Denny, DW

Starzl, TE

Van Thiel, DH

English

D-Scholarship@Pitt

E~1K 'Postmortem Organ Procurement for Transplantation THE I-YEAR SURVIVAL RATE of recipients of heart and liver transplants now exceeds that for recipients of post-mOl-tem donor kidney transplants according to recent re-ports (I-S). Very promising early results.with pancreas and heart-lung transplants have also been reported (6, 7). These accomplishments are due largely to advances in !he clinical treatment of allograft rejection. Kidney trans-plantation programs are well established; extrarenal transplantation programs for other organs will multiply rapidly in the months ahead to meet burgeoning needs. Liver transplantation was recently inaugurated at Massa-chusetts General Hospital. and cardiac transplantation will soon be initiated at Peter Bent Brigham Hospital. In the next few years. the number of patients in the United States who could benefit from transplants of organs other than kidneys is likely to exceed the nearly 6000 patients now waiting for cadaveric renal transplantation. The shortage of suitable postmortem organs is clearly impeding wider use of solid organ transplantation. Dur-ing a recent 2-year period at our center, for instance, 71 patients waiting for a liver transplant died before a donor organ became available. Congressional hearings were held recently to assess the reasons fO( the shortfall in organs. The Investigations and Oversight Subcommittee of the House pcie~ce and Technology Committee (8)· heard expert witnesses repOrt that in 1982 only 2200 of the estimated 20000 potential donors dying in American hospitals actually yielded organs for transplantation. The Surgeon General convened a workshop in June to seek remedies for this shortage. Specialists at the nation'S 110 organ procurement pro-grams state that at least three out of four families offered an opportunity to donate organs of family members suf-fering from brain death are willing to do so (8). Preoccu-pied with their own loss, however. these families seldom think to volunteer such donations unless informed of that option. Regional donor programs provide 24-hour assistance in donor evaluation, discussions with surviving family members,. and maintenance of donor organ function after determination of brain death. These programs are also available to remove and preserve donor organs for trans-plantation. Each regional program has up-to-date infor-mation on the need for extrarenal donors at centers per-forming heart. heart~lungI liver, and pancreas transplants through a nationwide organ-sharing system. Cooperation between surgical teams from geographically distant cen-ters in procuring multiple solid organs is now'"a routine experience (9). At our center 70% of over 200 extrarenal . organs transplanted have been recovered with the help of procurement teams 100 to 1500 miles distant from Pius-burgb. .' . . ' The participation of physicians attendin& victims of to-tal, irreparable destruction of brain function is critical to facilitate postmortem dO!lation and recovery of Qrgans. They should consider contacting their local organ-pro-curement team for information and assistance. Physicians unsure of how to reach the nearest procurement program can quickly secure . this information by- calling 800-24-DONOR (800-243-6667). a nationwide transplant hot-line operated by the North American Tra!"\splant Coordi-nators Organization (NATCO). Staffed by procuremetH personnel at the University of Pittsburgh. the NATCO 24-DONOR center can also proVide information abo the need for extrarenal organs at major centers in t~ United States and Canada. (DAVID H. VAN TI-II£l, M.D.; THOMAS E. STARZL, M.D.; and DONALD W. a£~ NY, M.S.W.; University of Pittsburgh, Pittsburgh. Pe1llJ: sylvania) REFERENCES REITZ BA. STINSON EB. Cardiac Iransplantalion-1982 , ... ,., 1982;248: 1225-7. .. 2. GRIFFITH BP. HARDESTY RL. DEED GM. STARZL TE. BAHNSON ftt Cardiac transplant allan With cyclosporin A and prednisone. Ann.sw, 1982;196:324-9. 3. STARZL TE. !WATSUKI S. VAN THIEL DH. et a\. Evalualion 0( Ihw transplantation. Hepll/ology. 1982;2:614-36. . 4. VAN THIEL DH. ScHADE RR. STARZL TE, eI sl. Li"er transplantlliaa adults. Heplltology. 1982;2:637-40. .. 5. GUrTMAN RD. Renal transplantation. N Engl J Med. 1979;301:IOll-4I 6. REITZ BA. WALlWORK JL. HUNT SA. PENNOCK JL. Hean.1un, I,. plantation: successful therapy for patients with pu1~onory vuculat .. ease. N Engl J Med. 1982;306:557-64. - . 7. SUTHERLAND DER. GOETZ FC. RYNASIEW1CZ 11. et a\. Segmenlal creas transplantation from h"ing related and cada"eric dono,,; • o!: ~xperi~nceK Surgery. 1981 ;90: 1 59-69. 8. Transcript of Hearings on Procurement and Distribution or Hu",. Qo,. gans for Transplantation !kfore the Subcomittee on lnyesti~Ktioat _ Oversight. Committee on Science and Technology. U.S. Houw: 0( -... sentalives. 13. 14. 27 April 1983. . 9. SHAW BW JR. HAKALA T. ROSENTHAL JT. IWAl'SUKI S. BIOZNICa l STARZL TE. Combination donor hepatectomy and n<:phrcctomy 1IId_ Iy functional results of allografts. Slug GynecoJ Obstet. 1982;155-.321_1 -;11983 American_College of Physicians Reprint of Annotated Bibliographies and library for Internists IV A COLLECTIVE reprint containing the 14 annotated ... liographies compiled for the Medical Knowledle Assessment Program (MKSAP) VI. three other anlU •. ed bibliographies on topics also of interest to tntm_ and The Library for Internists IV is now ava'I"U-' In compiling the MKSAP bibliographies. ... ......... committees reviewed MEDLINE printouts of ticles published since 1978 and drew on be available in medical libraries in the United Canada. Most of the bibliographies in each :lUtllllPl .. area contain about 100 citations to original papers and similar sources that repres~nt mr~rfK velopl1)ents in the concept and practice of intcmat . cine. The other annotated bibliographies included reprint were published in the journal in 1982 and are not part of the MKSAP pr.ogram: medical illness and pregnancy, eduCation medicine, and clinical research methM9sKqh~ Internists IV lists 150 books and SO journals ed by the American College of Physicians as a . a small personal o.r hospital library; the book annotated. Subjects covered in qh~ Library eral internar medicine, the 14 areas rn'veI'" . MKSAP prograI!l. and 23 other disciplines medical science .. Detaits for ordering the collected reprint page 424 of this issue. We believe these raphies and lists will Jlid those seeking to k~ developments in internal medicine and to budd of current Iiterature.-The Editor. 408 September 1983 • Annals of. Internal Medicine. Volume 99 • Number 3 

Postmortem organ procurement for transplantation.

http://d-scholarship.pitt.edu/3915/1/31735062114958.pdf

Postmortem organ procurement for transplantation.

Abstract

Similar works

Full text

Available Versions

D-Scholarship@Pitt