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PubMed1990

Is altruism enough? Required request and the donation of cadaver organs and tissues in the United States.

The lack of an adequate supply of cadaver organs and tissues for transplantation to those in need poses a major challenge to the transplant community and to those responsible for public policy. Historically, Americans have relied upon a combination of altruism and voluntarism to generate an adequate supply of cadaver organs and tissues. The ongoing shortage of organs and tissues has led, in recent years, for calls to abandon these values in favor of either a market system or a system of presumed consent. A survey of the impact of the federal and state laws that require that requests be made to next of kin for organ and tissue donation when a death occurs in a hospital setting shows that inadequate efforts have been made to implement these laws. Before abandoning altruism and voluntarism, health care professionals must insist that zealous efforts in education, enforcement, and coordination be made to implement these new laws and regulations.

Altruism↗

PubMed1990

The association of cyclosporine with the 1-year costs of cadaver-donor kidney transplants.

Cyclosporine is associated with lower hospitalization costs for transplantation of cadaver kidneys. Whether this cost-lowering effect persists after discharge was assessed for 203 patients who received cadaver kidneys at the University of California, San Francisco, between July 1982 and June 1986. During the transplantation hospitalization period, cyclosporine was associated with significantly better graft survival (88.7% vs 71.0%) and lower (standardized) costs ($37,174 vs $52,983). Following discharge, however, there were no significant differences in graft survival, total charges ($29,716 vs $34,434), the number of readmissions, the total number of days hospitalized, or physician charges, although cyclosporine was associated with higher drug costs ($3885 vs $373). The results suggest that the initial association of cyclosporine with lower costs diminished substantially over time. For grafts that survive beyond several months, there may be little additional cost-reducing benefits of cyclosporine.

Adolescent↗

PubMed1989

[Histological study on the ossification of the yellow ligament in the thoracolumbar spines of the cadavers. Especially on the early stage of the ossification].

The occurrence process of ossification of the yellow ligament (OYL) was studied radiographically and histologically by using the thoracolumbar spines of the cadavers taken out as en bloc. The subjects were from 44 to 89 years at age (average 66.1 years). After taking roentgenographs, the specimens were sectioned sagittally for histological observations with H-E stain, elastica.van-Gieson stain, safranin-O stain and alcian blue stain. The findings were as follows. 1. Roentgenographically, OYL was evidently found in 6 cases with average age of 71.5 years, while not found in 4 cases with average age of 58.0 years. OYL was more frequently recognized in elderly cadavers. This fact is presumed to be one of the physiological aging processes. 2. Histologically, ossification was found to start in the superior margin of the lamina. Ligament fibers of the yellow ligament attached to the bone tissue piercing through the uncalcified cartilage zone, tide mark and calcified cartilage zone in order. This structure is called enthesis. In the early stage of ossification, cartilage zone became wide being followed by endochondral ossification. Elastic fibers in the cartilage zone became sparse and fine granular calcification was focally found in the uncalcified cartilage zone. Then, these changes also occurred in the ligamentous attachment of the superior lamina, but they were more evident in the superior margin of the inferior lamina. 3. In the advanced stage of ossification, there were a widening of tide mark and an increase of chondrocytes in number. Linear calcified deposits were observed along the ligamentous fibers. Elastic fibers were reduced in the cartilage zone, enlarged and deranged.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Cadaver kidney retrieval for transplantation in Canterbury and Westland: 1972-1987.

In Canterbury and Westland, 106 cadaver kidney donors have provided 186 kidneys, which have been transplanted or submitted for transplantation. The overall rate of 16 donor/million population/year, since 1973, is high by international standards [1,2]. Male donors (68%) had a median age of 20 years, and females a median age of 24 years. Motor vehicle accidents were responsible for 58% of deaths, followed by subarachnoid haemorrhage (15%). Cadaver nephrectomy was performed outside normal working hours in 58% of cases. Overall, 10% of kidneys removed were discarded, but none have been discarded since September 1980. Anatomical anomalies were common (42%).

Adolescent↗

PubMed1987

Survival of sub-optimal cadaver renal grafts with prolonged cold ischaemic times using cyclosporin.

Between September 1983 and December 1985, 33 cadaver kidneys with prolonged ischaemic times (mean 47.3 +/- 11.0 h), and frequently in problematic conditions, were received from Europe and transplanted into adults (16 male, 12 female, mean age 34 +/- 11 years) and children (2 male, 3 female, mean age 8.8 +/- 4.0 years), using cyclosporin (CsA) and steroid immunosuppression. Six patients have died (three with functioning grafts) and 12 grafts have been lost. Eighteen grafts remain functioning, with a mean survival of 27 months. The 1 year actuarial patient and graft survivals were 82% and 69% respectively. The mean time to cessation of haemodialysis was 17 +/- 10 days, and to stable graft function was 28 +/- 11 days. At 3 months (27 patients) mean serum creatinine was 191 +/- 88 mumol/l (2.16 +/- 1.0 mg/dl), with a mean CsA dose of 6.7 +/- 2.2 mg/kg per day. There was an association between the immediate post-transplant renographic perfusion index and the serum creatinine at 3 months (r = 0.52, P less than 0.01). At no stage did the serum creatinine correlate with CsA dose or length of ischaemic time. These results demonstrate that despite suboptimal conditions, prolonged cold ischaemic times, and periods of oliguria, cadaver kidney transplants may be managed successfully with CsA and low-dose steroids.

Actuarial Analysis↗

PubMed1987

A multifactorial system for equitable selection of cadaver kidney recipients.

During 1986, a total of 270 cadaver renal transplantations were performed at the University of Pittsburgh. Kidneys were allocated by a point system that awarded points to recipients for waiting time, antigen matching, antibody analyses, medical urgency, and logistic practicality. Kidneys were given to patients with the highest point totals in 98% of cases. To our knowledge, this is the first such multifactorial system for cadaver kidney allocation. Possibly it may be modified for extrarenal organs.

Adolescent↗

PubMed1986

Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation.

Over a 7-year period the authors studied the vascular and ureteric anomalies of kidneys procured from brain dead, heart-beating cadavers for the purposes of transplantation. Four hundred donors had a bilateral nephroureterectomy performed using an en-bloc technique, followed by fine anatomical dissection in cold saline slush solution. Thus, 800 kidneys were available for study. Single renal arteries were found in 72 per cent of the kidneys, with multiple arteries occurring in 28 per cent. The renal veins showed a more uniform anatomical pattern and were single in 92 per cent of instances. There were nine ureteral anomalies, all duplications, being just 1 per cent of the total number studied. Sex, race, and blood group of the donor did not significantly influence the number of anomalies seen. In sum, anatomical variants were noted in 197 (49.3%) donors, 69 (17.3%) with bilateral anomalies and 128 (32.0%) with unilateral anomalies. A knowledge of these anatomical variants will allow surgeons responsible for organ procurement to proceed with caution and so prevent wastage of cadaver kidneys due to technical misadventures.

Adolescent↗

PubMed1978

Primary cadaver kidney transplantation in older patients: survival equal to dialysis.

In our experience, primary cadaver kidney transplantation is a reasonable alternative to dialysis in the older patient with ESRD. The probability for a transplant success is no different from that of other age groups receiving their first grafts from cadaver donors and the quality of life after transplantation is equal to or exceeds that obtained with chronic dialysis.

Aging↗

PubMedDate not supplied

Major factors affecting cadaver renal transplant outcome in a single center.

In this center, 3 major factors have favorably improved cadaver renal allograft survival rates. The good risk recipient has been associated with a better graft survival and lower mortality. This factor cannot easily be controlled because of an increasing percentage of poor risk recipients awaiting transplantation in most major centers. Recipient blood transfusions administered both before transplantation and at the operating table have led to a better allograft survival in our center. Cadaver donor genotyping with haplotype matching of donor-recipient pairs has resulted in an improved graft survival. As sharing of kidneys between centers becomes more common, it is encouraging to note that one method of preservation is not superior to the other.

Blood Transfusion↗

PubMed1979

Results of retransplantation in individuals who received two successive cadaver kidneys.

At the Royal Victoria Hospital in Montreal, 22 patients received two successive cadaver renal transplants. The results were analysed to determine which factors have the best predictive value for success or failure in renal retransplantation. The fate of a second cadaver renal allograft was found to be about the same as the first if the initial transplant has been lost because of rejection and not technical failure. The duration of survival of the initial transplant serves as the best guide to potential outcome of retransplantation after rejection of the initial graft.

Adolescent↗

PubMed1980

Female cadaver in the Han Tomb No. 1. X-ray diffraction studies on two kinds of fibrous protein.

The molecular structures of both native and false hairs as well as the tendon of the female cadaver buried about 2,100 years ago, which was excavated from the Han Tomb, No. 1 at Mawangdui near Changsha, Human Province, China, have been studied with X-ray fiber diffraction. It has been shown that the conformations of alpha-keratin and collagen and the basic longitudinal period of these fibrous protein molecular chains have been preserved in those specimens respectively, but the aggregations of fibrous molecules have somewhat changed. Some exploration was made on the origin where came the cubic mercury sulphide inside the cadaver's hair.

Cadaver↗

PubMed1982

Accelerated mixed lymphocyte culture test potentially useful for cadaver organ transplantation.

The mixed lymphocyte culture (MLC) test accurately predicts the strength of rejection of transplanted organs. Ironically, the MLC test can seldom be used in cadaver organ transplantation, where it would be most useful, because the test takes 4 to 6 days to get results. We have developed an accelerated MLC test using precultured cells, which gives interpretable results in 24-48 hr. Precultured cells become responsive to T cell growth factor, reflecting the generation of lymphoblasts during preculture. When 7 consecutive pairs of subjects were compared in the fast and conventional MLC tests, the response at 48 hr in the fast MLC was significantly correlated with the response in the conventional MLC test on days 5 and 6 (P less than 0.01). Precultured cells can be frozen in liquid nitrogen without loss of accelerated responsiveness and significant proliferation is also observed within 24 to 48 hr using frozen cultured cells. Thus, preliminary culture followed by cryopreservation provides the basis for a clinically useful fast MLC test for cadaver organ transplantation.

Animals↗

PubMed1982

Blood transfusions before and on the day of transplantation: effects on cadaver graft survival.

Pre-BTs significantly improve the survival rate for first cadaver transplants, by a mechanism that remains obscure. The maximal influence is seen with smaller numbers of pre-BTs (1-5 units), but is also observed with larger numbers of pre-BTs. The possible beneficial influence of Tx-BTs on graft survival is not proven, and if it exists at all is not nearly as striking as the effect seen with pre-BTs. Tx-BTs neither potentiate nor nullify the benefit of pre-BTs on graft survival. It is therefore recommended that pre-BTs in smaller numbers, such as 1-5 units, be administered to candidates for first cadaver transplants to increase the probability of a successful outcome. Tx-BTs should be utilized when clinically indicated but not with the expectation that they will necessarily improve graft survival.

Antilymphocyte Serum↗

PubMed1982

Necropsy of a cadaver containing 50 mCi of sodium131 iodide.

A patient who received an oral dose of iodine-131 for the treatment of metastatic thyroid carcinoma unexpectedly died with a large total-body retention of the radioiodine. An autopsy was required and the family requested the body to be transported out of state to their home town. Since the radiation intensity near the surface of the cadaver was above 200 mR/hr, advanced planning and special precautions were necessary in order for the autopsy to proceed safely. This required the immediate cooperation of the pathologists, nuclear medicine physicians, health physicists, an endocrine oncologist, and other hospital staff. As a result of team efforts, personnel radiation exposures were kept as low as reasonably achievable, contamination of the autopsy room was minimal, and the radiation level of the cadaver was adequately reduced for safe transport and burial.

Adult↗

PubMed1981

Cadaver nerve allografts in dogs.

Cadaver nerve allografts were studied in major histocompatibility complex-identical beagle donor/recipient combinations. Grafts were removed 3 and 6 hours after the death of the donor, preserved at -70 degrees C and transplanted as 7 cm long grafts at a later date. Graft function and histology was evaluated 9 to 11 months after transplantation by electromyographic examination and histological studies, respectively. Cadaver nerve allografts removed 3 and 6 hours after death show exactly the same excellent regeneration as the freshly removed cryopreserved nerve allografts in major histocompatibility complex identical combinations. This information is of value for future attempts to establish nerve banks of a many as possible different major histocompatibility types. Such banks will be required to accommodate the necessary donor/recipient matching for clinical nerve allografting.

Animals↗

PubMed1994

Renal transplantation from cadaver donors over 60 years old.

The influence of donor age on the short- and long-term outcome of cadaveric kidney transplantation was analyzed at our institution. During a 6-year period, 34 and 806 patients underwent kidney transplantation from cadaver donors over or less than age 60, respectively. Graft and patient survivals were compared throughout follow-up and herewith reported. In addition, main medical and surgical complications among recipients of elderly cadaver donors are detailed.

Adult↗

PubMed1995

Hemoconcentration prior to serology testing in hemodiluted cadaver bone and tissue donors.

Concern about false negative serology tests for infectious diseases in hemodiluted cadaver donors resulted in issuance of new regulations and guidelines from the FDA and CDC. Bone or tissue from donors receiving > or = 4 units of blood, blood products, colloids or crystalloids within 48 h of sampling must be quarantined unless: (a) a pretransfusion serum is available; or (b) an adequate algorithm is employed to ensure hemodilution is insufficient to alter test results, i.e. cause false negatives. Left undefined in these regulations is, what is an adequate algorithm and what amount of hemodilution would cause false negatives. A pretransfusion sample was not available for about 20% of our donors and many had incomplete infusion histories. We used the unambiguous quantitation of serum albumin and total protein to define hemodilution and, if present, hemoconcentration of sera by ultrafiltration to normal protein levels prior to serology testing. Control experiments showed excellent correlation between serum dilution and protein concentration (r > 0.99) and a quantitative recovery of 96.9 +/- 1.4% upon hemoconcentration. Known positive sera (CMV-Ab; HTLV-1Ab; HIV-1,2Ab; HBsAb; HCV-Ab; HBsAg) were spiked into normal sera and diluted up to 1:2000, well beyond detectable levels. A qualitative recovery of 100% and a quantitative recovery of 97.6 +/- 7.5% of antibody or antigen reactivity was achieved upon hemoconcentration and retesting. In two studies, 14% (30/210) and 43% (23/54) of cadaver donors had serum proteins below normal limits and their sera was hemoconcentrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Algorithms↗

PubMedDate not supplied

Gonioscopic ab interno Nd:YLF laser sclerostomy in human cadaver eyes.

We explored the potential of the picosecond Nd:YLF laser to perform gonioscopic ab interno sclerostomy in human cadaver eyes. Full-thickness sclerostomies were created in 12 such eyes and confirmed by external scleral and histopathologic examination. Optimum parameters for successful completion of a sclerostomy were: a rectangular pattern of 0.3 mm by 0.3 mm, a repetition rate of 1000 pulses per second, an energy-per-pulse of 400 mJ, and a spot separation between 10 and 50 microns, with no focal offset. The Nd:YLF laser reliably created successful gonioscopic sclerostomies with minimal adjacent thermal damage in human cadaver eyes.

Cadaver↗