Donor and Recipient Matching in Facial Vascularized Composite Allotransplantation: A Closer Look at the Donor Pool

Background In situations of increased need, such as mass casualty incidents (MCIs) and COVID-19, donated blood products are in shortage across the United States. Medical students are a potential pool for blood donors. The aim of this study was to determine overall attitudes of medical students at a single academic institution toward blood donation during times of increased need. Methods Three anonymous REDCap surveys were administered to all medical students at a rural academic institution. Surveys 1 and 2 were administered preceding and after an institution-wide MCI drill, in September and November 2019, respectively. Survey 3 was administered following a student-organized COVID-19 blood drive in June 2020. Multivariable analysis was performed to determine if factors, ie, experience with MCI drills and emergency medical services (EMS) training, were associated with willingness to donate blood. Furthermore, barriers to donation among those not willing to donate were assessed. Results Overall response rate for MCI surveys (surveys 1 and 2) was 38% (mean age 25.2 years and 50% women). 91% (n = 210) of respondents were willing to donate blood. Previous participation in MCI drills and EMS training was not associated with higher willingness to donate blood. Response rate for survey 3 was 15.6% (59.4% women), and 30 (31.3%) respondents indicated they did not volunteer to donate blood during the COVID-19 drive. Most common reasons for not donating were “other,” medical concerns, and being out-of-town. Conclusions Majority of medical students are willing to donate blood during times of increased need and offer a possible solution to increase blood donor pool.

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The Year 2020 in Review: Noteworthy Literature for Thoracic Transplant Anesthesiologists

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/10892532211007636 ◽

2021 ◽

pp. 108925322110076

Author(s):

Benjamin A. Abrams ◽

Barbara Wilkey

Keyword(s):

Lung Transplantation ◽

Adult Congenital Heart Disease ◽

Coagulation Factor ◽

Preoperative Assessment ◽

Total Artificial Heart ◽

Donor Pool ◽

Transplant Patients ◽

Adult Congenital ◽

Coagulation Factor Concentrates ◽

Made In

The year 2020 was a monumental year in medicine, and this review focuses on selected articles for cardiothoracic anesthesiologists and perioperative physicians involved in the care of heart and lung transplant patients. In the field of lung transplantation, significant strides were made in our knowledge of risk stratification during the preoperative assessment of potential recipients, perioperative transfusion medicine, and the administration of coagulation factor concentrates. In addition, variations in perioperative management and outcomes between institutions were studied across an assortment of metrics regarding lung transplantation, including case volumes and anesthetic practices. Transitioning to topics in the field of heart transplantation, consideration was given to recipients with adult congenital heart disease, and separately, approaches to expanding the donor pool through donation after circulatory death. With regard to preoperative support, outcomes for the total artificial heart as well as the MitraClip as bridges to transplantation were published.

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Preparedness for transplantation during COVID-19 outbreak: how to manage?

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.607 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

G Valdi ◽

G Varadi ◽

A Panzera ◽

M Parpinel ◽

R Peressutti

Keyword(s):

Organ Transplantation ◽

Task Force ◽

Emergency Situation ◽

Donor Pool ◽

Surge Capacity ◽

Emergency Procedures ◽

Life Saving ◽

Critical Patients ◽

End Stage ◽

Assessment Procedures

Abstract Problem When WHO declared COVID-19 “international”, it was important not to damage some critical patients who need emergency procedures like organ transplantation, due to end stage organ disease. In 2003 SARS outbreak demonstrated the vulnerability of organ transplantation services o network. Descritption If transplantation is required as a life-saving procedure, it can be conducted with appropriate risk infection assessment. It is crucial during these emergencies to assess donor pool, as it is expected to decrease. A crucial point is to organize and evaluate the surge capacity, in terms of understaffing and lack of supplies, especially in ICU. The research methods were literature review using Pub Med, CDC, ECDC, WHO, TTS, searching as key words “SARS-CoV-2”, “COVID-19”, “transplantation”, “preparedness”. The analysis has been conducted between Feb 26th 2020 and March 5th 2020. Results As happened during SARS breakout in 2003, it is essential to establish a task force for crisis, currently updated and skilled for this particular management. Preparedness should regard especially the adoption of donor safety assessment procedures, ICU capability, the availability of covid-19 test for all the donors, and the adoption of specific post-transplant care. It is essential in this case establish preparedness in several points: education and training of the staff, practice drills, inspection of supplies, evaluation of surge capacity, relocation of patients. Lessons SARS-CoV-2 imposed in public health to establish new protocols and guidelines, which should be regularly updated to be useful in other epidemics outbreaks or other emergency situation. These protocols should focus on donor pool and ICU capability in order to carry on transplantation activities. Key messages This outbreak has tested the resilience of the whole system by day-by-day updating for transplantation teams and preparedness of the staff involved in transplantation management. During outbreak, seems to be useful a task force for crisis in order to support organ transplantation services.

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Safety and effectiveness of kidney transplantation using a donation after brain death donor with acute kidney injury: a retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-84977-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kyeong Deok Kim ◽

Kyo Won Lee ◽

Sang Jin Kim ◽

Okjoo Lee ◽

Manuel Lim ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Transplantation ◽

Brain Death ◽

Graft Survival ◽

Low Dose ◽

Kidney Injury ◽

Induction Agent ◽

Donor Pool ◽

Donation After Brain Death

AbstractThe use of kidneys from donation after brain death (DBD) donors with acute kidney injury (AKI) is a strategy to expand the donor pool. The aim of this study was to evaluate how kidney transplantation (KT) from a donor with AKI affects long-term graft survival in various situations. All patients who underwent KT from DBD donors between June 2003 and April 2016 were retrospectively reviewed. The KDIGO (Kidney Disease: Improving Global Outcomes) criteria were used to classify donor AKI. The cohort included 376 donors (no AKI group, n = 117 [31.1%]; AKI group n = 259 [68.9%]). Death-censored graft survival was similar according to the presence of AKI, AKI severity, and the AKI trend (p = 0.929, p = 0.077, and p = 0.658, respectively). Patients whose donors had AKI who received using low dose (1.5 mg/kg for three days) rabbit anti-thymocyte globulin (r-ATG) as the induction agent had significantly superior death-censored graft survival compared with patients in that group who received basiliximab (p = 0.039). AKI in DBD donors did not affect long-term death-censored graft survival. Low-dose r-ATG may be considered as an induction immunosuppression in recipients receiving kidneys with AKI because it showed better graft survival than basiliximab.

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When is a Match Sufficient? A Score-based Balance Metric for the Synthetic Control Method

Journal of Causal Inference ◽

10.1515/jci-2020-0013 ◽

2020 ◽

Vol 8 (1) ◽

pp. 209-228

Author(s):

Layla Parast ◽

Priscillia Hunt ◽

Beth Ann Griffin ◽

David Powell

Keyword(s):

Los Angeles ◽

Control Method ◽

Control Unit ◽

Treated Group ◽

Control Group ◽

Synthetic Control ◽

Donor Pool ◽

Synthetic Control Method ◽

The Mean ◽

The Impact

AbstractIn some applications, researchers using the synthetic control method (SCM) to evaluate the effect of a policy may struggle to determine whether they have identified a “good match” between the control group and treated group. In this paper, we demonstrate the utility of the mean and maximum Absolute Standardized Mean Difference (ASMD) as a test of balance between a synthetic control unit and treated unit, and provide guidance on what constitutes a poor fit when using a synthetic control. We explore and compare other potential metrics using a simulation study. We provide an application of our proposed balance metric to the 2013 Los Angeles (LA) Firearm Study [9]. Using Uniform Crime Report data, we apply the SCM to obtain a counterfactual for the LA firearm-related crime rate based on a weighted combination of control units in a donor pool of cities. We use this counterfactual to estimate the effect of the LA Firearm Study intervention and explore the impact of changing the donor pool and pre-intervention duration period on resulting matches and estimated effects. We demonstrate how decision-making about the quality of a synthetic control can be improved by using ASMD. The mean and max ASMD clearly differentiate between poor matches and good matches. Researchers need better guidance on what is a meaningful imbalance between synthetic control and treated groups. In addition to the use of gap plots, the proposed balance metric can provide an objective way of determining fit.

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Combined Heart-Liver and Domino Liver Transplantation in Familial Amyloidosis

The American Surgeon ◽

10.1177/00031348211023427 ◽

2021 ◽

pp. 000313482110234

Author(s):

Angela Sickels ◽

Keyur B. Shah ◽

Brianna Ruch ◽

Adrian Cotterell ◽

Inna Tchoukina ◽

...

Keyword(s):

Liver Transplantation ◽

Total Artificial Heart ◽

Donor Pool ◽

Cardiac Rejection ◽

Recipient Age ◽

Hospital Stays ◽

The Mean ◽

Domino Liver Transplantation ◽

End Stage

Background Combined heart-liver transplantation (CHLT) is the only curative option for patients with concomitant pathology affecting the heart and liver. In some cases, the native livers of familial amyloidosis (FA) patients may be suitable for domino transplantation into other recipients. Methods Retrospective analysis (2013 to 2019) of all CHLT at our center was performed. Continuous data were presented as mean with standard deviation and discrete variables as percentages. Results Familial amyloidosis was the indication for CHLT in 5 out of 6 patients. The mean recipient age was 55 ± 5.62 years. Two patients were bridged with total artificial heart. The mean model for end-stage liver disease score at transplant was 17.17 ± 3.7. Two explanted livers were used for transplantation in a domino fashion. The median intensive care and hospital stays were 5.5 and 19 days, respectively. Complications included renal failure (1), groin abscess (1), pulmonary embolism (1), and cardiac rejection (1). Patient and graft survival for both organs was 100% at a median follow-up of 59 (range 20-76) months. Discussion Combined heart-liver transplantation for FA achieves excellent outcomes. The possible use of livers explanted from patients with FA for domino liver transplantation can contribute to the liver donor pool.

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Recent advances in lung transplantation

F1000Research ◽

10.12688/f1000research.15393.1 ◽

2018 ◽

Vol 7 ◽

pp. 1684 ◽

Cited By ~ 13

Author(s):

Keith C Meyer

Keyword(s):

Lung Transplantation ◽

Primary Graft Dysfunction ◽

Graft Dysfunction ◽

Donor Pool ◽

Post Transplant ◽

Antibody Mediated Rejection ◽

The Past ◽

End Stage ◽

Transplant Complications

Lung transplantation can improve quality of life and prolong survival for individuals with end-stage lung disease, and many advances in the realms of both basic science and clinical research aspects of lung transplantation have emerged over the past few decades. However, many challenges must yet be overcome to increase post-transplant survival. These include successfully bridging patients to transplant, expanding the lung donor pool, inducing tolerance, and preventing a myriad of post-transplant complications that include primary graft dysfunction, forms of cellular and antibody-mediated rejection, chronic lung allograft dysfunction, and infections. The goal of this manuscript is to review salient recent and evolving advances in the field of lung transplantation.

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