Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)最新文献

{"title":"Non—Heart-Beating Donors: A Case Study in Procurement","authors":"D. D. Lewis, W. Valerius, M. A. Sommerville","doi":"10.1177/090591999800800405","DOIUrl":"https://doi.org/10.1177/090591999800800405","url":null,"abstract":"To help meet the increasing need for transplantable organs, especially kidneys, organ procurement organizations are recovering organs from Non—Heart-beating patients. This article outlines the successful recovery and transplantation of kidneys from such a donor. Consent issues and historical background are also discussed.","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"8 1","pages":"218 - 220"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999800800405","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65464226","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}

{"title":"Conversion from Sandimmune to Neoral in Organ Transplant Recipients","authors":"M. Bartucci, L. Bayer, B. Brooks, L. Chandler, V. Himes, D. Meiergerd, B. Newby, N. T. Satmary, V. Shieck","doi":"10.1177/090591999800800407","DOIUrl":"https://doi.org/10.1177/090591999800800407","url":null,"abstract":"Journal of Transplant Coordination, Vol. 8, Number 4, December 1998 Pharmacokinetic parameters that are particularly important for cyclosporine include Cmax, tmax, Cmin, and area under the curve (AUC). Cmax represents the peak or maximum concentration of a drug, and tmax is the time needed to reach the maximum concentration. Conversely, Cmin is the minimum drug concentration or trough. Area under the curve is the area under the concentration-versus-time curve, reflecting the total drug exposure (bioavailability) over the dosing interval or duration of therapy. An important clinical mandate is that drugs must be delivered to target tissues in concentrations high enough to be therapeutic but low enough to avoid toxicity.2 The term “therapeutic range” refers to the range of drug concentrations in the blood in which the likelihood of the desired clinical response is relatively high and the risk of unacceptable toxicity is relatively low.1 It is typically a population mean, and there may be great individual differences in patient response within this range. Cyclosporine, like other immunosuppressants, has a relatively narrow therapeutic range.3 Conversion from Sandimmune to Neoral in organ transplant recipients","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"8 1","pages":"227 - 235"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999800800407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65464422","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}

{"title":"Attitudes of Black South Africans concerning Organ Donation","authors":"S. Ndlovu, A. Kobryń, M. Modiba","doi":"10.1177/090591999800800409","DOIUrl":"https://doi.org/10.1177/090591999800800409","url":null,"abstract":"prospectively from February 1, 1992, to January 6, 1994. During this period, 43 black and 1 white braindead potential donors were identified in the GaRankuwa Hospital ICU. Over the same period, 119 living-related potential donors were approached concerning kidney donation for relatives who had chronic kidney failure. The request for organ donation was made by a female black transplant coordinator who communicated in several ethnic languages. Cadaveric donors were accepted based on whether the creatinine level was below 200 μmol/L and whether screening for Hepatitis B, HIV, and possible bacterial infection was negative. Consent for donation from living-related donors did not necessarily result in transplantation because other factors such as tissue typing and mixed lymphocyte cultures were considered. Although current South African law permits retrieval of organs from brain-dead individuals with permission from the hospital superintendent or a magistrate in cases in which relatives could not be traced, such methods were not used in the present study. Donors were not paid for organs, and no contact between relatives of cadaveric donors and recipients was made possible.4","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"8 1","pages":"241 - 242"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999800800409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65464957","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}

{"title":"Increasing the donor pool in Chile.","authors":"J M Palacios","doi":"10.7182/prtr.1.8.4.c9h55624l443q7w2","DOIUrl":"https://doi.org/10.7182/prtr.1.8.4.c9h55624l443q7w2","url":null,"abstract":"<p><p>The purpose of this study was to evaluate organ donation in Chile following the creation of the \"Corporación Nacional de Fomento de Trasplantes.\" The corporation was created in 1991 as a private, nonprofit organization whose main purpose was to increase the number of actual donors and multiorgan procurement. The organization is independent of the national government and acts as a link between the needs of patients and society and those of the National Ministry of Health. Following the creation of the corporation, the number of actual donors increased from 32 to 98. The number of potential donors increased 3-fold. Family refusal for organ donation was between 28% and 53.4%. Pediatric and marginal donors increased from 2% to 15%. Ninety-five percent of the donors came from Santiago, where 33% of the population lives and most of the efforts were concentrated. The corporation is working to increase organ donation throughout the rest of the country by organizing public campaigns; promoting knowledge about transplantation among medical and nursing personnel at hospitals, schools, universities, and social gatherings; evaluating technical and financial results; and helping with the processes of organ procurement.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"8 4","pages":"243-9"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21076215","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}

{"title":"Organ recovery from a donor with presumed viral encephalitis: a case report and review.","authors":"J H McDowell,&nbsp;B L Zingaro","doi":"10.7182/prtr.1.8.4.9077436477141l34","DOIUrl":"https://doi.org/10.7182/prtr.1.8.4.9077436477141l34","url":null,"abstract":"<p><p>This article reviews the pathophysiology of viral encephalitis, which is specifically infectious to transplant recipients, and discusses the potential infectivity of donors who had this virus. In addition, the case report demonstrates one center's experience in placing organs from a donor who was presumed--but not confirmed--to have viral encephalitis. When a patient with viral encephalitis is considered for organ donation, it is recommended that a brain biopsy be obtained prior to organ placement to identify the suspected virus or confirm the absence of any viral entity.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"8 4","pages":"199-204"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21076271","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}

{"title":"In Sickness and in Health: Testing the Vow after Transplantation","authors":"","doi":"10.1177/090591999800800401","DOIUrl":"https://doi.org/10.1177/090591999800800401","url":null,"abstract":"Journal of Transplant Coordination, Vol. 8, Number 4, December 1998 T presents many challenges to patients, families, and the healthcare providers who attempt to manage the predicted and many unpredicted events that follow. Each of us knows the struggles that patients and their families often confront while awaiting transplantation, as well as the hope they have that the new organ will solve the problems they have experienced. When facing death, most patients and their families focus only on the outcome of the immediate crisis. They simply want to be assured of a longer life. A new organ often represents the only solution to the immediate problem. In an article that may be considered a classic, “Family Adjustment to Heart Transplantation: Redesigning the Dream,” Mishel and Murdaugh1 reported that families expect life to return to normal once their loved ones receive a new heart. Although life may have been extended in the months following transplantation, coping with stressors such as rejections, infections, frequent visits to the transplant center, and financial issues often complicates the reality. Perhaps technology is more advanced than our psychological coping abilities. Often, the integrity of the family unit is stressed to the point of instability when finances and health are at stake. We take a marriage vow that says “in sickness and in health, for richer and for poorer.” But more than often, for spouses these problems linger without intervention. If we could be more proactive in caring for the family, perhaps some of these stressors could be avoided. Research on caregiver burden was reported in a recent issue of the Journal of Transplant Coordination, and I encourage you to read it.2 Many self-help support groups have formed on the Internet for those coping with chronic illness, especially for families coping with cancer, lupus, and multiple sclerosis. One such group founded by family members of patients with multiple sclerosis aptly calls itself the Well Spouse Foundation. There seems to be a void for professional interventions with families of transplant recipients. In procurement, our colleagues have developed bereavement counseling and support groups for donor families. However, in the clinical world, we could do still more for families following transplantation. It is important for families and patients to begin learning about the realities of transplantation in the candidate stage. Transplantation should not be presented as a cure but as an adjustment to a new lifestyle. Ongoing education for patients and families should be part of every transplant center’s program. In keeping with the multidisciplinary approach to transplantation, social workers, nurses, pharmacists, physicians, psychologists, clergy, and financial coordinators all should be invited to participate in these programs on a regular basis. Two of probably the most effective support group sessions that I have observed consisted of a panel of transplant recipients discus","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"143 1","pages":"198 - 198"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999800800401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65464447","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}

{"title":"Organ Recovery from a Donor with Presumed Viral Encephalitis: A Case Report and Review","authors":"J. H. McDowell, B. L. Zingaro","doi":"10.1177/090591999800800402","DOIUrl":"https://doi.org/10.1177/090591999800800402","url":null,"abstract":"Journal of Transplant Coordination, Vol. 8, Number 4, December 1998 tion upon admission was normal except for a 2to 3-cm axillary lump. In addition, the computed tomography (CT) scan of the head was normal. The patient was started on ceftriaxone sodium (Rocephin) and loaded with phenytoin (Dilantin). A lumbar puncture was performed on day 2 (results listed in Table 1). The child was additionally placed on acyclovir and treated for an iron deficiency anemia. A magnetic resonance imaging of the brain did not show any abnormal findings. Dilantin was discontinued and carbamazepine (Tegretol) was started. The child had another seizure on day 3 and Dilantin was recontinued. After a decline in the child’s mental status, an electroencephalograph (EEG) was performed showing borderline normal activity. A repeat CT scan on day 4 was normal; a repeat EEG revealed a slow background rhythm for age with generalized electrocerebellar dysfunction. Rocephin was discontinued after a rapid Streptococcus test was positive. The patient was then started on ampicillin. Later that day, the patient had another seizure for which he was treated with phenobarbital. He subsequently had significant neurologic deterioration over the next several hours. On day 5, the patient’s mental status declined further, and intubation and mechanical ventilation were required to support his respiratory function. The patient was referred and transferred to our institution Organ recovery from a donor with presumed viral encephalitis: a case report and review","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"8 1","pages":"199 - 204"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999800800402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65464493","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}

{"title":"Improving the Request Process to Increase Family Consent for Organ Donation","authors":"S. Gortmaker, C. Beasley, E. Sheehy, B. A. Lucas, L. Brigham, Å. Grenvik, R. Patterson, R. Garrison, P. McNamara, M. Evanisko","doi":"10.1177/090591999800800404","DOIUrl":"https://doi.org/10.1177/090591999800800404","url":null,"abstract":"The greatest impediment to organ donation is refusal of family consent. This study examined the impact of 3 modifiable elements of the donation request on family consent rates: (1) decoupling (ie, the family understands and accepts brain death before discussion of organ donation is begun); (2) the procurement coordinator participates in the request for consent; and (3) donation is requested in a quiet, private place. Data on the request process were collected prospectively for 707 medically suitable potential donors who had been referred to 3 organ procurement organizations. The average rate of consent for donation was 62.2%. Higher consent rates were independently associated with the 3 characteristics studied. These components were summarized in the Request Process Scale. Multivariate regression analyses indicated that consent rates can be as high as 74% when all 3 process elements are present. Hospitals and organ procurement organizations should incorporate these elements into their standard of practice when requesting organ donation.","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"8 1","pages":"210 - 217"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/090591999800800404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65464172","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}

{"title":"Improving the request process to increase family consent for organ donation.","authors":"S L Gortmaker,&nbsp;C L Beasley,&nbsp;E Sheehy,&nbsp;B A Lucas,&nbsp;L E Brigham,&nbsp;A Grenvik,&nbsp;R H Patterson,&nbsp;N Garrison,&nbsp;P McNamara,&nbsp;M J Evanisko","doi":"10.7182/prtr.1.8.4.2g64j1x161620765","DOIUrl":"https://doi.org/10.7182/prtr.1.8.4.2g64j1x161620765","url":null,"abstract":"<p><p>The greatest impediment to organ donation is refusal of family consent. This study examined the impact of 3 modifiable elements of the donation request on family consent rates: (1) decoupling (i.e., the family understands and accepts brain death before discussion of organ donation is begun); (2) the procurement coordinator participates in the request for consent; and (3) donation is requested in a quiet, private place. Data on the request process were collected prospectively for 707 medically suitable potential donors who had been referred to 3 organ procurement organizations. The average rate of consent for donation was 62.2%. Higher consent rates were independently associated with the 3 characteristics studied. These components were summarized in the Request Process Scale. Multivariate regression analyses indicated that consent rates can be as high as 74% when all 3 process elements are present. Hospitals and organ procurement organizations should incorporate these elements into their standard of practice when requesting organ donation.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"8 4","pages":"210-7"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21076273","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}

{"title":"Conversion from Sandimmune to Neoral in organ transplant recipients.","authors":"M R Bartucci,&nbsp;L Bayer,&nbsp;B K Brooks,&nbsp;L Chandler,&nbsp;V Himes,&nbsp;D Meiergerd,&nbsp;B Newby,&nbsp;N T Satmary,&nbsp;V Shieck","doi":"10.7182/prtr.1.8.4.t272k7g0717144h1","DOIUrl":"https://doi.org/10.7182/prtr.1.8.4.t272k7g0717144h1","url":null,"abstract":"<p><p>The pharmacokinetic profiles of Sandimmune and Neoral vary considerably among transplant recipients. Cyclosporine exposure is far more consistent with Neoral than it is with Sandimmune. Because intrapatient variability of drug exposure has been demonstrated to be a risk factor for chronic rejection, this difference becomes important. Neoral also has a linear dose response and a stronger correlation between trough level and drug exposure. Dose linearity greatly facilitates accurate dose titration. Results of controlled studies in which kidney, liver, and heart transplant recipients were converted from Sandimmune to Neoral have shown that conversion on a 1:1 mg basis results in more predictable bioavailability and often in reductions in cyclosporine dose. Carefully monitored conversion has not been associated with increased side effects, and any side effects that do emerge can usually be managed by taking Neoral with food, changing the dose from every 12 hours to every 8 hours, or through dose reduction.</p>","PeriodicalId":79507,"journal":{"name":"Journal of transplant coordination : official publication of the North American Transplant Coordinators Organization (NATCO)","volume":"8 4","pages":"227-33; quiz 234-5"},"PeriodicalIF":0.0,"publicationDate":"1998-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21076276","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}