The procurement process for organ donation begins with the identification of potential organ donors in emergency or critical care units(CCU),followed by their clinical evaluation,diagnostic procedures,and therapeutic ...The procurement process for organ donation begins with the identification of potential organ donors in emergency or critical care units(CCU),followed by their clinical evaluation,diagnostic procedures,and therapeutic interventions,mostly conducted in CCUs.It concludes with the request for organ donation and,if accepted,the retrieval of organs.Despite most interventions occurring in detection units,there has been a neglect of the strategic role played by critical care specialists(CCS)in managing and caring for brain-dead or near-brain-death patients.Questions arise:Are they willing to undertake this responsibility?Do they fully comprehend the nature of organ procurement?Are they aware of the specific interventions required to maintain possible organ donors in optimal physiological condition?Our objective is to examine the role of CCS in organ procurement and propose ways to enhance it,ultimately aiming to increase and enhance organ donation rates.展开更多
AIM: To determine the incidence of surgical injury during deceased donor organ procurements. METHODS: Organ damage was classified into three tiers, from 1-3, with the latter rendering the organ nontransplantable. For ...AIM: To determine the incidence of surgical injury during deceased donor organ procurements. METHODS: Organ damage was classified into three tiers, from 1-3, with the latter rendering the organ nontransplantable. For 12 consecutive months starting in January of 2014, 36 of 58 organ procurement organization's(OPO)'s prospectively submitted quality data regarding organ damage(as reported by the transplanting surgeon and confirmed by the OPO medical director) seen on the procured organ.RESULTS: These 36 OPOs recovered 5401 of the nations' s 8504 deceased donors for calendar year 2014.A total of 19043 organs procured were prospectively analyzed. Of this total, 59 organs sustained damage making them non-transplantable(0 intestines; 4 pancreata; 5 lungs; 6 livers; 43 kidneys). The class 3 damage was spread over 22(of 36) reporting OPO's.CONCLUSION: While damage to the procured organ is rare with organ loss being approximately 0.3% of procured organs, loss of potential transplantable organs does occur during procurement.展开更多
There is increasing evidence that adequate donor management with a goal of optimization of organ function is essential to maximize the number of organs that can be procured.Therefore,identification of the cause of hem...There is increasing evidence that adequate donor management with a goal of optimization of organ function is essential to maximize the number of organs that can be procured.Therefore,identification of the cause of hemodynamic instability is crucial in order to direct the right therapy.Several donor management goals for better hemodynamic management including serial echocardiography can guide hemodynamic management in potential donors to increase both number and quality of donor hearts.展开更多
The Best Value Approach(BVA)is a new project delivery method that has been developed at Arizona State University.It has been documented to increase performance and value on projects by the identification and utilizati...The Best Value Approach(BVA)is a new project delivery method that has been developed at Arizona State University.It has been documented to increase performance and value on projects by the identification and utilization of expertise instead of management,direction,and control(MDC).It utilizes perfomance information that is simple,observable,and countable.It allows the expert vendor to know what the client proj-ect requires,why they can achieve success and what they will do before they do it.The tracking of the project cost and time deviation requires an initial plan and method to tack it.Preliminary results of the BVA have shown a 90%decrease in effort by client organizations,98%customed satisfaction and has led to 1%vendor cost and time deviation rate.It ap-plies to construction,services/TT projects,and any long-term service.In 2014,a large private organization having dificulty delivering information technology(T)and construction/facility services identified the BVA as a potential solution.This paper will summarize a major IT Enterprise Resource Planming case study that the large private organization used the BVA on and identify the full results.展开更多
Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a signifi...Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a significant increase in the number of patients on transplant waiting lists globally.Societies worldwide have employed different methods to address this,each with specific ethical concerns surrounding them.Over three decades ago,a governmentally regulated program of kidney transplantation from living unrelated donors was introduced in Iran and since practiced which has been the subject of hot debate in the literature.Nevertheless,despite all these extensive discussions and publications,several key aspects of the program have still not been properly elucidated and addressed.In this article,the author aims to illuminate some dark corners related to this issue that have largely escaped the notice of ethicists.展开更多
BACKGROUND： In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.METHODS： From July 2011 to August 2012, our ...BACKGROUND： In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.METHODS： From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively.RESULTS： Among the 29 donors, 24 were China Category II donors（organ donation after cardiac death）, and five were China Category III donors（organ donation after brain death followed by cardiac death）. The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422（2-696） days. Among the five mortalities during the follow-up,three died of tumor recurrence. In terms of post-transplant complications, 9 recipients（34.6%） experienced early allograft dysfunction, 1（3.8%） had non-anastomotic biliary stricture,and 1（3.8%） was complicated with hepatic arterial thrombosis.None of these complications resulted in patient death. Notably,primary non-function was not observed in any of the grafts.CONCLUSION： With careful donor selection, liver transplant from deceased donors can be performed safely and plays acritical role in overcoming the extreme organ shortage in China.展开更多
Organ transplantation saves thousands of lives every year but the shortage of donors is a major limiting factor to increase transplantation rates. To allow more patients to be transplanted before they die on the waitl...Organ transplantation saves thousands of lives every year but the shortage of donors is a major limiting factor to increase transplantation rates. To allow more patients to be transplanted before they die on the waitlist an increase in the number of donors is necessary. Patients with devastating irreversible brain injury, if medically suitable, are potential deceased donors and strategies are needed to successfully convert them into actual donors. Multiple steps in the process of deceased organ donation can be targeted to increase the number of organs suitable for transplant. In this review, after describing this process, we discuss current challenges and potential strategies to expand the pool of deceased donors.展开更多
The public procurement market is classified as one of the most important segments of the world economy with share of 7-18%in the world GDP.The importance of this segment leads to continuous liberalization.Despite the ...The public procurement market is classified as one of the most important segments of the world economy with share of 7-18%in the world GDP.The importance of this segment leads to continuous liberalization.Despite the existing legislative framework,the share of cross-border public procurement remains limited due to several obstacles including discrimination in public procurement that was raised by governments as one of the non-tariff barriers to international trade.Surveys of the European Commission or the European Bank for Reconstruction and Development(EBRD)indicate that there are many other obstacles to entry to international public procurement markets.These obstacles are discussed in the first chapter of this article.The goal of this paper is to review aspects of international public procurement regulation and find ways of eliminating the obstacles through this regulation.Therefore,the second,third,and fourth chapters of the paper analyse the WTO Government Procurement Agreement(GPA),the United Nations Commission on International Trade Law(UNCITRAL)Model Law on Public Procurement,and the role of regional trade agreements.展开更多
Despite organ transplantation being the most successful treatment for end-stage organ dysfunction,the number of annual solid organ transplantations is much lower than that required to satisfy the demand of patients on...Despite organ transplantation being the most successful treatment for end-stage organ dysfunction,the number of annual solid organ transplantations is much lower than that required to satisfy the demand of patients on waiting lists.The explanation for this phenomenon is the relative scarcity of non-living organ donors due to several factors,such as:(1)Late arrival of patients with a neurocritical condition to an emergency service;(2)lack of detection of those patients as possible organ donors by health professionals dedicated to procurement or by clinicians at emergency and intensive care units,for instance;(3)late transfer of the patient to an intensive care unit to try to recover their health and to provide hemodynamic,ventilatory,and metabolic support;(4)lack of confirmation of the physiological status of the possible donor;(5)late or incorrect positive diagnosis of the subject’s death,either due to brain or cardiac death;(6)difficulty in obtaining legal authorization,either by direct relatives or by the authority,for the extraction of organs;and(7)deficient retrieval surgery of the organs actually donated.The recent reports of relatively successful xenotransplants from genetically modified pigs open the possibility to fix this mismatch between supply and demand,but some technical(organ rejection and opportunistic infections),and economic issues,still remain before accepting a progressive replacement of the organ sources for transplantation.An approximate economic cost analysis suggests that the hypothetical acquisition cost of any genetically modified pig derived organ is high and would not even satisfy the solid organ demand of the wealthiest countries.展开更多
There is currently a lack of standard kidney-only procurement technique. Known techniques such as kidney-only procurement using the standard multi-organ procurement technique could potentially cause more iatrogenic in...There is currently a lack of standard kidney-only procurement technique. Known techniques such as kidney-only procurement using the standard multi-organ procurement technique could potentially cause more iatrogenic injuries due to less adequate exposure. An alternative using the live open kidney donation technique could also be less than ideal due to prior unknown anatomical variation and potential the inability to adequately topically cool the kidneys. We describe here a novel easy kidney-only technique leading to an improved exposure, better cold perfusion and topical cooling. Herein we show how total bowel evisceration can be achieved by stapling the hepatic hilum, superior mesenteric artery and coeliac trunk. There is a need of a kidney only procurement in order to increase the quality of deceased kidney donation in our opinion. Results have to be compared in the future to determine the potential benefits.展开更多
文摘The procurement process for organ donation begins with the identification of potential organ donors in emergency or critical care units(CCU),followed by their clinical evaluation,diagnostic procedures,and therapeutic interventions,mostly conducted in CCUs.It concludes with the request for organ donation and,if accepted,the retrieval of organs.Despite most interventions occurring in detection units,there has been a neglect of the strategic role played by critical care specialists(CCS)in managing and caring for brain-dead or near-brain-death patients.Questions arise:Are they willing to undertake this responsibility?Do they fully comprehend the nature of organ procurement?Are they aware of the specific interventions required to maintain possible organ donors in optimal physiological condition?Our objective is to examine the role of CCS in organ procurement and propose ways to enhance it,ultimately aiming to increase and enhance organ donation rates.
文摘AIM: To determine the incidence of surgical injury during deceased donor organ procurements. METHODS: Organ damage was classified into three tiers, from 1-3, with the latter rendering the organ nontransplantable. For 12 consecutive months starting in January of 2014, 36 of 58 organ procurement organization's(OPO)'s prospectively submitted quality data regarding organ damage(as reported by the transplanting surgeon and confirmed by the OPO medical director) seen on the procured organ.RESULTS: These 36 OPOs recovered 5401 of the nations' s 8504 deceased donors for calendar year 2014.A total of 19043 organs procured were prospectively analyzed. Of this total, 59 organs sustained damage making them non-transplantable(0 intestines; 4 pancreata; 5 lungs; 6 livers; 43 kidneys). The class 3 damage was spread over 22(of 36) reporting OPO's.CONCLUSION: While damage to the procured organ is rare with organ loss being approximately 0.3% of procured organs, loss of potential transplantable organs does occur during procurement.
文摘There is increasing evidence that adequate donor management with a goal of optimization of organ function is essential to maximize the number of organs that can be procured.Therefore,identification of the cause of hemodynamic instability is crucial in order to direct the right therapy.Several donor management goals for better hemodynamic management including serial echocardiography can guide hemodynamic management in potential donors to increase both number and quality of donor hearts.
文摘The Best Value Approach(BVA)is a new project delivery method that has been developed at Arizona State University.It has been documented to increase performance and value on projects by the identification and utilization of expertise instead of management,direction,and control(MDC).It utilizes perfomance information that is simple,observable,and countable.It allows the expert vendor to know what the client proj-ect requires,why they can achieve success and what they will do before they do it.The tracking of the project cost and time deviation requires an initial plan and method to tack it.Preliminary results of the BVA have shown a 90%decrease in effort by client organizations,98%customed satisfaction and has led to 1%vendor cost and time deviation rate.It ap-plies to construction,services/TT projects,and any long-term service.In 2014,a large private organization having dificulty delivering information technology(T)and construction/facility services identified the BVA as a potential solution.This paper will summarize a major IT Enterprise Resource Planming case study that the large private organization used the BVA on and identify the full results.
文摘Renal transplantation is the treatment of choice for end stage kidney disease.However,despite all the efforts to expand the donor pool,the shortage of donors is increasing and as a consequence,there has been a significant increase in the number of patients on transplant waiting lists globally.Societies worldwide have employed different methods to address this,each with specific ethical concerns surrounding them.Over three decades ago,a governmentally regulated program of kidney transplantation from living unrelated donors was introduced in Iran and since practiced which has been the subject of hot debate in the literature.Nevertheless,despite all these extensive discussions and publications,several key aspects of the program have still not been properly elucidated and addressed.In this article,the author aims to illuminate some dark corners related to this issue that have largely escaped the notice of ethicists.
基金supported by grants from the National High Technology Research and Development Program of China(863 Program)(2012AA021008)the Special Fund for Science Research by Ministry of Health(201302009)
文摘BACKGROUND： In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program.METHODS： From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively.RESULTS： Among the 29 donors, 24 were China Category II donors（organ donation after cardiac death）, and five were China Category III donors（organ donation after brain death followed by cardiac death）. The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422（2-696） days. Among the five mortalities during the follow-up,three died of tumor recurrence. In terms of post-transplant complications, 9 recipients（34.6%） experienced early allograft dysfunction, 1（3.8%） had non-anastomotic biliary stricture,and 1（3.8%） was complicated with hepatic arterial thrombosis.None of these complications resulted in patient death. Notably,primary non-function was not observed in any of the grafts.CONCLUSION： With careful donor selection, liver transplant from deceased donors can be performed safely and plays acritical role in overcoming the extreme organ shortage in China.
文摘Organ transplantation saves thousands of lives every year but the shortage of donors is a major limiting factor to increase transplantation rates. To allow more patients to be transplanted before they die on the waitlist an increase in the number of donors is necessary. Patients with devastating irreversible brain injury, if medically suitable, are potential deceased donors and strategies are needed to successfully convert them into actual donors. Multiple steps in the process of deceased organ donation can be targeted to increase the number of organs suitable for transplant. In this review, after describing this process, we discuss current challenges and potential strategies to expand the pool of deceased donors.
基金This research paper is a part of the research project F2/70/2018“Preshranicni verejné zakázky―analýza mezinárodního prostredia prekazky v zapojeníceskych firem”supported by the Internal Grant Agency(IGA)of the University of Economics,Prague.
文摘The public procurement market is classified as one of the most important segments of the world economy with share of 7-18%in the world GDP.The importance of this segment leads to continuous liberalization.Despite the existing legislative framework,the share of cross-border public procurement remains limited due to several obstacles including discrimination in public procurement that was raised by governments as one of the non-tariff barriers to international trade.Surveys of the European Commission or the European Bank for Reconstruction and Development(EBRD)indicate that there are many other obstacles to entry to international public procurement markets.These obstacles are discussed in the first chapter of this article.The goal of this paper is to review aspects of international public procurement regulation and find ways of eliminating the obstacles through this regulation.Therefore,the second,third,and fourth chapters of the paper analyse the WTO Government Procurement Agreement(GPA),the United Nations Commission on International Trade Law(UNCITRAL)Model Law on Public Procurement,and the role of regional trade agreements.
文摘Despite organ transplantation being the most successful treatment for end-stage organ dysfunction,the number of annual solid organ transplantations is much lower than that required to satisfy the demand of patients on waiting lists.The explanation for this phenomenon is the relative scarcity of non-living organ donors due to several factors,such as:(1)Late arrival of patients with a neurocritical condition to an emergency service;(2)lack of detection of those patients as possible organ donors by health professionals dedicated to procurement or by clinicians at emergency and intensive care units,for instance;(3)late transfer of the patient to an intensive care unit to try to recover their health and to provide hemodynamic,ventilatory,and metabolic support;(4)lack of confirmation of the physiological status of the possible donor;(5)late or incorrect positive diagnosis of the subject’s death,either due to brain or cardiac death;(6)difficulty in obtaining legal authorization,either by direct relatives or by the authority,for the extraction of organs;and(7)deficient retrieval surgery of the organs actually donated.The recent reports of relatively successful xenotransplants from genetically modified pigs open the possibility to fix this mismatch between supply and demand,but some technical(organ rejection and opportunistic infections),and economic issues,still remain before accepting a progressive replacement of the organ sources for transplantation.An approximate economic cost analysis suggests that the hypothetical acquisition cost of any genetically modified pig derived organ is high and would not even satisfy the solid organ demand of the wealthiest countries.
文摘There is currently a lack of standard kidney-only procurement technique. Known techniques such as kidney-only procurement using the standard multi-organ procurement technique could potentially cause more iatrogenic injuries due to less adequate exposure. An alternative using the live open kidney donation technique could also be less than ideal due to prior unknown anatomical variation and potential the inability to adequately topically cool the kidneys. We describe here a novel easy kidney-only technique leading to an improved exposure, better cold perfusion and topical cooling. Herein we show how total bowel evisceration can be achieved by stapling the hepatic hilum, superior mesenteric artery and coeliac trunk. There is a need of a kidney only procurement in order to increase the quality of deceased kidney donation in our opinion. Results have to be compared in the future to determine the potential benefits.
