Extending the Carrel system to mediate in the organ and tissue allocation processes: a first approach

In this paper we extend the formalization of Carrel, a virtual organization for the procurement of tissues for transplantation purposes, in order to model also the procurement of human organs for transplants. We will focus in the organ allocation process to show how it can be formalized with the ISLANDER formalism. Also we present a first mechanism to federate the institution in several geographically-distributed platforms.Postprint (published version

Small bowel and liver/small bowel transplantation in children.

A clinical trial of intestinal transplantation was initiated at the University of Pittsburgh in May 1990. Eleven children received either a combined liver/small bowel graft (n = 8) or an isolated small bowel graft (n = 3). Induction as well as maintenance immunosuppression was with FK-506 and steroids. Four patients were male, and seven were female; the age range was 6 months to 10.2 years. There were 3 deaths (all in recipients of the combined liver/small bowel graft), which were attributed to graft-versus-host disease (n = 1), posttransplant lymphoproliferative disease (n = 1), and biliary leak (n = 1). Transplantation of the intestine has evolved into a feasible operation, with an overall patient and graft survival rate of 73%. These survivors are free of total parenteral nutrition, and the majority are home. These encouraging results justify further clinical trials

Surgical technique of orthotopic liver transplantation

Athough significant strides have been made in the surgical technique of orthotopic liver transplantation, numerous problems and nuisances are still encountered. Further surgical refinements will certainly evolve. The development of better preservation techniques, the use of intraoperative flowmeters, and the availability of new technologies, such as an artificial liver, should impact and advance the techniques of liver transplantation significantly and improve the overall results even further

How to counteract the lack of donor tissue in cardiac surgery? Initial experiences with a newly established homograft procurement program

Homograft heart valves may have significant advantages and are preferred for the repair of congenital valve malformations, especially in young women of childbearing age, athletes and in patients with active endocarditis. A growing problem, however, is the mismatch between tissue donation and the increasing demand. The aim of this paper is to describe the initiation process of a homograft procurement program to attenuate the shortage of organs. A comprehensive description of the infrastructure and procedural steps required to initiate a cardiac and vascular tissue donation program combined with a prospective follow-up of all homografts explanted at our institution. Between January 2020 and May 2022, 28 hearts and 12 pulmonary bifurcations were harvested at our institution and delivered to the European homograft bank. Twenty-seven valves (19 pulmonary valves, 8 aortic valves) were processed and allocated for implantation. The reasons for discarding a graft were either contamination (n = 14), or morphology (n = 13) or leaflet damage (n = 2). Five homografts (3 PV, 2 AV) have been cryopreserved and stored while awaiting allocation. One pulmonary homograft with a leaflet cut was retrieved by bicuspidization technique and awaits allocation, as a highly requested small diameter graft. The implementation of a tissue donation program in cooperation with a homograft bank can be achieved with reasonable additional efforts at a transplant center with an in-house cardiac surgery department. Challenging situations with a potential risk of tissue injury during procurement include re-operation, harvesting by a non-specialist surgeon and prior central cannulation for mechanical circulatory support

Heart transplantation: a history lesson of Lazarus

One of the notable advances in modern day medicine is organ transplantation. None more so than the heart. A complex interaction between physiology, surgery and immunology that spanned decades, involving the hard work of many pioneers in their fields. We revisit the contributions of the pioneers as well as marvel at the paradigm shifts in medicine that have made heart transplantation safe and reproducible with in excess of 3000 transplants done yearly today

Heart transplantation: a history lesson of Lazarus

One of the notable advances in modern day medicine is organ transplantation. None more so than the heart. A complex interaction between physiology, surgery and immunology that spanned decades, involving the hard work of many pioneers in their fields. We revisit the contributions of the pioneers as well as marvel at the paradigm shifts in medicine that have made heart transplantation safe and reproducible with in excess of 3000 transplants done yearly today

Xenotransplantation:The Science, the Advantages, the Ethics

Xenotransplantation is a breakthrough medicinal technology that is an attempt to change the lives of millions of people. The problems in the current organ transplant system risk the lives of patients each and every day. Intense waiting periods and extremely costly procedures exemplify the stress and pressure that these patients face as an attempt to save their own lives. Xenotransplantation is the idea of growing human organs in a different species, using incredible stem-cell and CRISPR technology. This can introduce an answer to some of the issues in the current transplant system. Many technical and ethical issues are becoming relevant with the introduction of this new medical phenomenon. If these barriers can be overcome, xenotransplantation can offer a quicker, cheaper, and more effective option for patients in need of an organ transplant

Extending CARREL's architecture for agents to argue over the viability of a human organ

In this report we present an extension to CARREL's architecture. CARREL is an agent-based organization designed to improve the overall transplant process. The proposed extension will enable CARREL agents to reason and deliberate over the viability of a human organ for transplantation. We believe that allowing this deliberation has the potential to augment the organ pool for transplantation and thus, reduce the disparity between demand for, and supply of, human organs for transplantation.Postprint (published version

Hyperspectral Imaging and Machine Perfusion in Solid Organ Transplantation: Clinical Potentials of Combining Two Novel Technologies

Organ transplantation survival rates have continued to improve over the last decades, mostly due to reduction of mortality early after transplantation. The advancement of the field is facilitating a liberalization of the access to organ transplantation with more patients with higher risk profile being added to the waiting list. At the same time, the persisting organ shortage fosters strategies to rescue organs of marginal donors. In this regard, hypothermic and normothermic machine perfusion are recognized as one of the most important developments in the modern era. Owing to these developments, novel non-invasive tools for the assessment of organ quality are on the horizon. Hyperspectral imaging represents a potentially suitable method capable of evaluating tissue morphology and organ perfusion prior to transplantation. Considering the changing environment, we here discuss the hypothetical combination of organ machine perfusion and hyperspectral imaging as a prospective feasibility concept in organ transplantation