/090591999900900311","url":null,"abstract":"Journal of Transplant Coordination, Vol. 9, Number 3, September 1999 ber of studies have been done to determine either the potential for donation or overall donation and transplantation rates. Roels and De Meester1 showed higher rates of thoracic transplantation in the Eurotransplant (the exchange organization that coordinates organ procurement, allocation, and exchange in and between Austria, Belgium, Luxembourg, Germany, and the Netherlands) countries with presumed consent than those with explicit consent legislation. Data are reported in this study as donors and donated lungs per million population per year. A calculation based on their reported populations shows a rate of 25 available lungs per 100 donors for the presumed consent countries compared with a rate of 13 per 100 donors for the nonpresumed consent Eurotransplant countries. The investigators concluded that presumed consent legislation accounted for this discrepancy. A similar calculation based on population applied to a study by Colpitts and Freitag2 shows an overall lung utilization rate of 15 lung transplants per 100 donors in Canada for the same years as reported by Roels and De Meester1 (1992-1994). The United Network for Organ Sharing (UNOS)3 and United Kingdom Transplant Support Service Authority (UKTSSA)4 data for these years show rates of 13 to 15 and 14 to 18 lung transplants per 100 donors, Utilization of donated lungs in Australia: 1989-1997","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 1","pages":"181 - 185"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999900900311","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65466348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-09-01DOI: 10.7182/prtr.1.9.3.r535v41283n05248
L Ohler
{"title":"Quality of life after transplantation.","authors":"L Ohler","doi":"10.7182/prtr.1.9.3.r535v41283n05248","DOIUrl":"https://doi.org/10.7182/prtr.1.9.3.r535v41283n05248","url":null,"abstract":"","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"9 3","pages":"135-6"},"PeriodicalIF":0.0,"publicationDate":"1999-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21556009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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