Obesity surgery in patients with end-stage organ failure: Is it worth it?

“I think there’s a big strong belief in [...] the community … and maybe it’s in the world at large that somehow the doctors are more concerned about harvesting the organs than what’s best for the patient.”1 In the past 45 years, organ and tissue recovery and transplantation have moved from the occasional and experimental to a standard of care for end-stage organ failure; receiving an organ transplant is for many the only opportunity for increased quantity and/or quality of life. The increasing prevalence of diseases such as viral hepatitis, diabetes, and hypertension has significantly increased the incidence of end-organ failure. Additionally, surgical advances have permitted less stringent qualification criteria, so that people of advanced age or patients who may be in a physiologically fragile state are now eligible to be organ recipients. These changes have created a significant demand for organs.

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The use of MELD scores in critically ill cirrhotic patients

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v4i16.329 ◽

2016 ◽

Vol 4 (16) ◽

pp. 45

Author(s):

Supannee Rassameehiran ◽

Tinsay Woreta

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Hospital Mortality ◽

Organ Failure ◽

Critically Ill ◽

Meld Score ◽

Chronic Liver Failure ◽

End Stage Liver Disease ◽

Cirrhotic Patients ◽

End Stage

The Model for End-Stage Liver Disease (MELD) was originally created to predict survival following transjugular intrahepatic portosystemic shunt and was subsequently found to accurately predict mortality in patients with end-stage liver disease. It has been used in the United States for liver allocation since 2002, and implementation of the MELD score resulted in a reduction in total number of deaths on the waitlist and a reduction in waiting time. Critically ill cirrhotic patients have an in-hospital mortality greater than 50%. Although the MELD score was also found to be an accurate predictor of in-ICU mortality and in-hospital mortality after ICU admission in critically ill cirrhotic patients, the Sequential Organ Failure Assessment (SOFA) score appears to perform better in many studies. The Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF) score was later developed by using specific cut-points for each organ failure score system in CLIF patients to predict mortality in patients with ACLF. Neither the MELD nor SOFA score independently predicts post-liver transplantation mortality in cirrhotic patients with extrahepatic organ failure and should not be use as a delisting criterion for these patients. More data are needed to determine the accuracy of the CLIF-C ACLF score in predicting post-liver transplantation outcomes. Prospective evaluation of critically ill cirrhotic patients is needed to optimize liver organ allocation.

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Role of Bariatric Surgery in End-Stage Organ Failure

Bariatric Surgical Practice Guide ◽

10.1007/978-981-10-2705-5_18 ◽

2017 ◽

pp. 145-153

Author(s):

Rachel Maria Gomes

Keyword(s):

Bariatric Surgery ◽

Organ Failure ◽

End Stage

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Treatment of End-Stage Organ Failure in Canada

Healthcare Quarterly ◽

10.12927/hcq.2012.22908 ◽

2012 ◽

Vol 15 (2) ◽

pp. 84-84 ◽

Cited By ~ 1

Keyword(s):

Organ Failure ◽

End Stage

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The Case against Conscription of Cadaveric Organs for Transplantation

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180108080407 ◽

2008 ◽

Vol 17 (3) ◽

pp. 330-336 ◽

Cited By ~ 3

Author(s):

WALTER GLANNON

Keyword(s):

Organ Failure ◽

Organ Procurement ◽

Consent Requirement ◽

The Dead ◽

End Stage ◽

Severe Shortage

In a recent set of papers, Aaron Spital has proposed conscription or routine recovery of cadaveric organs without consent as a way of ameliorating the severe shortage of organs for transplantation. Under the existing consent requirement, organs can be taken from the bodies of the deceased if they expressed a wish and intention to donate while alive. Organs may also be taken when families or other substitute decisionmakers decide on behalf of the deceased to allow organ procurement for the purpose of transplantation. When patients or families do not consent to organ procurement, many transplantable organs are lost. This is a tragic yet avoidable situation. The dead are beyond any benefit or harm, and their organs could be used to prevent harm by saving and improving the lives of many people suffering and dying from end-stage organ failure.

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Organ engineering: promise, progress and perspective

The Biochemist ◽

10.1042/bio03804020 ◽

2016 ◽

Vol 38 (4) ◽

pp. 20-23

Author(s):

Michelle E. Scarritt ◽

Stephen F. Badylak

Keyword(s):

Extracellular Matrix ◽

Organ Failure ◽

Treatment Option ◽

Curative Treatment ◽

Microscopic Structure ◽

Support Structures ◽

Organ Engineering ◽

Human Organs ◽

End Stage ◽

Donor Organs

The only curative treatment option for patients with end-stage organ failure is transplantation. Organ engineering offers an alternative to traditional transplantation that may address the critical shortage of donor organs and eliminate the need for recipient immunosuppression. Organ engineering may be accomplished through the use of scaffold – support structures that contain the architecture of an organ. As organs are exceedingly complex, creating an organ scaffold is a difficult task; however, organ scaffolds can be derived through a process known as decellularization, which is the mechanical, chemical and/or enzymatic removal of cells from a tissue or organ. Through decellularization of xenogenic (animal) organs, biocompatible extracellular matrix (ECM) scaffolds can be produced that retain the complex macroscopic and microscopic structure and composition of the native organ ECM. These 3D ECM scaffolds are ideal for engineering human organs.

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Szervtranszplantáció gyermekkorban

Orvosi Hetilap ◽

10.1556/650.2018.31284 ◽

2018 ◽

Vol 159 (46) ◽

pp. 1948-1956

Author(s):

Antal Dezsőfi ◽

György Reusz ◽

Lajos Kovács ◽

Dolóresz Szabó ◽

Kata Kelen ◽

...

Keyword(s):

Organ Failure ◽

Organ Transplantation ◽

Immunosuppressive Drugs ◽

Pharmacokinetics And Pharmacodynamics ◽

Donor Organ ◽

Success Story ◽

Childhood Diseases ◽

Before And After ◽

Working Groups ◽

End Stage

Abstract: Paediatric organ transplantation today is considered and accepted and widely available therapy in children with end-stage organ failure. It is important to know that in childhood, diseases leading to end-stage organ failure differ from those in adults. Beside this, in children there are different surgical and paediatric challenges before and after transplantation (size differences of the patient and donor organ, special and paediatric infections, different pharmacokinetics and pharmacodynamics of immunosuppressive drugs, noncompliance). However, paediatric organ transplantation in the last decades became a success story of the Hungarian health care owing to several working groups in Hungary and outside the country. Orv Hetil. 2018; 159(46): 1948–1956.

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