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At least 19 recordsLinked to original sources
PubMed1990

Impact of an organ donor and tissue donor advocacy program on community hospitals.

A crucial shortage of organ donors exists in the United States. The majority of donor referrals come from large (greater than 500) beds) hospitals and trauma centers. To determine whether a significant number of donors who are not being recognized or referred also existed in medium-sized (300 beds) community hospitals, a Donor Advocacy Program was instituted at Francis Scott Key Medical Center in May 1987. This team developed policies and procedures to identify potential donors and conducted educational programs for physicians and nurses. A designated "Donor Advocate" made daily rounds on the inpatient units to maintain donor awareness and facilitate potential donations. After the first year, the program was evaluated. In comparison to the average of the previous three years, donor referrals increased by approximately 400 per cent and tissue donations increased over 500 per cent. Four organs were retrieved from two donors. It is concluded that an increase in referrals and tissue donations can be achieved at community hospitals through a structured donor awareness program. Recommendations are made to further examine the age group most often eligible for organ and tissue donations in community hospitals and target educational efforts accordingly. Commitment of hospital administration is vital to a positive outcome in such a program.

Baltimore↗
PubMed1996

Tolerance to rat liver allografts: IV. Acceptance depends on the quantity of donor tissue and on donor leukocytes.

Liver allografts in some rat strains are often spontaneously accepted across a complete major histocompatibility barrier without the requirement for immunosuppression while other nonliver allografts are rejected. In previous studies, we have shown that spontaneous acceptance is dependent on liver passenger leukocytes. Depletion of passenger leukocytes by donor irradiation allows rejection, with DA recipients of irradiated PVG livers having a median survival time (MST) of 16 days. Here we show that, in this model, spontaneous acceptance is reconstituted by intravenous injection of donor leukocytes. Intravenous injection of 3-5x10(7) PVG liver leukocytes significantly prolonged DA survival time (MST=96 days, P=0.026), as did 5x10(7) spleen leukocytes (MST>100 days, P=0.002). Deletion of T cells from the reconstituting inoculum reduced survival time (MST=78 days, P=0.039), whereas deletion of B cells or monocytes/macrophages had no effect on survival time. In contrast, PVG hearts are regularly rejected by DA recipients, and PVG liver or spleen leukocytes, even at doses of greater than 3x10(8) cells/recipient, were unable to induce heart acceptance. To investigate the possibility that acceptance of the irradiated liver but not the heart might be due to the large mass of the liver, two kidneys and two hearts of PVG origin were transplanted to each DA recipient together with 1.5x10(8) PVG leukocytes. These organs survived for greater than 200 days, thereby showing that a large mass of donor tissue, in association with donor leukocytes, leads to acceptance of organs that are rejected if transplanted singly. It appears likely that spontaneous liver transplant tolerance is a high-dose or activation-associated immune phenomenon.

Animals↗
PubMed1999

[The application of external skin expansion in the soft tissue donor site].

OBJECTIVE: To overcome the insufficiency of donor tissue for repairing a large postburn defect. METHODS: The donor site was pre-expanded with an external expansion device in 54 clinical cases. RESULTS: The expansion process was uneventful. The external expansion had delay effect that enabled the flap to be transferred with greater length to width ratio. After external expansion, the donor site of a flap or skin graft could be closed directly. The recipient and donor sites healed simultaneously. CONCLUSION: External expansion is a practical method to provide 'extra' skin for reconstruction of a large skin defect.

Adolescent↗
PubMed1998

Bone allograft contamination in multiorgan and tissue donors.

Multiorgan and tissue donors offer a larger quantity and high quality of bone allograft that cannot be obtained from living donors. The risk of bone contamination must be borne in mind if secondary sterilization is not performed. The bacteriological cultures of 270 bone segments obtained from 53 multiorgan or tissue donors were analysed to study the relationship between previous organ and tissue procurements and bone retrieval contamination. We concluded that no significant differences in bacterial contamination percentage were found for each type of previous organ and tissue procurement, nor in the number of teams per donor.

Animals↗
PubMed2005

Bacterial contamination of tissue allografts - experiences of the donor tissue bank of Victoria.

The aim of this study is to report the experience of the Donor Tissue Bank of Victoria with bacteria isolated from musculoskeletal, skin and cardiac allografts retrieved from cadaveric donors. The results of all quality control samples for bacterial culture, taken during retrieval and processing of allografts at the DTBV for a 12 month period, were extracted and analysed. It was found that 15.7% of skin, 15.1% of heart valves and 5.8% of musculoskeletal samples had positive culture results. The number and types of organisms isolated varied with tissue type. The most commonly isolated organisms were Staphylococcus species (including S. aureus). The identity of the isolate and the number of positive specimens from the same donor were considerations in the decision concerning the suitability of tissue for subsequent implantation.

Australia↗
PubMed2006

Descemet's stripping with endothelial keratoplasty: comparative outcomes with microkeratome-dissected and manually dissected donor tissue.

PURPOSE: To compare outcomes with 2 donor dissection methods for Descemet's stripping with endothelial keratoplasty (DSEK). DESIGN: Retrospective, comparative, nonrandomized case series. PARTICIPANTS: Three hundred thirty consecutive transplants, 114 with manually dissected and 216 with microkeratome-dissected donor tissue. METHODS: Donor posterior stroma/endothelium was transplanted, after stripping recipient Descemet's membrane/endothelium and dissecting the donor tissue by hand or with a microkeratome. MAIN OUTCOME MEASURES: Incidences of donor perforation and donor detachment were compared for all eyes. Visual and refractive outcomes were compared for the first 100 consecutive eyes in each group. RESULTS: Visual recovery was faster with microkeratome-dissected donor tissue, as evidenced by statistically better best spectacle-corrected visual acuity (VA) in that group 1 month after surgery (P = 0.015). Best spectacle-corrected VA was statistically comparable for the 2 groups preoperatively and 3 and 6 months postoperatively. Best spectacle-corrected VA was not correlated significantly with postoperative central corneal thickness (P = 0.25). Corneal thickness was significantly higher in the microkeratome group (690+/-77 mum, compared with 610+/-62 mum after hand dissection; P<0.0001). Mean refractive astigmatism was 1.5 diopters (D) preoperatively and 6 months postoperatively in both groups. Spherical equivalent refraction did not change in the microkeratome group (P = 0.64) but increased by 0.66 D in the hand dissection group (P = 0.0007). Methods designed to remove fluid from the donor/recipient graft interface ultimately reduced the detachment rate to <1% (1 in the last 140 cases). No donor perforations occurred in 216 microkeratome dissections, compared with 5 in 114 hand dissections (P = 0.002). CONCLUSIONS: Microkeratome dissection reduced the risk of donor tissue perforation, provided faster visual recovery after DSEK, and did not alter the refractive outcome.

Aged↗
PubMed1996

A new scleral suction trephine for retrieval of corneoscleral donor tissue.

BACKGROUND: Removal of donor corneo-scleral shell from a cadaver, leaving the remainder of the eye in place, has become a popular technique. Manual removal can result in excessive trauma to the corneal endothelium or an uneven scleral rim. METHODS: We describe a new technique for corneal retrieval using a sceral suction trephine. RESULTS: The scleral suction trephine was cut evenly in our eyebank study. There was no additional trauma to the endothelium and the scleral rim was regular. CONCLUSION: Suction trephination of the sclera in retrieval of corneal donor tissue appears to be safe and effective.

Aged↗
PubMed2004

Probability of viremia with HBV, HCV, HIV, and HTLV among tissue donors in the United States.

BACKGROUND: Tissue-banking organizations in the United States have introduced various review and testing procedures to reduce the risk of the transmission of viral infections from tissue grafts. We estimated the current probability of undetected viremia with hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T-lymphotropic virus (HTLV) among tissue donors. METHODS: Rates of prevalence of hepatitis B surface antigen (HBsAg) and antibodies against HIV (anti-HIV), HCV (anti-HCV), and HTLV (anti-HTLV) were determined among 11,391 donors to five tissue banks in the United States. The data were compared with those of first-time blood donors in order to generate estimated incidence rates among tissue donors. The probability of viremia undetected by screening at the time of tissue donation was estimated on the basis of the incidence estimates and the window periods for these infections. RESULTS: The prevalence of confirmed positive tests among tissue donors was 0.093 percent for anti-HIV, 0.229 percent for HBsAg, 1.091 percent for anti-HCV, and 0.068 percent for anti-HTLV. The incidence rates were estimated to be 30.118, 18.325, 12.380, and 5.586 per 100,000 person-years, respectively. The estimated probability of viremia at the time of donation was 1 in 55,000, 1 in 34,000, 1 in 42,000, and 1 in 128,000, respectively. CONCLUSIONS: The prevalence rates of HBV, HCV, HIV, and HTLV infections are lower among tissue donors than in the general population. However, the estimated probability of undetected viremia at the time of tissue donation is higher among tissue donors than among first-time blood donors. The addition of nucleic acid-amplification testing to the screening of tissue donors should reduce the risk of these infections among recipients of donated tissues.

Adult↗
PubMed2000

Grafting of neural tissue in chronically injured spinal cord: influence of the donor tissue on regenerative activity.

BACKGROUND: To determine the influence of different nervous tissue grafts on the regenerative activity of chronically injured spinal cord, an experimental study examining the expression of the proliferating cell nuclear antigen (PCNA) in chronically injured spinal cord subjected to neural grafting was performed. METHODS: Three months after induced spinal cord injury, paraplegic Wistar rats were subjected to grafting of neural tissue. Grafts consisted of fetal brain cortex, fetal spinal cord, crushed adult peripheral nerve tissue, or fetal brain cortex combined with crushed adult peripheral nerve tissue. Four months later, the spinal cord was removed and the grafted zone was studied by means of immunohistochemical demonstration of PCNA. RESULTS: Different patterns of PCNA expression were recorded in the different experimental groups. PCNA-immunostained cells in injured spinal cord tissue, mainly ependymal cells and astrocytes, increased when co-transplantation of fetal brain cortex and crushed adult peripheral nerve tissue was used, in comparison to other neural donor tissues. In the grafted tissue, proliferative activity was greater when fetal brain cortex, alone or with peripheral nerve, was used, in comparison to the use of fetal spinal cord or adult peripheral nerve tissue. Nevertheless, the number of PCNA-positive cells does not seem to be influenced by the presence of peripheral nerve tissue in the donor tissue. CONCLUSIONS: Our present findings suggest the effectiveness of co-transplantation of peripheral nerve tissue and fetal brain tissue in attempts at spinal cord reconstruction after injury.

Animals↗
PubMedDate not supplied

HIV and hepatitis C virus RNA in seronegative organ and tissue donors.

The objective of our study was to determine whether nucleic acid testing could detect HIV RNA or hepatitis C virus (HCV) RNA in a large series of seronegative organ and tissue donors, and whether this technique should be routinely used to improve viral safety of grafts. We studied 2236 organ donors, 636 tissue donors, and 177 cornea donors. We identified five HCV RNA-positive donors in 2119 HCV-seronegative organ donors, and one HCV RNA-positive donor in 631 HCV-seronegative tissue donors. No HIV-seronegative, HIV RNA-positive donor was identified. Our data suggest that routine nucleic acid testing of organ and tissue donors might increase viral safety in transplantation.

HIV↗
PubMed1999

Evaluation of prior photorefractive keratectomy in donor tissue.

PURPOSE: To describe a case in which an eye donor had prior bilateral photorefractive keratectomies and to elucidate possible methods of evaluation and screening of donor tissue. METHODS: Case report. A 62-year-old eye donor was reported to have received radial keratotomy before his death. Further investigation by the eye bank showed a history of photorefractive keratectomy (PRK), not radial keratotomy. The corneas were therefore not used for transplantation, and the eyes were evaluated by slit-lamp examination, photography, corneal topography, and histology. RESULTS: Slit-lamp and photographic examination did not indicate the presence of PRK ablations. Corneal topography mapping with the TMS-1 was relatively ambiguous for identifying PRK flattening, while multiple data formatting of the cornea with the Orbscan resulted in the strongest suggestion of prior PRK. Histologic analysis showed central corneal thinning and loss of Bowman's membrane consistent with PRK. CONCLUSIONS: In the absence of a positive donor history for PRK, current methods of screening donor tissue for prior PRK often are insufficient to exclude these corneas from use in transplantation. More refined placido imagery corneal topography or newer technologies such as the Orbscan may allow more sensitive and specific methods of donor tissue screening.

Contraindications↗
PubMed2005

Challenges in the testing of non-heart-beating cadavers for viral markers: implications for the safety of tissue donors.

Natural changes that occur in blood and tissue after death may result in false positive results in antigen and antibody detection tests performed to identify markers of viral infection in potential tissue donors. Such tissue, which might otherwise be acceptable for therapeutic purposes, would not meet current standards for safe tissue banking. This is especially important in the context of insufficiency in the tissue supply. In this study, a series of blood samples collected during routine post-mortem examination was assayed using a range of commercially available kits for the detection of HBsAg, anti-HCV and anti-HIV 1 + 2 antibody/antigen. Results of tests on 104 samples collected from 97 individuals indicate that some kits result in a higher number of initial reactive samples than others. Approximately 40% of samples were reactive in one or more HBsAg assay, less than 10% in at least one anti-HIV kit and only 1 sample at low level on an anti-HCV kit. Liver or lymph node samples from individuals whose serum sample gave reactive results in antigen/antibody assays were tested for viral nucleic acid in the corresponding nucleic acid amplification test. Only one individual's sample was confirmed to test positive for HBsAg in a confirmatory neutralisation test and by nucleic acid amplification technology, and a second individual whose serum was scored reactive for anti-HCV, but negative for HBsAg, had a liver sample which was HBV DNA positive and HCV RNA negative. The results of the study indicate that antibody/antigen assays are not as specific as NAT using state of the art DNA extraction techniques. Both types of assay complement each other and used together will help assure the safety of tissues for transplantation.

Biomarkers↗