What are the effects of interventions for increasing solid organ donor registration?

2021 ◽  
Author(s):  
Jane Burch ◽  
Sera Tort
Keyword(s):  
Organ Donor ◽  
Solid Organ

Organizational characteristics of solid-organ donor hospitals and nondonor hospitals

1999 ◽  
Vol 9 (2) ◽  
pp. 87-96 ◽  
Author(s):  
Ann Klassen ◽  
David Klassen ◽  
Remy Aronoff ◽  
Allyson Hall ◽  
Judith Braslow
Keyword(s):  
Organ Donor ◽  
Organizational Characteristics ◽  
Solid Organ

The Faltering Solid Organ Donor Pool in the United States (2001–2010)

2012 ◽  
Vol 36 (12) ◽  
pp. 2909-2913 ◽  
Author(s):  
Reza F. Saidi ◽  
James F. Markmann ◽  
Nicolas Jabbour ◽  
YouFu Li ◽  
Shimul A. Shah ◽  
...  
Keyword(s):  
United States ◽  
Organ Donor ◽  
The United States ◽  
Solid Organ ◽  
Donor Pool

scholarly journals Transmission of synovial sarcoma from a single multi-organ donor to three transplant recipients: case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jian Zhang ◽  
Yang Yang ◽  
Ye Tian ◽  
Ruifang Xu ◽  
Jun Lin
Keyword(s):  
Synovial Sarcoma ◽  
Solid Organ Transplantation ◽  
Organ Donor ◽  
Malignant Potential ◽  
Solid Organ ◽  
Renal Transplant Recipients ◽  
Tumor Type ◽  
Transplant Recipients ◽  
Allograft Nephrectomy

Abstract Background Transmission of malignancy is a notable problem that cannot always be absolutely predicted at the time of transplantation. In particular, donor-derived transmission of synovial sarcoma in solid-organ transplantation is a rare but catastrophic event. Case presentation We are the first to report three cases of synovial sarcoma transmitted from a single multi-organ donor in China. The donor died of respiratory failure caused by an intrathoracic tumor, which was diagnosed as benign at the time of donation. All three recipients developed synovial sarcoma 3–13 months after transplantation; all three cases were confirmed to be donor transmitted. The liver transplant recipient died of tumor metastasis after partial-allograft hepatectomy. The two renal-transplant recipients survived after comprehensive therapy, including allograft nephrectomy, withdrawal of immunosuppressants and targeted therapy with anlotinib. Conclusions This report highlights the importance of detailed donor assessment, close follow-up and timely treatment of unexpected donor-transmitted malignancy. Although pathology is the most important evidence for the exclusion of donors for malignant potential, it should be combined with tumor type, tumor size and speed of growth. Organs from donors with malignant potential should be discarded. Allograft nephrectomy should be considered after confirmation of renal-allograft synovial sarcoma. Anlotinib for synovial sarcoma seems to be effective and well tolerated during long-term follow-up.

Third Party Donor Derived EBV Specific T Cells for the Treatment of Refractory EBV-Related Malignancies in Immunodeficient Recipients

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 577-577
Author(s):  
Susan E. Prockop ◽  
Ekaterina Doubrovina ◽  
Juliet N Barker ◽  
Karim Baroudy ◽  
Farid Boulad ◽  
...  
Keyword(s):  
T Cells ◽  
Organ Transplant ◽  
Organ Donor ◽  
Primary Immunodeficiency Disease ◽  
Solid Organ Transplant ◽  
Third Party ◽  
Solid Organ ◽  
Hla Alleles ◽  
Immunodeficiency Disease

Abstract Abstract 577 Adoptive immunotherapy is an effective strategy for the treatment of EBV+ lymphoproliferative diseases (EBV-LPD) arising after an allogeneic hematopoietic stem cell (HSCT) or solid organ transplant (SOT). This approach is, however, often limited by an inability to generate donor derived in vitro expanded EBV-specific cytotoxic T-lymphocyte (EBV-CTL) lines in a timely manner and/or the fact that EBV CTL lines derived from HLA non-identical donors may be restricted by non-shared HLA alleles. To date, we have treated 25 consecutive patients with an EBV LPD (N=20) or EBV Leiomyosarcoma (LMS) (N=5) with in vitro expanded EBV-CTLs derived from a donor other than the patient or their transplant (HSCT or SOT) donor. EBV CTLS were selected from a bank of 345 lines generated under GMP conditions from normal HSCT donors. Each donor was specifically consented for use of their T cells in patients other than their designated transplant recipient. Patients were recipients of unmodified (n=4), T cell depleted (n=5) or unrelated cord blood (n=5) HSCT, a solid organ transplant (n=6), a combined SOT and HSCT (n=1), or were non-transplanted patients with a primary immunodeficiency disease (n=4). EBV disease in transplanted patients was of host origin in 5 of 10 evaluable HSCT recipients, in 3 of 4 evaluable solid organ recipients, and in the one patient who underwent a combined HSCT/solid organ transplant. Third party EBV-CTLs were selected on the basis of HLA matching at a minimum of 2/8 recipient alleles. Where possible EBV-CTLs were selected that were restricted through HLA alleles present on the EBV+ tumor. HLA restriction was evaluated in vitro in 20 EBV-CTL donor lines. The restriction was at a single HLA allele (n=12), at two alleles (n=6) and at >than two alleles (n=2). Patients received infusions of 3rd party EBV-CTLs after failing a median of 2 prior therapies including rituximab in all but one case of EBV LPD. Four patients failed prior infusions with EBV-CTLs which were autologous (n=1), derived from their original HSCT (n=2) or from their solid organ donor (n=1). In two patients who progressed after treatment with EBV CTLs generated from their HSCT or organ donor, it was demonstrated that the donor derived EBV CTLs were restricted by a non-shared HLA allele. Patients received a median of 5 infusions most at 1×106 EBV-CTL/kg/infusion. Four patients received EBV-CTLs from >1 3rd party donor. Nine patients achieved a completed response. Nine patients died of progressive disease, 6 shortly after the first infusion (17–29 days). Two patients with LMS achieved long term stable disease (46 and 8 months); 5 achieved partial remissions which have been sustained in 4 (11- 68 months), and 1 patient progressed after 10 months in a partial remission. Response to EBV CTL therapy did not correlate with the degree of HLA matching between donor and recipient or donor and tumor. Radiographic and clinical responses correlated with detectable increases in the frequency of CTL precursors in the blood. However durable EBV CTL engraftment was not seen. One patient developed mild skin GvHD after infusion with 3rd party EBV-CTLs, but tolerated subsequent infusion of EBV-CTLs from an alternate 3rd party donor. Although no SOT recipient developed anti-HLA antibodies, one developed and episode of steroid responsive renal transplant rejection more than 6 months after infusion of EBV CTLs without evidence of donor (by STR analysis) in biopsied tissue. This study demonstrates a high response rate among patients with otherwise refractory EBV malignancy treated with EBV specific 3rd party CTLs restricted by HLA alleles shared by the tumor. Treatment failures correlated with the use of EBV CTLs restricted by HLA alleles not shared by the tumor. In addition two patients with a primary immunodeficiency disease who were unable to mount an endogenous EBV T cell response had transient but not durable responses to 3rd party cells. EBV CTLs can be effective when selected based on restriction to shared alleles despite significant HLA disparity. The bank of EBV specific T cells can provide an immediate source of HLA partially matched appropriately restricted T cells for adoptive immunotherapy to treat EBV associated malignancy. This enables treatment early in the course of disease and the use of EBV-CTL lines previously prepared and characterized in terms of HLA restriction. This is anticipated to maximize the response rate. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Multiple organ procurement

2007 ◽  
Vol 60 (7-8) ◽  
pp. 339-342
Author(s):  
Milivoje Vukovic ◽  
Nebojsa Moljevic ◽  
Zoran Milosevic ◽  
Nenad Katanic ◽  
Dragan Krivokuca
Keyword(s):  
Brain Death ◽  
Health Care Professionals ◽  
Organ Procurement ◽  
Multiorgan Failure ◽  
Organ Donor ◽  
Organ Damage ◽  
Multiple Organ ◽  
Solid Organ ◽  
Cadaveric Donors ◽  
The Ideal

Introduction. Liver transplantation is the most demanding of all solid organ transplantations. It requires perfect organization and motivation of health care professionals, patients and their families. This article deals with the procedure for multiple organ procurement, reviews criteria for organ donation and describes the surgical technique for multiple organ procurement. Discussion. Adequate selection and evaluation of cadaveric donors and of organs for transplantation should include early identification of potential donors, and early diagnosis of brain death. The procurement of the highest number of viable organs for transplantation requires excellence in each of the phases. Early and aggressive physiologic support in the maintenance of potential donors can reduce organ donor loss due to irreversible asystole or multiorgan failure (it is almost always possible to maintain organ perfusion pressure) and increase the number of organs without increasing post-transplant morbidity or mortality. The ideal donor is a young, previously healthy, brain dead, victim of an accident. Conclusion. The surgical procedure for multiple organ procurement from brain death donors must be performed without intraopertive organ damage. .

scholarly journals When Operating on Dead People Saves Lives: Benefits of Surgical Organ Donor Intensivists

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Kristin Long ◽  
Cynthia Talley ◽  
Rebecca B. Yarrison ◽  
Andrew Bernard
Keyword(s):  
Ethical Issues ◽  
Solid Organ Transplantation ◽  
Organ Donor ◽  
Time Frame ◽  
Solid Organ ◽  
Organ Donors ◽  
Life Saving ◽  
Decompressive Laparotomy ◽  
End Stage ◽  
Aggressive Interventions

Solid organ transplantation has emerged as a life-saving treatment for many patients suffering from end-stage organ failure. Organs have been successfully recovered after a variety of aggressive interventions. We propose that decompressive laparotomy, when clinically indicated, should be considered in the aggressive resuscitation of potential organ donors. A thorough literature review examining aggressive interventions on potential organ donors was conducted after experience with a unique case at this institution. Articles were reviewed for the types of interventions performed as well as the time frame in relation to organ donation. In our case, several ethical issues were raised when considering decompressive laparotomy in a patient pronounced dead by neurologic criteria. We propose that having a surgical intensivist involved in the management of potential donors will further increase the salvage rate, as more invasive resuscitation options are possible.

scholarly journals A Large-Scale Bank of Organ Donor Bone Marrow and Matched Mesenchymal Stem Cells for Promoting Immunomodulation and Transplant Tolerance

2021 ◽  
Vol 12 ◽  
Author(s):  
Brian H. Johnstone ◽  
Franka Messner ◽  
Gerald Brandacher ◽  
Erik J. Woods
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Living Donor ◽  
Progenitor Cell ◽  
Large Scale ◽  
Organ Donor ◽  
Mixed Chimerism ◽  
Solid Organ ◽  
Transplant Tolerance ◽  
Hematopoietic Stem

Induction of immune tolerance for solid organ and vascular composite allografts is the Holy Grail for transplantation medicine. This would obviate the need for life-long immunosuppression which is associated with serious adverse outcomes, such as infections, cancers, and renal failure. Currently the most promising means of tolerance induction is through establishing a mixed chimeric state by transplantation of donor hematopoietic stem cells; however, with the exception of living donor renal transplantation, the mixed chimerism approach has not achieved durable immune tolerance on a large scale in preclinical or clinical trials with other solid organs or vascular composite allotransplants (VCA). Ossium Health has established a bank of cryopreserved bone marrow (BM), termed “hematopoietic progenitor cell (HPC), Marrow,” recovered from deceased organ donor vertebral bodies. This new source for hematopoietic cell transplant will be a valuable resource for treating hematological malignancies as well as for inducing transplant tolerance. In addition, we have discovered and developed a large source of mesenchymal stem (stromal) cells (MSC) tightly associated with the vertebral body bone fragment byproduct of the HPC, Marrow recovery process. Thus, these vertebral bone adherent MSC (vBA-MSC) are matched to the banked BM obtained from each donor, as opposed to third-party MSC, which enhances safety and potentially efficacy. Isolation and characterization of vBA-MSC from over 30 donors has demonstrated that the cells are no different than traditional BM-MSC; however, their abundance is >1,000-fold higher than obtainable from living donor BM aspirates. Based on our own unpublished data as well as reports published by others, MSC facilitate chimerism, especially at limiting hematopoietic stem and progenitor cell (HSPC) numbers and increase safety by controlling and/or preventing graft-vs.-host-disease (GvHD). Thus, vBA-MSC have the potential to facilitate mixed chimerism, promote complementary peripheral immunomodulatory functions and increase safety of BM infusions. Both HPC, Marrow and vBA-MSC have potential use in current VCA and solid organ transplant (SOT) tolerance clinical protocols that are amenable to “delayed tolerance.” Current trials with HPC, Marrow are planned with subsequent phases to include vBA-MSC for tolerance of both VCA and SOT.

scholarly journals Infections in the solid-organ transplant recipients

2021 ◽  
pp. 64-76
Author(s):  
Manal El Said
Keyword(s):  
Solid Organ Transplantation ◽  
Organ Transplant ◽  
Organ Donor ◽  
Solid Organ Transplant ◽  
Molecular Techniques ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Antimicrobial Drugs ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

The advancement in the field of transplant has led to the increasing number of solid-organ transplant recipients (SOTRs). This success leads to novel confronts in communicable infections, which are compound by the emergence of newly contagious and antimicrobial drugs resistant microorganisms. The prevention of infections is a cornerstone of any modern solid organ transplantation program. Understanding the fundamentals of these infections with early detection is crucial for improving the outcomes of such patients and lowers the probable extra complications.  The probability of critical infections in SOTRs is established by relations between the patient’s epidemiological exposures and the net condition of immune repression. A timeline was formed to build up a discrepancy diagnosis of infection in SORTs. The improvement in screening, the investigations including imaging and molecular techniques and prophylactic intervention protocols, has made it promising to limit the penalty of infections and act towards better patient endurance. Pre-transplant screening of the prospective organ donor and recipient provides a chance to evaluate the viability and wellbeing of transplantation, to decide the prophylaxis and protective approaches developed post-transplant, to find out and entirely treat active infection in the possible recipient proceeding to transplant, to renovate the vaccination condition of the potential recipient.

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