Donación y transplante / Donation and transplantation

Mayo 4, 2017. No. 2679

Donación de órganos y transplantes en México. Perspectiva de los profesionales de la salud sobre los trasplantes Organ donation and transplantation in Mexico. A transplantation health professionals' perspective. Hernández-Ibarra LE1, Mercado-Martínez FJ2, Martínez-Castañeda A2. Salud Publica Mex. 2017 Jan-Feb;59(1):53-58. doi: 10.21149/7755. Abstract OBJECTIVE: We aimed to explore organ donation and transplantation in Mexico from the point of view of transplantation health professionals. MATERIALS AND METHODS: A qualitative study was carried out. Twenty six organ transplantation health professionals from seven states of Mexico participated. Semi-structured face-to-face interviews were conducted mainly in hospital settings. Critical discourse analysis was performed. RESULTS: According to participants, living organ transplantation offers benefits for recipients as well as for donors. Several factors influence the field of transplantation negatively, among them the scarcity of resources that impedes the incorporation of new health personnel, as well as conflicts between transplantation teams with diverse health professionals and authorities. CONCLUSION: Besides increasing economic resources, transplantation health personnel should be sensitized to find solutions in order to avoid conflicts with different health professionals. Studies on organ donation and transplants also should include other social actors' viewpoint. PDF Donación después de la determinación de la circulación cerebral de la muerte. Donation after brain circulation determination of death. Dalle Ave AL1, Bernat JL2. BMC Med Ethics. 2017 Feb 23;18(1):15. doi: 10.1186/s12910-017-0173-1. Abstract BACKGROUND: The fundamental determinant of death in donation after circulatory determination of death is the cessation of brain circulation and function. We therefore propose the term donation after brain circulation determination of death [DBCDD]. RESULTS: In DBCDD, death is determined when the cessation of circulatory function is permanent but before it is irreversible, consistent with medical standards of death determination outside the context of organ donation. Safeguards to prevent error include that: 1] the possibility of auto-resuscitation has elapsed; 2] no brain circulation may resume after the determination of death; 3] complete circulatory cessation is verified; and 4] the cessation of brain function is permanent and complete. Death should be determined by the confirmation of the cessation of systemic circulation; the use of brain death tests is invalid and unnecessary. Because this concept differs from current standards, consensus should be sought among stakeholders. The patient or surrogate should provide informed consent for organ donation by understanding the basis of the declaration of death. CONCLUSION: In cases of circulatory cessation, such as occurs in DBCDD, death can be defined as the permanent cessation of brain functions, determined by the permanent cessation of brain circulation. KEYWORDS: Brain criterion of death; Determination of death; Donation after circulatory determination of death [DCDD]; Ethics; Extracorporeal membrane oxygenation [ECMO]; Transplantation PDF Donación de órganos y ventilación electiva. Una estrategia necesaria Organ Donation and Elective Ventilation: A Necessary Strategy. Escudero D1, Otero J2, Menéndez de León B3, Perez-Basterrechea M2. Biomed Res Int. 2017;2017:7518375. doi: 10.1155/2017/7518375. Epub 2017 Jan 15. Abstract Organ transplantation is the sole treatment to improve or save the life of patients with final-stage organ failure. The shortage of available organs for transplantation constitutes a universal problem, estimating that 10% of patients on waiting lists die. Brain death is an undesirable result; nevertheless, it has beneficial side-effects since it is the most frequent source of organs for transplantation. However, this phenomenon is relatively uncommon and has a limited potential. One of the options that focuses on increasing organ donation is to admit patients with catastrophic brain injuries (with a high probability of brain death and nontreatable) to the Intensive Care Unit, with the only purpose of donation. To perform elective nontherapeutic ventilation (ENTV), a patient's anticipated willingness to donate organs and/or explicit acceptance by his/her relatives is required. This process should focus exclusively on those patients with catastrophic brain injuries and imminent risk of death which, due to its acute damage, are not considered treatable. This article defends ENTV as an effective strategy to improve donation rate, analyzing its ethical and legal basis. PDF

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Transplante con riñon marginal / Transplantation with marginal kidney

Marzo 9, 2017. No. 2623

¿Es un abuelo de 87 años de edad demasiado marginal para ser un donante de riñón? La visión de los anestesiólogos Is an 87-Year-Old Grandfather Too Marginal for Being a Kidney Donor? The View of Anesthesiologists. Kesimci E1, Erkilic E1, Kilinc I2, Kilic M3. J Clin Med Res. 2016 Sep;8(9):680-2. doi: 10.14740/jocmr2629w. Epub 2016 Jul 30. Abstract Living kidney donation has been accepted increasingly as a result of growth in the number of end-stage renal disease patients awaiting organ. In this aspect using grafts from marginal donors such as with advanced age is increasing in worldwide practice and also in Turkey. Therefore, anesthetic management of donors is particularly important. We herein report the anesthetic management of an 87-year-old grandfather donating his kidney to her granddaughter and review the current anesthetic strategies in a geriatric patient. KEYWORDS: Anesthesia; Elderly donor; Geriatrics; Kidney; Transplantation PDF ¿Cuándo es Justificable el Trasplante con un "Riñón Marginal"? When is Transplantation with a "Marginal Kidney" Justifiable? Rouchi AH1, Mahdavi-Mazdeh M1. Ann Transplant. 2016 Jul 26;21:463-8. Abstract The ability of kidney transplantation to improve quality of life has made this therapeutic modality the treatment of choice among renal replacement therapies; however, the continuing organ shortage has forced the use of marginal kidneys as a supplementary source of allografts. It has been repeatedly suggested that failed kidney transplant recipients have greater morbidity and mortality compared with dialysis patients with no renal transplant history. Achieving an optimal balance between the advantages of kidney transplant and disadvantages of allografts with marginal quality is a topic of controversy in transplant medicine. The major and potentially life-threatening complications of immunosuppressive therapies and shorter lifespan following graft failure necessitate a reappraisal of kidney transplant programs from expanded-criteria deceased donors, which can neither necessarily give dialysis patients a better quality of life nor a significant survival benefit, especially in settings with additional diminished graft survival due to HLA-mismatch. It should be offered just to those with short life expectancy and with HLA-matching. The last item is very important in countries without mandatory HLA-matching protocols for kidney transplantation programs. PDF Curso sobre Anestesia en Trasplantes, Cirugía abdominal, Plástica, Oftalmología y Otorrinolaringología. Committee for European Education in Anaesthesiology (CEEA)  y el Colegio de Anestesiólogos de León A.C. Abril 7-9, 2017, León Guanajuato, México Informes  (477) 716 06 16, kikinhedz@gmail.com

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Transplante facial / Face transplantation

Enero 18, 2017. No. 2573 Estimad@ Dr@ Víctor Valdés:

Transplante de cara. Retos anestésicos Face transplantation: Anesthetic challenges. Dalal A World J Transplant. 2016 Dec 24;6(4):646-649. doi: 10.5500/wjt.v6.i4.646. Abstract 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. KEYWORDS: Face transplantation; Facial reconstruction; Organ harvest; Vascular composite allotransplantation PDF Algoritmo para la procuración de la cara y mútiples órganos de un donador con muerte cerebral Algorithm for total face and multiorgan procurement from a brain-dead donor. Brazio PS1, Barth RN, Bojovic B, Dorafshar AH, Garcia JP, Brown EN, Bartlett ST, Rodriguez ED. Am J Transplant. 2013 Oct;13(10):2743-9. doi: 10.1111/ajt.12382. Epub 2013 Aug 5. Abstract Procurement of a facial vascularized composite allograft (VCA) should allow concurrent procurement of all solid organs and ensure their integrity. Because full facial procurement is time-intensive, "simultaneous-start" procurement could entail VCA ischemia over 12 h. We procured a total face osteomyocutaneous VCA from a brain-dead donor. Bedside tracheostomy and facial mask impression were performed preoperative day 1. Solid organ recovery included heart, lungs, liver, kidneys, and pancreas. Facial dissection time was 12 h over 15 h to diminish ischemia while awaiting recipient preparation. Solid organ recovery began at 13.5 h, during midfacial osteotomies, and concluded immediately after facial explantation. Facial thoracic and abdominal teams worked concurrently. Estimated blood loss was 1300 mL, requiring five units of pRBC and two units FFP. Urine output, MAP, pH and PaO2 remained normal. All organs had good postoperative function. We propose an algorithm that allows "face first, concurrent completion" recovery of a complex facial VCA by planning multiple pathways to expedient recovery of vital organs in the event of clinical instability. Beginning the recipient operation earlier may reduce waiting time due to extensive recipient scarring causing difficult dissection. KEYWORDS: Composite tissue transplantation; face transplantation; multiorgan donor; organ and tissue procurement; organ protection and preservation; organ sharing PDF 5to Curso Internacional de Anestesiología cardiotorácica, vascular, ecocardiografía y circulación extracorpórea. SMACT Mayo 4-6, 2017, Ciudad de México Informes Dr. Hugo Martínez Espinoza bajamed@hotmail.com  Regional Anesthesiology and Acute Pain Medicine Meeting April 6-8, 2017, San Francisco, California, USA ASRA American Society of Regional Anesthesia and Pain Medicine Información / Information California Society of Anesthesiologists Annual Meeting April 27-30, 2017 San Francisco California Información / Information

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