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第一篇Yan报告提到的Genomic characterization and infectivity of a novel SARS-like coronavirus in Chinese bats的12名作者在中国人民解放军南京军区军事医学研究所军队流行病学研究室,例如王长军、胡丹,王长军、胡丹也在第三军医大学军事预防医学院军队流行病学系。王长军、胡丹和黎介寿啥关系? 南京军区南京总医院副院长黎介寿,解放军普通外科研究所所长、器官移植重点实验室主任,第二、第三军医大学外科学兼职教授,国际外科学会国家级会员,欧洲肠外与肠内营养学会会员、消化道外科学会会员,解放军总后勤部医学科学委员会委员。有人是否为了器官移植问题不追中共病毒真相。

第一篇Yan报告提到的Genomic characterization and infectivity of a novel SARS-like coronavirus in Chinese bats的12名作者在中国人民解放军南京军区军事医学研究所军队流行病学研究室,例如王长军、胡丹,王长军、胡丹也在第三军医大学军事预防医学院军队流行病学系。王长军、胡丹和黎介寿啥关系? 南京军区南京总医院副院长黎介寿,解放军普通外科研究所所长、器官移植重点实验室主任,第二、第三军医大学外科学兼职教授,国际外科学会国家级会员,欧洲肠外与肠内营养学会会员、消化道外科学会会员,解放军总后勤部医学科学委员会委员。有人是否为了器官移植问题不追中共病毒真相。

‘장기 보존을 위한 체외막산소화장치(organ preserving extracorporeal membrane oxygenation, OPECMO)’가 혈역학적으로 불안정성을 보이는 뇌사자, 잠재적 뇌사자에서 활력 징후를 안정시켜 원하는 장기를 구득하기 위한 뇌사자 관리의 한 방안으로 이용되고 있다. 하지만 뇌사자나 잠재적 뇌사자가 처한 상황에 따라 기증자와 가족에게 심리적, 물리적 해를 야기할 수 있어 윤리적 문제가 야기된다. 연명의료를 거절한 기증자는 자신이 원하는 삶의 마지막 모습을 누리지 못할 수 있으며, 가족은 뇌사 판정에도 불구하고 ECMO로 인해 환자의 죽음을 인정하는 데 어려움을 겪을 수도 있다. 잠재적 뇌사자에서 만약 의료진이 뇌사 가능성을 설명하지 않은 채 ECMO를 시행한다면, 이는 환자와 가족, 제3지불자를 기만하는 행위가 된다. 또한 한정된 의료자원 이용의 측면에서 OP-ECMO 사용은 신중히 접근하여야 한다. 장기구득과 이식 절차에 참여함에 있어 의료진은 장기기증의 결과가 장기적출이 아니라 생명나눔에 있음을 분명히 해야 한다. 기증과 장기구득의 과정은 기증자 중심으로 이루어져야 하며, 이를 실현하기 위해 의료진은 장기기증과 이식에 관련하여 합의된 원칙을 제시할 수 있어야 한다.

Face transplantation is a complex vascular composite allotransplantation (VCA) surgery. It involves multiple types of tissue, such as bone, muscles, blood vessels, nerves to be transferred from the donor to the recipient as one unit. VCAs were added to the definition of organs covered by the Organ Procurement and Transplantation Network Final Rule and National Organ Transplant Act. Prior to harvest of the face from the donor, a tracheostomy is usually performed. The osteotomies and dissection of the midface bony skeleton may involve severe hemorrhagic blood loss often requiring transfusion of blood products. A silicon face mask created from the facial impression is used to reconstruct the face and preserve the donor's dignity. The recipient airway management most commonly used is primary intubation of an existing tracheostoma with a flexometallic endotracheal tube. The recipient surgery usually averages to 19-20 h. Since the face is a very vascular organ, there is usually massive bleeding, both in the dissection phase as well as in the reperfusion phase. Prior to reperfusion, often, after one sided anastomosis of the graft, the contralateral side is allowed to bleed to get rid of the preservation solution and other additives. Intraoperative product replacement should be guided by laboratory values and point of care testing for coagulation and hemostasis. In face transplantation, bolus doses of pressors or pressor infusions have been used intraoperatively in several patients to manage hypotension. This article reviews the anesthetic considerations for management for face transplantation, and some of the perioperative challenges faced.

Organ donation and transplantation is an important component of pediatric critical care. In the United States, over 100 children die annually while listed for organ transplantation, while others are too sick to be listed. The pediatric intensivist strives to ensure one of her patients is not among those, through both excellent clinical care and through advocating for organ donation. However, the intensivist must be aware of some of the ethical concerns that are present with organ donation. With donation after circulatory determination of death (DCDD) there continues to be question of when death has actually occurred, with many arguing that Uniform Declaration of Death Act’s definition of death may not have been achieved at the time of organ harvest. This would violate the Dead Donor Rule, that only organs may be harvested from dead patients. Additionally, there are practices within organ donation that are viewed as treating the patient as a means to an end, other than their own well-being. While many argue this is an altruistic goal we should all share, others argue that it should not be imposed upon a pediatric patient. Organ allocation also has ethical concerns, about selection criteria for appropriate recipients to ensure we are being the best steward of a valuable and limited resource. These allocation decisions may impact our patients awaiting transplantation. Organ donation and transplantation serves the greater good of patients and society, but we must recognize some the ethical concerns to ensure each patient is being treated with respect.

Decellularized scaffolds are promising for organ regeneration; to facilitate analyses of decellularization and preclinical research, experiments using large animals are indispensable. An efficient protocol using large animals requires the modification of current methods to account for differences in anatomy, size, stiffness, and animal handling. This chapter describes a method for the decellularization of livers from large animals (especially porcine livers), including anesthesia, organ harvest, organ decellularization, and storage, with a summary of potential pitfalls. This methodology can hypothetically be applied to large animals for preclinical studies and subsequent clinical applications.

During the time of organ harvest, it is crucial for the kidney procurement team to consider significant vascular anatomical variations. Multiple renal arteries are not uncommon, and unintentional injury can result in an irreversibly damaged kidney graft that needs to be discarded. We present a kidney graft with 5 renal arteries and a single vein that was successfully procured and implanted with good graft function at discharge and at 4-yr follow-up. According to the literature, additional renal arteries can be found in about 33% of kidneys. This is the first study on a kidney with 5 arteries in the published literature, especially in the context of transplantation.

Major medical progress has been made in the field of renal transplantation over the last 40 years, thanks to advances in areas such as metabolism, immunology, therapeutics, and pathology. This progress has been accompanied by important changes in French legislation that governs organ harvest and transplantation, as well as the institutions that regulate organ allocation. Patient and graft survival have both increased markedly, although long-term improvements have been somewhat offset by complications, including adverse effects of immunosuppression. On average recipients are older than in the past and some recipients are now dying from age-related comorbidities despite having functional grafts.

Background Only 20% of organ donors are considered suitable for lung transplantation. No extensive study exists that has evaluated changes in thoracic radiographic abnormalities in organ donors. The purpose of this study was to determine the impact of radiographic abnormalities on successful transplantation. Methods In a retrospective survey of 110 organ donors, chest radiographs ( N = 417) taken during the initial 24 hours after admission and just before organ harvest were evaluated for 9 radiographic criteria, radiographic diagnoses and clinical characteristics and their association with lung transplantation. Results Initial lung densities were present in 37% of lungs; there were bilateral infiltrates in 25% of cases. During evaluation (69.7 ± 60 hours), 38% of right lungs and 28% of left lungs improved radiographically. Up to 51% of lungs with initial infiltrates resolved completely. Worsening of lung infiltrates was more common in the non-transplant group ( p = 0.02); however, improvement in densities was not associated with transplantation ( p = 0.6). Multivariate analysis determined that moderate and severe lung densities (OR 7.68, p = 0.01; OR 10.8, p = 0.004) and bilateral infiltrates (OR 4.79, p = 0.02) were independent predictors of rejection for transplantation. With densities removed from the model, the number of abnormal diagnoses on the final films was an independent predictor of rejection for transplantation (OR 3.23, p = 0.003). Conclusions More than 33% of proposed organ donors initially have lung infiltrates, with >33% showing improvement or resolution, but this improvement does not impact on procurement. Multiple abnormal radiographic diagnoses also contribute to transplant rejection.

Heart transplantation has in recent years become the treatment of choice for end stage heart failure. However while the waiting list for transplantation is growing steadily, the donor pool is not increasing. Therefore, in order to meet demand, transplant programs are using older, “marginal donors” and accepting longer ischaemic times for their donor hearts. As donor organs are injured as a consequence of brain death, during the period of donor management, at organ harvest, preservation, implantation and reperfusion, expansion of acceptance criteria places a great burden on achieving optimal long-term outcomes. However, at each step in the process of transplantation strategies can be employed to reduce the injury suffered by the donor organs. In this review, we set out what steps can be taken to improve the quality of donor organs.

The pig has been identified as the most likely source of xenograft material for clinical use and studies are ongoing to overcome the immunological hurdles of pig-to-human transplantation. Attention is now being focussed on identifying and reducing the potential microbiological hazards associated with this technique. Studies have primarily addressed issues surrounding the production and health monitoring of xenograft source pigs and none have so far specifically evaluated the possible risks of microbial contamination during xenograft harvest. In this report, we evaluate the possible routes for contamination of a pig kidney xenograft during organ harvest and describe approaches to the control of these hazards, including the novel use of a custom designed airtight surgical canopy. A standard procedure for microbiological monitoring during xenograft harvest was devised and evaluated. This allowed the rapid identification and anti-microbial sensitivity testing of any isolated organisms. This would enable an early and appropriate pre-emptive treatment of infection because of transmission of pig micro-organisms.

Nanotechnology Organ transplantation is limited by the availability of viable donor organs. Although cryopreservation could extend the time between organ harvest and transplant, the current gold standard for rewarming, convection, leads to cracking and crystallization in samples larger than a few milliliters. Manuchehrabadi et al. rewarmed cells and tissues by radiofrequency inductive heating, using magnetic nanoparticles suspended in a cryoprotectant solution. This nanowarming technique rapidly and uniformly rewarmed cryopreserved fibroblasts, porcine arteries, and porcine heart tissue, yielding tissues with higher viability than those rewarmed by convection. Sci. Transl. Med. 9 , eaah4586 (2017).

Background . The injury resulting from postmortem ischemia is a critical deterrent to the availability of donor valves. Using the reduction of XTT-tetrazolium salt as a marker of metabolic sequelae, we assessed the injurious effect of ischemia and the metabolic sequelae in 156 porcine semilunar leaflets. Methods . The leaflets were randomly allocated to noncryoprocessed (n = 72) or cryoprocessed (n = 72) groups. At each preservation temperature of 4°C, 24°C, or 37°C, 24 leaflets each were exposed to one of four storage periods of 9, 17, 30, or 60 hours. Twelve fresh aortic leaflets served as baseline reference samples. Results . There was a progressive loss in the metabolic functioning of valve leaflet cells in both noncryopreserved and cryopreserved tissue as the storage times increased. Cryopreserved tissue showed a greater loss of function than noncryopreserved tissue did. The metabolic injury was mainly a consequence of cryoprocessing. The greatest loss in metabolic functioning occurred in the valves stored for 60 hours. The least favorable combination of variables was cryopreservation and a precryopreservation storage time of 60 hours. Conclusions . We conclude that 30- to 60-hour delays do not have a significant metabolic effect on cardiac leaflets. Thus it may be possible to safely extend the permissible ischemic periods after organ harvest.

This paper offers a philosophical consideration and evaluation of several different criteria of moral standing, and discusses their implications for persistent vegetative state (PVS) individuals who were once competent. It is argued that the only criterion PVS individuals meet is that of being human, which is not the best test of moral standing. Accordingly it is, in principle, morally acceptable to perform passive or active euthanasia on PVS individuals or to use their bodies for research or for organ harvest. Nevertheless, the autonomous choices made by the persons the PVS individuals used to be can still impose moral obligations. Indeed, it is argued that the capacity for autonomy is a particularly appealing criterion of moral standing, and that the implications of this standard for PVS individuals confirm that appeal.

The brain-dead organ donation programme is slowly gathering momentum in India. There is a long way to go before our cadaver donor numbers, currently at 0.35 per million reaches 35 per million as is the case in countries like Spain. Each donor, therefore, has to be managed immaculately. The anaesthesiologists will be well served by familiarising themselves with the challenges during the crucial period preceding and during the actual harvest of organs in a brain-dead donor. There are significant opportunities for anaesthesiologists to make great contributions in this cause due to their unique skill sets and perspective. A robust brain-dead cadaver programme will go a long way in saving numerous lives as well as reduce the requirements of the living donor programme. A well-managed harvest will ensure good quality organs and an overall superior outcome in the recipients.

Large numbers of human hepatocytes were obtained from split and whole livers by using an adaptive form of the collagenase perfusion technique employed in rodent and human biopsies. In order to guarantee a homogenous distribution of the perfusate within the whole specimen, major hepatic veins were cannulated with large bore catheters. This technique allowed for the isolation of human hepatocytes on a large scale (up to 18.5 × 109 in one case) from normal and diseased liver specimens. The yield of isolated normal viable hepatocytes is inversely proportional to the donor age. In addition, it was noted that a short time between declared death and organ harvest (cross clamp time) results in higher viability of hepatocytes. In contrast, the time of cold organ preservation did not correlate with the viability or the yield of isolated hepatocytes. We conclude that the technique presented here allows isolation of large numbers of human hepatocytes from specimens unsuitable for transplantation but very valuable for biomedical research.

The effect of total-body irradiation of the donor on hepatic allograft survival was studied in the rat, with ACI(RT1a) as the donor and LEW(RT1(1)) as the recipient. LEW recipients of ACI liver transplants experienced severe acute rejection, with a mean survival of only 10.2 +/- 0.3 days. The doses of irradiation were 450, 750, and 1000 rads administered 24 hr prior to harvesting or subsequent transplantation. TBI with a dose of 750 rads significantly prolonged the survival of the hepatic allograft to 30.3 +/- 1.7 days, without concomitant immunosuppression. However, neither 450 rads nor 1000 rads of TBI resulted in successful suppression of graft rejection. TBI appeared to have a beneficial effect on hepatic allograft survival and to have no deleterious effect on isograft survival, suggesting a possible modulation of the immunogenicity of the donor organ. Although the cause of this beneficial effect is not clear, TBI with a dose of 750 rads 24 hr prior to organ harvest seems to be optimal to eliminate-antigen presenting cells in the donor organs.

Harvesting trauma to the graft dramatically decreases survival after liver transplantation. Since activated Kupffer cells play a role in primary nonfunction, the purpose of this study was to test the hypothesis that organ manipulation activates Kupffer cells. To mimic what occurs with donor hepatectomy, livers from Sprague-Dawley rats underwent dissection with or without gentle organ manipulation in a standardized manner in situ. Perfused livers exhibited normal values for O2uptake (105 ± 5 μmol · g−1· h−1) measured polarigraphically; however, 2 h after organ manipulation, values increased significantly to 160 ± 8 μmol · g−1· h−1and binding of pimonidazole, a hypoxia marker, increased about threefold ( P < 0.05). Moreover, Kupffer cells from manipulated livers produced three- to fourfold more tumor necrosis factor-α and PGE2, whereas intracellular calcium concentration increased twofold after lipopolysaccharide compared with unmanipulated controls ( P < 0.05). Gadolinium chloride and glycine prevented both activation of Kupffer cells and effects of organ manipulation. Furthermore, indomethacin given 1 h before manipulation prevented the hypermetabolic state, hypoxia, depletion of glycogen, and release of PGE2from Kupffer cells. These data indicate that gentle organ manipulation during surgery activates Kupffer cells, leading to metabolic changes dependent on PGE2from Kupffer cells, which most likely impairs liver function. Thus modulation of Kupffer cell function before organ harvest could be beneficial in human liver transplantation and surgery.

THE GOAL of donor heart assessment is not to estimate the functional status of the heart immediately before organ harvest but rather to predict the performance of the transplanted graft after weaning from extracorporeal circulation and in the postoperative period. For that appraisal, one must take into account cumulative damage from preexisting injury to the donor heart as well as brain deathinduced injury. This cumulative damage may be functionally inert only becoming evident after subsequent damage by ischemic time and reperfusion. Moreover donor-independent parameter—ie, size matching between donor and recipient as well as the pulmonary vascular resistance (PVR) of the recipient—have to be considered, because these parameters represent the hurdle that have to be cleared by the cumulatively damaged graft.

In the process of harvesting an organ for transplantation, flushing the organ with various perfusates, and, ultimately, implanting the organ into the recipient, a number of abnormal hemodynamic forces have an impact on the microvasculature of the graft. First, the microvasculature can be acutely overdistended by the preservation solution infused at the time of organ harvest from the donor. Second, there is a loss of the usual pulsatile blood flow when the organs lie flaccid on ice during the transport period. At this point, the microvasculature is sensing a minimal intravascular pressure. Finally, when the graft is implanted, the conditions of reperfusion may have an impact on graft function as well. It is increasingly appreciated that extremes in perfusion pressure may ultimately affect graft function both in the short and long term. Inasmuch as these are variables that can be controlled, it is important to define the optimal hemodynamic conditions for organ preservation and reperfusion.

The Chinese Medical Association has signalled its formal opposition to the use of transplant organs from executed prisoners, except for their immediate family. Facing pressure from the World Medical Association in recent years to take a stand against the extraction of, and trafficking in, prisoners

To the Editor: In their thorough review of respiratory problems in the neurologically critically ill, Wijdicks and Borel1 conclude with the topic of apnea testing in brain death and clearly spell out many of the issues. However, they also make a statement that potentially compromises the process of caring for the terminally ill. In detailing the downsides of apnea testing, they note that “the procedure may induce hypotension and hypoxemia, which may make organs unsuitable for transplantation … .”1 It is important to note that the patient in question is not dead yet, and such preparation for organ harvest, no matter how discrete or professional, subconsciously permeates discussions in the final hours. It is easily misinterpreted by family members as contrary to the …