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The aim of this cadaver study was to evaluate the possibility of using the zygomatic bone as an intraoral bone harvesting donor site and to determine the safety of this harvesting procedure. In addition, the volume of bone material harvested from the zygomatic bone was measured. Twenty fixed adult cadavers were used to yield a total of 40 zygomatic bone harvest sites, from which bone was collected. The volume of bone obtained from the zygomatic harvests was measured with a water displacement method and by compressing the graft into a syringe. The safety of the technique was evaluated by assessing possible encroachment upon the neighbouring structures. After bone harvesting, the zygomatic sites were exposed and evaluated for visible perforations or fractures. Possible damage to the neighbouring tissues was also examined with computed tomography scans at 18 sites in nine cadavers. The average bone graft volume obtained from the zygomatic bone was measured to be 0.53 ml (SD 0.25) with water displacement and 0.59 ml (SD 0.26) with the syringe. The complications in the zygoma included 15 small perforations into the maxillary sinus and 7 perforations into the infratemporal fossa. CT scans showed that bone could be harvested safely without encroaching upon the orbital floor or the surrounding nerves and vessels in the zygoma. The zygomatic bone is a safe intraoral donor site for the reconstruction of small- to medium-sized alveolar defects.

Publisher Summary The movement (or dispersal) of propagules among suitable patches of habitats is an essential ingredient of metapopulation dynamics. At the birth of the metapopulation concept, only colonization was considered (i.e., movement to empty patches). However, all patches within a metapopulation are, to some extent, exchanging individuals due to dispersal, even those that are already occupied. This phenomenon leads to a re-enforcement of the extant local populations (the rescue effect). This chapter focuses on condition-dependent dispersal because it is important to take condition dependence into account to make realistic predictions about the dispersal evolution and its consequences. In more recent developments of metapopulation theory, dispersal has been considered to be a function of the density in the patch of departure and other features such as the patch size and the distance between patches. In addition to these attempts, dispersal was largely considered to be unconditional of the status of the individual, the potential donor, and recipient patches, as well as the matrix between patches.

Summary In the State of Indiana, blood donors are screened by a written questionnaire prior to donation to identify potential exposures to infectious diseases and to assess medications. The potential donor is not asked about aPL-related events. Animal experiments have shown, however, that passive transfer of aPL can produce aPL-associated pathology in the recipient. We determined the incidence of antiphospholipid antibodies (aPL) in 775 volunteer blood donors in Indiana. Tubing segments containing 2 ml of anticoagulated blood were obtained from donor units. The average donor age was 43 years (range 17 – 82); 45% were female. Our in-house aPL ELISA tested for IgG, IgA and IgM to cardiolipin (aCL), phosphatidylserine (aPS), phosphatidylethanolamine (aPE) and phosphatidylcholine (aPC). The plasmas were tested with and without supplemental phospholipid (PL)-binding plasma proteins from adult bovine plasma (ABP). A total of 24 tests were performed for each donor. Normal ranges were determined for 98% of the donors by calculating multiples of the means (MoM) of OD values for each antigen-isotype combination. No decimals were used, all MoMs were rounded up to the next whole number. An additional two MoMs were added to the calculated cutoff values to eliminate borderline positive values. Results revealed that 63 (8.1%) donors had positive findings for one or more aPL. The relatively high number of aPL-positive individuals reflects the observation that different donors were often in the highest 2% of each antigen-isotype combination tested. The aPL specificities, isotypes, and PL-binding protein dependence are summarized in this report.

This article discusses the rationale behind living (related) donor liver transplantation, the role of imaging in the preoperative evaluation of the potential donor, and the currently available imaging modalities for fulfilling this task. Furthermore, the normal hepatic vascular and biliary anatomy, as seen on imaging, is reviewed and the most common anomalies are highlighted. Finally, critical concepts in the diagnostic evaluation of a donor are discussed with special emphasis on how to accurately measure liver volumes. (Liver Transpl 2003;9:S6-S14.)

HE Community of Madrid (CM), a Spanish area with more than 5 million inhabitants, has 19 authorized hospitals for organ and tissue procurement. Each hospital has a transplant coordination team (TCT) in charge of the donation process and the organ procurement. TCTs and the Regional Office for Transplant Coordination constitute the Transplant Coordination in the Community of Madrid (TCCM). As laid down in Spanish law, it is necessary to have an interview with the potential donor’s (PD) relatives to respect the deceased’s desire regarding donation. The TCCM designed a prospective multicentre study to learn the response to the organ donation requests in CM hospitals, analysing the associated circumstances such as the PD characteristics, interview aspects, and reasons argued.

Background Donors specific anti-HLA antibodies (DSA) in renal transplantation have been associated with higher incidence of graft failure. Therefore, potential living donors cells are tested against recipient serum using flow cytometric crossmatch (FCXM) to determine if the presence of DSA will cause positive FCXM. Antibody determination prior to crossmatching potential donors allows for the determination of the virtual crossmatch (VXM) as either being positive or negative. Herein, we report a case where the FCXM did not correlate at all with the VXM. Methods Pre-transplant serum was tested by solid-phase immunoassays for the presence of unacceptable antibodies. Strength of the antibody is determined from mean fluorescence intensity (MFI) cut-offs established by the laboratory. Results An initial FCXM was performed with potential donor cells and recipient serum. Based on a single DSA with MFI of Conclusion Distortion of antigen integrity may have caused the B62 from not being detected by solid phase assay. Antibody testing using solid phase methods are helpful tests but one cannot completely relay on them when trying to determine antibody status of recipients waiting for transplant.

Anti-pathogen adoptive T-cell immunotherapy has been proven to be highly effective in preventing or controlling viral infections following hematopoietic stem cell transplantation. Recent advances in manufacturing protocols allow an increased number of targeted pathogens, eliminate the need for viral transduction, broaden the potential donor pool to include pathogen-naïve sources, and reduce the time requirement for production. Early studies suggest that anti-fungal immunotherapy may also have clinical benefit. Future advances include further broadening of the pathogens that can be targeted and development of T-cells with resistance to pharmacologic immunosuppression.

Theorists have only recently shown that cooperation through indirect reciprocity can evolve. The first modelling approach favoured a mechanism called image scoring. Helping someone increases one's image score, whereas refusing to help reduces it. The evolutionary outcome was a discriminator image scoring strategy that helps everybody who has, for example, a positive image score. Two experimental studies with humans found results that were compatible with discriminator image scoring. However, a new analysis of other theorists, based on another population structure, has cast doubts on the evolutionary stability of strategies using the recipient's score as a sole basis for decision. The new theoretical study confirmed that a strategy aiming at "good standing" has superior properties and easily beats image scoring. An individual loses good standing by failing to help a recipient in good standing, whereas failing to help recipients who lack good standing does not damage the standing of a potential donor (but would reduce his image score). The present empirical study with 23 groups of seven human subjects each was designed for distinguishing between the two proposed mechanisms experimentally. The results differed strongly from standing strategies, which might demand too much working memory capacity, but were compatible with image scoring or a similar strategy to a large extent. Furthermore, donors of constant "NO players" compensated for their refusing to help these players by being more generous to others.

In Idaho, the burbot Lota lota are native only to the Kootenai River and are genetically distinct from burbot in the Montana reach of the river. Burbot once provided a substantial fishery with tens of thousands of burbot harvested annually. Burbot now number fewer than 1000 in the Kootenai River and Kootenay Lake and may be nearing demographic extinction. Studies completed in the winter of 1997-1998 indicated flow management at Libby Dam likely affected burbot spawning migration during winter. The objective of our study was to monitor the movement of burbot during a period of normal winter operation and a low flow period to test the null hypothesis (H{sub o}) that winter operation of Libby Dam does not affect burbot migration distance or travel rate. In addition, we monitored the stock status of burbot. We captured 36 burbot in Idaho and British Columbia with baited hoop nets. Twenty-three burbot were caught in Idaho, including 12 at Ambush Rock. The remaining 13 burbot were caught in British Columbia, including eight in the Kootenai River and five in the Goat River. One burbot escaped and was not measured, and one recaptured burbot was not measured. Burbot ranged from 332 mm to 705 mm total length (TL) (mean = 541 mm, SE = 14.02) and weighed from 350 g to 2,850 g (mean = 1,059 g, SE = 90.51). Relative weight (W{sub r}) ranged from 40.5 to 127.6 and averaged 88.6 (SE = 2.44). Population estimates for 1996, 1997, and 1998 were made for the Kootenai River from Bonners Ferry to Kootenay Lake; they were 738, 540, and 43 fish respectively. These estimates were not considered valid because we had so few recaptures, and confidence intervals could not be provided. Four burbot were implanted with sonic transmitters and their movement was monitored. We requested a low flow test (170 m{sup 3}/s) period of five weeks from the US Army Corps of Engineers (USACE) to study burbot migration distance or travel rate. The USACE could not provide an adequate low flow test period. Mitochondrial DNA (MtDNA) analysis indicated Duncan Lake, British Columbia burbot are genetically similar to Kootenai River fish and are a potential donor stock. The capture of eight post-spawn burbot and the subsequent examination of milt and gonadal tissue indicated they were in at least four different stages of reproductive readiness. These findings further support the hypothesis that high fluctuating flows from Libby Dam, which have continuously disrupted burbot migrations, may also be responsible for the failure of some burbot to spawn.

A 49 year old Indonesian high ranking military officer on peritoneal dialysis because of renal failure due to a congenital horseshoe kidney arrives in the United States with two blood type-identical young men — aged 23 and 25 years old — who are said to be his cousins from another Island. Neither potential donor speaks English and both carry documents stipulating that they are related to the patient. After preliminary testing, both donors are found medically acceptable with two and three antigen matches respectively (equivalent to a closely related sibling). Uneasy over the actual relationship of patient and donors, the transplant nephrologist discusses the matter with the Indonesian counsel who advises that there is no way to clarify the issue. “In our country,” he advises, “any high placed person can get whatever papers he needs.” Upset over what appears to be fakery, the senior surgical resident declines to scrub on the scheduled transplant operation.

This report describes the discovery and characterization of the human leukocyte antigen-B*4466 allele.

Introduction. Family refusal is an important factor that limits the number of organ donors. Cultural and religious factors as well as perception of brain death are the principal reasons for these refusals. We examined whether the type of potential donor, that is brain-dead or non-heart-beating, had an influence on family refusal. In July 2005, we initiated a program of non-heart-beating donors who had died in the street or at home. Materials and methods. We compared family refusals among these potential donors with those among potential brain-dead donors from July 2005 to October 2008. Results. The mean time of stay in the hospital was significantly greater for brain-dead donors than those who were non-heart-beating: 4 ± 2 versus 0.23 ± 0.01 days (P < .01). The rate of family refusals was significantly greater among the families of potential brain-dead donors, that is 24% (24/99) than non-heart-beating donors, that is, 4% (2/47; P < .01). Donor age was similar in both groups. Conclusion. The rate of family refusals among potential non-heart-beating donors was significantly lower than that among families of brain-dead individuals. Greater understanding of death because the heart is not beating, less time of uncertainty about death, and shorter hospital stay could explain this difference.

The angiograms of 258 potential kidney donors were retrospectively reviewed to assess the influence of angiography for deciding whether or not to accept the potential donor for nephrectomy and which kidney to use for transplantation. Twenty-five potential donors were rejected. In only 8 of these was angiography necessary to reveal the pathology. Angiography was found to be important in deciding which kidney to donate. In 81 donors the right kidney was used for donation and in 50 this decision was based on findings at angiography.

The need for organ transplants has increased 200% over the past decade, while the number of organ donors has remained relatively constant. The family's refusal to consent to organ donation has been cited as one of the key factors in the shortage of organs. Lack of understanding about brain death and organ donation have been identified as reasons for refusal to consent. Families of potential organ donors are receiving inadequate information to make informed choices about organ donation, and their emotional needs are not consistently met. Neuroscience nurses can improve consent rates for organ donation by effectively addressing the needs of the potential donor family and offering them the option to donate their loved one's organs.

The probability of a successful kidney transplantation decreases as the warm ischemic time in the donor prior to nephrectomy increases. Based on this statistical background a large number of potential donor kidneys, namely those that can be harvested from non-heart beating donors, is discarded. It is expected that the pool of donor organs can be considerably enlarged when an objective test will become available which can evaluate graft viability before transplantation.

Many potential donor organs are currently lost because of misunderstanding of the law. John Coggon and colleagues clarify what is permissible in non-heart-beating donation

In a recent editorial, Reese et al. (1) discussed the “ethics of accepting complex living kidney donors” ( i.e. , donors at added risk). We take exception to three of their main points. (Note that our comments refer to all potential living donors, “complex” or not.) Reese et al. (1) imply that when determining donor acceptability, the risk of donor harm should be balanced against anticipated recipient benefit. We disagree. Such a standard asks physicians to change the primary focus of their loyalty in a major and, we believe, unacceptable way. More than 20 yr ago, Levinsky (2) argued cogently that “in caring for an individual patient, the doctor must act solely as that patient’s advocate.” Physicians cannot accomplish this goal if, when trying to decide whether to recommend a procedure for one patient, they are asked to balance the risks for that person against the benefits for another. Such an approach would pose a clear conflict of interest, the recognition of which has led to the sensible recommendation that potential donors and recipients be evaluated by separate physicians (3), a position that Reese et al. support (1). How then should physicians decide whether a volunteer is acceptable? We propose that, as is true of other medical situations, for a physician to support her patient as an organ donor, she must believe that there will be benefits for her patient ( i.e. , the potential donor) that are …

Our purpose was to survey recipients in an ovum donation program and report on their expectations while waiting for their potential donor recipient match.Accepted or rejected anonymous ovum donor matches (n = 80) from January 1996 to May 1997 were evaluated. Patients generated a "wish list" of desired traits and physical characteristics. From an approved donor pool of medically and psychologically screened women, candidates were drawn upon as potential matches and presented to the potential recipient, who decided whether to accept the donor. Reasons for accepting or rejecting the donor were tallied and were compared to the patient's wish list.Medical history and race were ranked by 33 and 23% of recipient couples as the two most important characteristics, while 74 and 54% stated that these were among the three most important factors in a potential donor compared with other traits. Fifty-seven (71%) recipients accepted, while 23 (29%) rejected, the first donor presented to them. Eleven were subsequently given a second choice within 6 months, with 10 (91%) accepting the next presented match. Recipients waiting for a donor were just as likely to accept or reject a potential candidate whether waiting3 months (33%; 15/46), 3-6 months (25%; 4/16), or6 months (22%; 4/18) (P0.05; NS). In all but five recipients, the reason for rejection was consistent with their top three priorities reported in their wish list.Phenotypic, ethnic, educational, and other interests are important in the selection of an ovum donor. Recipients are proactive in their decision process, making educated and well considered decisions in spite of the limited pool and the extended time frame in waiting for an appropriate ovum donor.

Gamete donation in assisted reproduction is an accepted treatment option for certain infertile couples. Traditionally, men donating spermatozoa have been paid a nominal fee, whilst women donating oocytes have not. The issue of payment for sperm donors has recently attracted attention following the Human Fertilisation and Embryology Authority's (HFEA) suggestion that such payment may be withdrawn. Prior to the final meeting of the HFEA working party which is examining this issue, here we report the results of a survey designed to solicit opinion on whether sperm donors should be paid, to identify social or other factors which influence this opinion, and to examine the influence of financial incentive on potential donors. We surveyed 717 individuals in three distinct groups: the general public, students (potential donors), and infertility patients (potential recipients). The majority of the potential donor group (students) was in favour of paying sperm donors, as were infertility patients. In contrast the general public was not. The opinion of the general public on this issue was influenced by their prior knowledge of whether donors were paid: those of the general public favouring the payment of sperm donors had a prior awareness that such payments were made. Although not in favour of paying sperm donors, the general public overwhelmingly approved of the use of donated spermatozoa for the treatment of infertile couples, and thought that ways should be sought to increase the availability of donor spermatozoa for the treatment of infertility and for research purposes. Within the potential donor group (students), the majority indicated that financial reward was an important factor which would influence their decision to donate spermatozoa. As the majority of both the potential recipients and potential donors feels that sperm donors should be paid, perhaps the views of these groups should carry significant weight when the decision whether or not to withdraw payment is taken. This is especially the case in view of the fact that the majority of the general public is in favour of the use of donated spermatozoa for the treatment of infertile couples.

By understanding the size and characteristics of the potential donor pool, the concentration and location of the potential donors and factors influencing low rates of donation, it is possible to identify opportunities to improve the organ donation system. The exact donor gap needs to be established for each hospital/area, as published figures do not necessary reflect local potential. Nevertheless, marked differences with respect to the minimum standards in the number, location, and characteristics of organ donors should be considered as suggestive of low performance. The first stage where potential donors are lost is the detection of people who can be diagnosed as brain dead and, hence, could be considered a potential organ donor. Improving the donor identification implies the development of donor detection programmes. That and other initiatives to improve the donation rate need to be started in hospitals after the assessment of the local potential and local factors specifically implicated in the local performance.

Intensive care management changes direction at the moment that the patient is declared to be dead. Previously all therapy has been directed to achieving recovery of the patient. Suddenly all therapy is aimed at establishing the best possible function of the various potential donor organs.

To overcome the donor shortage, any potential donor resource must be detected. By establishing a professional Service for peripheral hospitals, the numbers of donors available in small hospitals could be nearly doubled: 85% of all donors in our region come from nonuniversity hospitals. By using total quality management techniques, the time requirements for organ donation after confirmation of brain-death and given consent could be reduced to 6 h.

Introduction The increasing number of immigrant residents has resulted in more foreign patients on the kidney transplant waiting list. While the willingness of their relatives to participate in a living kidney donation program is not different from that of relatives of autochthonous patients, many extra logistic and financial problems have to be solved, when the potential donor has to travel to Rotterdam. The fear of the authorities that the donor might stay in the Netherlands after donation is another hurdle. Methods and Results We analysed 395 living kidney transplantations performed in Rotterdam from 1981 to 2003. In 32 instances the donor came from abroad. Another 14 potential foreign donors came to Rotterdam but did not donate for various reasons. We calculated the costs for visa, travel, insurance, and loss of income. Total financial impact for the 46 (potential) donors, amounted to Є 56,604.09, which is Є 1768.88 per actual performed donation. One kidney donor remained illegally in the Netherlands. Conclusion We conclude that the efforts and support for foreign kidney donors to come to the Netherlands is justified and cost-effective. No evidence was found for a kidney donation immigration route.

Aim We have noted that anti-B44 (44:02) detected with LABScreen® SA beads may not result in a positive crossmatch (XM). Inclusion of B44 as an avoidance antigen could unnecessarily exclude XM-compatible donors. Therefore, we sought to develop a protocol for authenticating when anti-B44 detected by SA beads should be classified for avoidance, ie, potential donor-specific antibody (DSA). We chose to use CDC PRA, C1qScreen™, and iBeads™ assays, and XM with surrogate donors (Flow and CDC) for verifying the presence or absence of anti-B44. It was felt that multiple tests may be needed, since we would be expecting negative detection results. Methods Sera from a patient with several determinations yielding anti-B44:02 (∼5000 MFI) by LABScreen® SA beads were analyzed. The sera were Flow XM negative with a potential donor, despite the positive virtual XM. Lambda™ Antigen Trays (LAT), C1qScreen™, iBeads™ (non-denatured SA beads), and XM with surrogate donors by CDC and Flow were used for confirmation of the presence or absence of the putative anti-B44 (44:02) DSA. Results Anti-B44 was not detected using LAT. C1qScreen™ and iBeads™ assays did not detect anti-B44. CDC and Flow XM were negative with the potential donor and 3 additional surrogate donors. Taken altogether, it would appear that the detected anti-B∗44:02 antibody was directed against denatured or partially denatured antigen, not in the native conformation, as normally found on cell surfaces. Conclusions Anti-B∗44:02 antibody detected on SA beads may be directed to denatured or partially denatured antigens, which have no in vivo relevance. One must carefully scrutinize apparent anti-HLA B∗44:02 antibodies (and possibly others) for the ability to bind to HLA-antigens in their native conformation and activate complement for clinical relevance. Therefore, the CDC assay remains relevant. One must be careful in the declaration of DSA, which could result in elimination of a good potential donor with the Virtual XM.

Objective Organ and tissue transplantation has gained increased acceptance as a medical procedure. Costs for most transplantations are reimbursed by insurance companies, and the list of transplantable tissues and organs has doubled during the past 10 years. To meet this resulting increased demand, more organs and tissues need to be recovered from potential donors. The purpose of this study was to examine the relationship between emergency nurses' attitudes and their intention to ask potential donor families if they will donate their family member's organs and tissues. Methods Thirty hospitals were sent a letter inviting them to participate in this descriptive survey research design. Survey packets were sent to the 17 hospitals that responded positively to the request. Surveys contained a cover letter to the participants with directions and assurance that anonymity would be maintained. Completed surveys were returned directly to the researcher. Results We found a relationship between the nurses' attitudes and the frequency with which they approached families regarding donation. Further analysis revealed that nurses' attitudes about organ and tissue donation were related to their confidence in asking families about donation. The study also demonstrated that emergency nurses want educational programs that offer information on how to approach donor families. Discussion These results can be used to develop educational programs for emergency nurses to provide them information that can increase their confidence in asking families about donation and subsequently increase the number of families they approach regarding donation.

It remains uncertain whether xenotransplantation can sensitize the recipient to alloantigens, rendering subsequent allotransplantation unsuccessful. This is of considerable importance if a xenograft is to be used as a "bridge" to support the patient until a suitable allograft becomes available. When sera from 9 baboons that had received pig or African green monkey heart or liver xenografts were tested against a panel of lymphocytes from 5 or 6 potential donor baboons, positivity was seen in only 1 baboon (and then to only 2 of the potential 5 donors). In 4 baboons that had undergone previous xenotransplants (1 from this series of 9 baboons and 3 others), subsequent organ allografting was not followed by hyperacute, antibody-mediated, or accelerated cellular rejection. We conclude that organ xenotransplantation using discordant or concordant donor species does not prohibit subsequent allotransplantation.

The growing shortage of cadaveric organ donors remains the major obstacle to the full development of transplants. Organ and tissue transplants are probably the only sanitary field that cannot be supported solely by research and financial resources. We need the participation of the entire society to cover the most important part of the process: the donors. Without them the transplants cannot proceed. Given the enormous benefits of transplants, there exists an overriding commitment to continue the drive to increase organ donation rates. Although transplants save thousands of lives and transform the quality of life of thousands more, many people die or remain on renal replacement therapy because the organ supply falls drastically short of actual demand.

While the outcome following organ transplantation in the United Kingdom has never been better, the waiting list has never been longer and the organ shortage is now the most pressing issue. UK Transplant has invested in four initiatives to promote donor and transplant numbers: coordinating the coordinators, establishing donor liaison posts, improving living donor coordination, and encouraging non-heart-beating donation. The Potential Donor Audit to be introduced as soon as possible will clarify the likely maximum number of heart-beating donors. A major review of the legal framework covering donation and transplantation in England and Wales is currently underway. It is hoped that in due course the benefits of these initiatives will be translated into a rise in both donor and transplant numbers.

Generally, the Swiss hold favourable attitudes to organ donation, but only few carry a donor card. If no card is found on a potential donor, families have to be approached about donation. The aim of this paper is to model the role that some family communication factors play in the family decision to consent or not to organ donation by a brain dead relative. Information was gathered in face-to-face interviews, using a questionnaire and recording open answers and comments. Eight heads of intensive care units (ICU) of Swiss hospitals and one representative from Swisstransplant were interviewed. Questions asked respondents to estimate the prevalence and effect of communication factors in families facing a decision to consent to donation. Answers were averaged for modelling purposes. Modelling also relies on a previous representative population survey for cross-validation. The family of the deceased person is almost always approached about donation. Physicians perceive that prior thinking and favourable predisposition to donation are correlated and that the relatives’ predisposition is the most important factor for the consent to donation, up to the point that a negative predisposition may override an acknowledged wish of the deceased to donate. Donor cards may trigger family communication and ease the physicians’ approach to family about donation. Campaigns should encourage donate-willing people to talk to their families about it, make people think about organ donation and try to change unfavourable predispositions. Acknowledgement the authors wish to thank the interviewees whose collaboration has provided them an overview of today’s situation in Switzerland.

Apnea test is an obligatory test confirming brain death, but can also challenge the oxygenation of potential donor organs. A recruitment maneuver after the apnea test has been reported to prevent hypoxemia. We have previously reported that a recruitment maneuver before the apnea test followed by apneic oxygenation can have also beneficial effects on oxygenation; and also improve the survival time. In our study, the increase in PaCO2 has not been affected after the recruitment maneuver. A recruitment maneuver before and/or after the apnea test can be beneficial; and possible effects on CO2 elimination should also be kept in mind.

Purpose : To histologically compare the anterior branch of the medial antebrachial cutaneous nerve (MACN) with the sural nerve using biometric techniques. Patients and Methods : Twenty-centimeter segments of the right and left (MACN) and sural nerves from three cadavers were analyzed. The number of fascicles within the nerves were counted and the neural to connective tissue ratio was estimated. Results : Sural nerves consistently showed greater amounts of connective tissue between the fascicles than the MACN. Fascicle diameter varied less throughout the length of the MACN. Fascicle diameter varied less throughout the length of the MACN and it showed fewer and larger fascicles, more closely approximating the anatomy of the inferior alveolar nerve. Conclusion: These preliminary data suggest that the MACN, on anatomic grounds, is theoretically more suited for grafting to the alveolar and lingual nerves than the sural nerve.

Miniature swine have several advantages over other potential donor species as a xenograft donor for clinical use. Among these advantages are: (1) unlimited availability; (2) size (similar to human beings); (3) breeding characteristics; (4) physiologic and immunologic similarities to humans. Because of the genetic disparity between these two species, routine immunosuppression will probably not suffice for the long-term survival of pig to primate xenografts. Studies are therefore underway to induce tolerance across this species barrier, utilizing a mixed chimerism approach which has previously been successful for allogeneic and concordant xenogeneic combinations. Hyperacute rejection has been eliminated by an absorption technique and pig kidney xenograft survivals up to 13 days have been achieved.

It is well known that an agent can be hurt by accepting a gift, the donor of which is made better off. Why then does the recipient accept this welfare reducing gift? This paper examines the strategic aspects of the paradox. It shows that if the recipient refuses the gift, it would suffer an even greater loss of welfare since there is a mutually advantageous reallocation between the donor and a third agent. It is shown that the recipient does have a viable alternative strategy: it could destroy some of its endowment, raising its welfare level and reducing that of the potential donor.

Appropriate management of the brain-dead patient who is considered for multiple organ donation can be a challenging but rewarding experience. With the increasing success of all solid organ transplants, the number of potential recipients who would benefit has increased exponentially. In order to maximize the number of suitable organs, knowledgeable and careful management of the potential donor is imperative. This chapter will attempt to define the role of the caregiver, review the general management strategies, and emphasize the factors, specific to each different organ as they relate to care of the donor patient.

There are several steps on the path from potential donor toactual donor. These steps have been defined as: identifi-cation and detection of all potential donors; brain death de-termination; approaching potential donor families for con-sent; and donor medical management (1). Taking these differ-ent steps into account, transplant coordinators involved in thewhole process have designed strategies to maximize do-nation rates, with impressive results (2). Unfortunately, thesesteps and the correct methods for implementing them arenot widely practiced. As a result, cadaveric organ donationremains inadequate despite a large potential organ donorpopulation.Donor management has been considered the most ne-glected area of transplant medicine (3,4). In their article (5),Rosendale et al. state the consequences of inadequate car-diopulmonary support when the pathophysiological changesassociated with brain death occur. Failure to provide ade-quate physiological support to potential donors accounts forat least 25% of lost donor organs (6). Hypotension can occurin most potential brain dead donors (over 80%), and a highrate (25%) of cardiac arrest requiring cardiopulmonary re-suscitation has been described (7). This instability results inthe loss of organ donors and the impairment of organ viabil-ity, leading to a lack of potential suitable organs for transplan-tation.A number of papers dealing with this issue have already beenpublished (8), and actuation rules and algorithms have beenproposed (9). The adoption of an aggressive protocol for do-nor management, including both intensive monitoring andtherapy, has allowed the donor retrieval rate to increase byapproximately 30% (4). Comprehensive hemodynamic moni-toring is essential in performing an objective assessment oforgan function and to achieve optimum management (4).Several relevant aspects are discussed in the study by Rosen-dale. It has been demonstrated that brain death is often ac-companied by significant reductions in serum free thyroxine

used a prospectively collected database of 1798 recipi-ents of deceased donor livers from the eras before andafter the implementation of the Model for End-StageLiver Disease (MELD) to evaluate the effects of theMELD score on the development of biliary complica-tions. We believe that these data are important andhighlight some of the limitations of the MELD score withrespect to specific outcomes after liver transplantation.Two issues perhaps could be clarified. After theyevaluated more than 20 potential donor, recipient,and technical risk factors, Sundaram et al.

one at week 18 and the other at week 16. The week 16 ACR episode was secondary to Prograf non-adherence. All protocol RV biopsy’s were negative for C4d. There were no instances of allograft dysfunction or death. Conclusions: Sensitized heart transplant candidates can be safely and effectively transplanted without the need for a prospective XM when Luminex antibody testing and a VXM strategy are used for decision-making. In contrast to our program’s previous method of using panel reactive antibody (PRA) data to make transplant decisions, this alternative method expands the potential donor pool for a given recipient.

Organ donation offers opportunities for people in critical care units to help save the lives of other patients. It is not always easy, however, to handle the transition from treating a patient to preserving a potential donor, and organ donation consistently provokes ethical questions in critical care units. What do we expect ethics to deliver? In light of a recent ethics conference in Denmark, we suggest that by acknowledging that decisions made in the clinic rarely abide to rational decision trees with clear ethical priorities, we can better learn from each other's experiences. We suggest embracing an 'ethics of muddling through' to enhance relevant reflections and stimulate a productive dialogue among health professionals.

A randomized retrospective analysis of patients who suffered trauma-related deaths over 36 months (May 1987-April 1990) was performed to study their utilization as candidates for organ and tissue harvesting. There were a total of 108 patients: 79 males, 29 females. The average age was 46.2 years; 38 (36%) of these patients were 65 years of age or older. Over 50% of fatalities were the result of motor vehicle crashes. There were 61 potential tissue donors. Forty-three were lost without documentation of a request for organ procurement. There were 23 patients with potentially salvageable organs: one candidate was lost without documentation of a request for organ procurement. Twenty-eight (26%) of the patients had support withdrawn; 16 were 65 years old or older. Brain death protocol was instituted in 17 (20%); organs were obtained from 70% of these patients. Reasons for failure of procurement after request by a physician included family refusal in seven cases, cardiopulmonary arrest during brain death protocol in two cases, and religious bias in one candidate. Twelve patients were organ donors: 10 patients were tissue donors. We conclude that the greatest source of underutilization lies in the failure to request tissue for harvesting, since there were no isolated tissue donors. Pertinent information should be more widely distributed to physicians regarding candidacy for tissue donation. Further consideration of the adequacy of organs or tissue in relation to the candidates' age should be given, since patients aged 65 years and older can be a significant source of potential donor candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective : to know the nursing care to the patients with death encephalic, potential donors of multiples organs. Methods : this is a descriptive study, from qualitative approach, performed in a hospital of reference in Urgency and Emergency from Goias state. Data were collected in September 2008, by means interviews semi-structured with 34 employees from nursing team. Data have been analyzed according to Bardin’s methodology. The study was approved by the Research Ethics Committee of the Hospital de Urgencias de Goiânia (protocol number 027/08). Results : the survey showed that the majority from the interviewers no has knowledge on the death encephalic physiopathology. The cautions about they perform in most from the turns do not have difference regarding to another patients, the furtherance isn't optimize should and sometimes occur negligent into the care. Another factors influence into the care: lack of working conditions and education continued one’s. The majority from the interviewers care with a thought of humanizing, but does not appear compromised with the possibility of donation. Conclusion : the nursing team is critical to servicing and maintenance of the potential donor. Therefore, it’s necessary to direct more attention to the care, increasing the chances of success in transplantation . Descriptors : death encephalic; cautions of sicken; donation of organs. RESUMO Objetivo : conhecer a assistencia de enfermagem a pacientes em morte encefalica, potenciais doadores de multiplos orgaos. Metodos : estudo descritivo de abordagem qualitativa, realizado em um hospital referencia em atendimento de Urgencia e Emergencia em uma cidade de Goias. Os dados foram coletados em setembro de 2008, por meio de entrevistas semi-estruturadas com 34 funcionarios da equipe de enfermagem, que se adequaram nos criterios de inclusao. Os dados foram analisados de acordo com Bardin. O projeto de pesquisa foi aprovado pelo Comite de Etica do Hospital de Urgencias de Goiânia (numero de protocolo 027/08). Resultados : o estudo mostrou que a maioria dos entrevistados nao possui conhecimento sobre a fisiopatologia da morte encefalica. Os cuidados que realizam, na maioria das vezes, nao tem diferenca quanto a outros pacientes. A assistencia nao e otimizada como deveria, e, por vezes, ocorre negligencia no cuidado. Outros fatores influenciam no cuidado como: falta de condicoes de trabalho e educacao continuada. A maioria dos entrevistados cuida com um pensamento de humanizacao, mas nao se mostra comprometida com a possibilidade de doacao. Conclusao : a equipe de enfermagem e fundamental para assistencia e manutencao do potencial doador. Portanto, ha necessidade de voltar uma atencao maior para o cuidado, aumentando as chances e sucesso nos transplantes. Descritores : morte encefalica; cuidados de enfermagem; doacao de orgaos. RESUMEN Objetivo : conocer los cuidados de enfermeria a los pacientes en muerte cerebral, potenciales donantes de organos multiples. Metodos : estudio descriptivo de enfoque cualitativo, realizado en un hospital de referencia en situaciones de emergencia y atencion de emergencia en una ciudad de Goias. Los datos fueron recolectados en septiembre de 2008, con entrevistas semi-estructuradas con 34 funcionarios del equipo de enfermeria, que adapten los criterios de inclusion. Los datos fueron analizados de acordo con Bardin. El estudio fue aprobado por el Comite de Etica del Hospital de Urgencias de Goiânia (numero de registro 027/08). Resultados : el estudio demostro que la mayoria de los encuestados no tienen conocimiento sobre la fisiopatologia de la muerte cerebral. El cuidado que realizan la mayor parte del tiempo no se diferencia de otros pacientes, la asistencia no es como deberia ser optimizado y, a veces, se produce el abandono en la atencion. Otros factores que influyen en la atencion como: la falta de condiciones de trabajo y la educacion continua. La mayoria Los correspondientes se ocupo con humanization pensar, pero no compromete a mostrar la posibilidad de la donacion. Conclusion : el equipo de enfermeria es esencial para el cuidado y mantenimiento de potenciales donantes, por eso que no necesita devolver una mayor atencion a la atencion y aumentar las posibilidades de exito del trasplante. Descriptores : muerte cerebral; cuidado de enfermeria; donacion de organos. Objective : Attentions the furtherance of sicken the patients Death Encephalic, potential donors of multiples organs. Methods: study descriptive of approach qualitative, realized in the hospital reference to attend of Urgency and Emergency a city of Goias. The dice have been collection on September of 2008, have been realized interviews semi - structure with 34 employees from staff of sicken , nurse , technicians and assist of sicken , that if accommodate on the criteria of inclusion. The dice have been analyzed under the thematic of Bardin. Results: the survey showed that the majority from the interview no has knowledge above the phisiopathology from Death Encephalic. The cautions about they perform in most from the turns do not have difference regarding another patients, the furtherance isn't optimize should and sometimes occur negligent into the care. Another factors influence into the care: lack of working conditions and education continued. The majority from the interview they care with a thought of humanize, but haven't you they show under obligation with the possibility of donation. Completion : the team of sicken is fundamental about to aid and conservation of the potential donor, so there are necessity of round an attention major about to the caution adding the chances and success on the transplants. Descriptors: Death Encephalic. Cautions of Sicken. Donation of Organs.

The idea of presumed consent for organ donation to increase donation rates may be praiseworthy but it is not altogether popular.1 The World Medical Association believes that a potential donor’s wishes are paramount, whether by agreeing to donate or choosing to refuse. Consent and autonomy are essential concepts of medical law, …

We compared the efficacy of MR angiography with that of conventional angiography for visualizing the renal arteries and detecting renovascular disease. Thirty-three MR angiographic studies, consisting of axial two-dimensional (2-D) phase-contrast, coronal 2-D phase-contrast, and coronal 2-D time-of-flight acquisitions, were performed within 48 hr of conventional arteriography. The studies were done to evaluate possible renovascular hypertension (n = 25) or potential donor nephrectomy (n = 8). The three MR image sets were interpreted independently, in random order by three observers, with regard to the number of renal arteries, degree of vessel visualization, arteriovenous overlap, and presence of renovascular disease. A fourth interpretation was based on the combined axial and coronal phase-contrast image sets. Evaluation was limited to the proximal 35 mm of each renal artery. Renal artery visualization and detection of renovascular disease were more complete with coronal phase-contrast (80% sensitivity, 91% specificity) than with time-of-flight (53% sensitivity, 97% specificity) images. Combined axial and coronal phase-contrast images permitted visualization of the proximal 35 mm of all dominant renal arteries and detection of 13 of 15 stenoses (87% sensitivity, 97% specificity). Our data suggest that biplanar MR angiography has considerable potential as a noninvasive screening technique for the evaluation of renovascular disease.

following bereavement and is primarily the decision of the potential donor’s next of kin. Recent UK legislation may transfer the timing and primacy of this decision to the donor who may have registered advance intentions to donate on a national register. We hypothesised that postive televison media coverage of heart transplantation may affect the potential donor registration rate. Methods and Materials: We examined web-based requests to register on the UK Organ Donor Register between January 2005 and August 2006. Changes in registration numbers were compared according to media coverage events. Results: In the 20 month period there were 286,207 registration requests and 5 transplant topic television items. The mean registration rate was 14,310( 95%, CI 9951-18,668) per month. The number of registrations in months following media coverage were significatly higher than in those without (20,904(95% CI 11,115-30,694) versus 9,864(95%CI8047-681) p 0.006).The observed effect appeared greatest when a heart transplant related topic arose in a fictional “soap opera” with a high viewing audience compared to non-fictional coverage but this was not significant(p 0.27). This apparent effect of positive coverage was short lived. Registration rates fell to the previous baseline within a month of coverage. The greatest increase in registration was seen on the day of broadcast( 2.8 times previous rate). This enhanced rate halved within 24 hours. Conclusions: Positive media coverage increases advance registration rates to a National Donor Register. The effect is short lived and may be insufficient to change rates of actual transplantation. Nevertheless, such coverage together with other educational initiatives may increase the number of potential donors for consideration of transplantation.

Xenotransplantation—the use of animal organs or tissues for transplantation into humans—may overcome the severe problem posed by organ shortages. However, it also has the potential to compromise public health through the spread of novel viral diseases between species. Fundamental questions regarding the relative risks of viruses from potential donor species and different sources of donor material must be addressed. Policy developers must consider whether there are significant differences between xenografts and the unsterilized biological products derived from animals that are now commercially available. A national system for virus screening, discovery, detection, and diagnostics is necessary and will require infrastructural changes.

Reconstruction of large skin defects of extremities necessitates wide and flat donor sites. The abdominal region, being a potential donor area, is not suitable due to its concave and relaxed structure. Aiming to create a concave and tense surface, pneumoperitoneum was performed in two selected cases with extensive skin defects of the lower extremities due to burn trauma and successfully obtained split-thickness grafts from this region. Although further studies are needed to evaluate the safety and efficacy of this technique, we think that pneumoperitoneum greatly facilitates obtaining a sufficient amount of high quality grafts, even with hand dermatomes.