Transplantation has developed as an established treatment modality for endstage organ diseases. However, the shortage of available organs remains the main obstacle to organ transplantation. The big discrepancy between the number of potential recipients on the waiting list and cadaveric transplantations has become a serious issue in Korea. The first step in the process of cadaveric organ donation is the identification of potential donors. The identification and notification of potential donors are essential for the activation of cadaveric organ donations. To increase the number of brain dead donors following components are critical: the increase of public understanding of organ donation, improvement of legal and systematic processes, establishment of a donor action program, interests and cooperation of attending physicians, and management of an organ donation process focused on donor families. Public education and campaign are also crucial to the understanding of brain death and organ donation. To improve legal and systematic processes, required referrals or routine notifications are advisable. Also, presumed consent is necessary to decrease the psychological stress on donor families during the agreement process. For the effective management of a donor action program, an education program to well-train medical staff and medical record reviews should be maintained. In conclusion, a comprehensive donor action program including a practical donor detection system, an education program, and improvement of the organ donation system are mandatory to increase the cadaveric organ donations effectively.
Brain Death ; Cadaver ; Education ; Humans ; Korea ; Medical Records ; Medical Staff ; Organ Transplantation ; Presumed Consent ; Referral and Consultation ; Stress, Psychological ; Tissue and Organ Procurement ; Tissue Donors* ; Transplantation ; Transplants ; Waiting Lists

PURPOSE: The purpose of this study was to investigate symptom frequency and symptom discomfort in liver, kidney and heart transplant recipients. METHODS: This descriptive, comparative study included 191 subjects (86 liver, 81 kidney, 24 heart: 135 male, 56 female). The symptom frequency and distress questionnaires were used to examine the symptom experience of the subjects. RESULTS: The most frequent and distressing symptom was fatigue. Increased hair, increased appetite, poor concentration and poor vision were frequently reported and poor vision, poor concentration, muscle weakness, and headache were causing high distress. Women reported a significantly higher level of symptom frequency and discomfort than men. Heart recipients reported a significantly higher level of symptom frequency and discomfort than renal or liver recipients. Significant (P<0.05) differences were found in symptom frequency and discomfort depending on transplant organs, numbers of immunosuppressants genders, age and types of drug and time after transplantation. Most of symptoms were related to the side effects of cyclosporine or corticosteroids. CONCLUSION: The results provide a basis for patient and family education and for symptom management. Further investigation of the symptom experience of the transplant patients is needed, especially in relation to quality of life.
Adrenal Cortex Hormones ; Appetite ; Cyclosporine ; Education ; Fatigue ; Female ; Hair ; Headache ; Heart ; Humans ; Immunosuppressive Agents ; Kidney ; Liver ; Male ; Muscle Weakness ; Quality of Life ; Surveys and Questionnaires ; Transplantation ; Transplants*

PURPOSE: The demand for suitable organs in the world greatly outweighs the supply of transplantable organs. Perceptions and attitudes of the attending physician to brain death are pivotal for the organ donation process in brain dead donors. The purpose of this study is to evaluate the perceptions and attitudes of the attending physician on brain death and organ donation in order to promote the organ donation from brain dead donors in Korea. METHODS: Questionnaires were collected from 194 (17.9%) among 1,018 physicians and were analyzed by descriptive statistics. RESULTS: 97.5% (189/194) of respondents have positive attitudes toward organ donation. Although 97.9% (190/194) have experienced donor management, the referral rate was no more than half (96/194, 49.5%). The main barriers against organ donation were lack of knowledge on organ donation and transplantation (60/129, 46.5%), cultural background (27/120, 20.9%) and complexity in the organ donation process (12/129, 9.3%). CONCLUSION: Promotion of organ procurement organization and well trained-education programs are crucial to help attending physicians to understand the organ donation process, and eventually to increase the rate of organ donations in brain dead donors.
Brain Death* ; Brain* ; Humans ; Korea ; Surveys and Questionnaires ; Referral and Consultation ; Surveys and Questionnaires ; Tissue and Organ Procurement* ; Tissue Donors* ; Transplantation

BACKGROUND: This study was conducted to develop a pre-discharge group education program for liver transplant patients, and to contribute to improving the knowledge and performance of self-management after discharge. METHODS: This investigation was a methodological study consisting of analysis, design, development, operation, and evaluation stages. RESULTS: The constituent items of the pre-discharge group education program for liver transplant patients include medication management, infection management, emergency management, outpatient management, complication management, nutrition management, exercise management, wound and drainage management, disability registration, and sex life. The pre-discharge group education program for liver transplant patients was conducted once a week, 30 minutes for the coordinator, 40 minutes for the clinical nurse specialist (including 10 minutes for wound and drainage management), 30 minutes for pharmacists, 20 minutes for the nutritionist, and 20 minutes for social workers. Additionally, the contents of the lecture announced by PowerPoint were made the same as the booklet. The overall knowledge level before and 3 months after the pre-discharge group education program for liver transplantation patients increased significantly from 17.32±1.53 to 19.74±0.89. At the 3-month time point, the overall compliance was 77.39±3.04 out of 80. Overall satisfaction was 9.32±0.93 on a scale of 10. Finally, the need for medication was the highest at 3 months. CONCLUSIONS: It is expected that this program can be utilized in the clinical field as an effective nursing education intervention.
Compliance ; Drainage ; Education* ; Education, Nursing ; Emergencies ; Humans ; Liver Transplantation ; Liver* ; Methods ; Nurse Clinicians ; Nutritionists ; Outpatients ; Pamphlets ; Pharmacists ; Self Care ; Social Work ; Social Workers ; Wounds and Injuries

BACKGROUND: Since the first successful kidney transplantation from a brain death donor (BDD) was done in 1979, organ transplantations from BDD have steadily increased. The number of BDDs have been increasing year by year. The purpose of this study is to analyze clinical status of organ donor from BDDs. METHODS: We analyzed retrospectively the status of BDDs registerd for organ transplant program in Asan Medical Center from January, 1992 to March, 1997. RESULTS: The male to female ratio was 3 : 1, and the age distribution was the highest in twenties. The distribution of cause of brain death was the highest in motor vehicle accidents. The distribution of acquired organ was the highest in kidney, heart, liver in order. The distribution of days stayed in ICU before organ donation was the highest in 2 days. The choice of agent for inotropic support of the myocardium is dobutamine. The donors have been transfused with packed red blood cell (PRBC) to maintain the hematocrit between 25~35%. Two units of PRBC should be readily available at all times for transfusion. The failure of organ donation was mainly very poor organ condition. CONCLUSIONS: We wish that these results were made use of bases of status of organ donation from BDDs.
Age Distribution ; Brain Death* ; Brain* ; Chungcheongnam-do ; Dobutamine ; Erythrocytes ; Female ; Heart ; Hematocrit ; Humans ; Kidney ; Kidney Transplantation ; Liver ; Male ; Motor Vehicles ; Myocardium ; Organ Transplantation ; Retrospective Studies ; Tissue and Organ Procurement ; Tissue Donors* ; Transplants

PURPOSE: This study was aimed to understand the experience and adjustment process of organ transplantation recipients in Korea, using grounded theory method. METHODS: Eight patients after liver transplantation and two patients after heart transplantation were selected for this study, for whom minimum follow-up duration was at least 6 months after transplantation. Data was collected from July to November 2005 through in-depth individual interviews either at home or hospital. The data were analyzed using a constant comparative method in which new data was continuously coded into categories and properties. RESULTS: Data analysis revealed that "safekeeping the graft" was the core category in experience of organ transplantation recipients. In order to safekeep transplanted organ, recipients used seven different strategies to deal with various problems and conflicts which occurred during the recovery process: 1) altering the role function of family, 2) complying the treatment regimen, 3) developing the know-how for self-care, 4) returning to the normal life, 5) keeping the positive thinking, 6) concerning for the donor, and 7) improving the self-fulfillment. CONCLUSION: The results of this study provided deep understanding on the recovery process after organ transplantation and these would help establishing more appropriate intervention to improve quality of life for organ transplantation recipients.
Adaptation, Psychological ; Follow-Up Studies ; Heart Transplantation ; Humans ; Korea* ; Liver Transplantation ; Organ Transplantation* ; Qualitative Research ; Quality of Life ; Self Care ; Social Adjustment ; Statistics as Topic ; Thinking ; Tissue Donors ; Transplants*

BACKGROUND AND OBJECTIVES: Staphylococcus aureus (S. aureus) exotoxins (SE) have been implicated in the pathogenesis of chronic sinusitis with nasal polyposis (CRSwNP). The aim of this study was to identify the contribution of S. aureus exotoxin as allergen in the development of nasal polyp. MATERIALS AND METHOD: Nasal polyp and serum were obtained from 30 patients who underwent endoscopic sinus surgery for CRSwNP and 10 control turbinate mucosae were used. Nasal culture was done for each patients. Specific IgE levels for S. aureus exotoxin A (SEA), S. aureus exotoxin B (SEB), and toxic shock syndrome toxin 1 (TSST-1) were measured using ImmunoCAP method in nasal tissue and serum. The patients were divided into three groups : A, nasal polyp (+)/culture (+) ; B, nasal polyp (+)/culture (-) ; C, nasal polyp (-)/culture (-). RESULTS: The culture for S. aureus was 27% in CRSwNP when compared to 10% in control. The specific IgE for S. aureus in serum was significantly expressed in nasal polyp (30%) compared to control (0%). Also the Group A showed a significant high rate of specific IgE (63%) compared to Group B (18%) and Group C (0%) in serum. In nasal polyp tissue, the specific IgE has showed no specific difference between nasal polyp (7%) and control (10%). However, it was also increased in Group A (25%), compared to Group B (0%) and Group C (11%). CONCLUSION: Our results demonstrated that there was a correlation between nasal polyp and specific IgE levels to S. aureus exotoxin. These results suggest that S. aureus exotoxin can act as a traditional allergen and induce the inflammatory reaction in CRSwNP. Background and Objectives : Staphylococcus aureus (S. aureus) exotoxins (SE) have been implicated in the pathogenesis of chronic sinusitis with nasal polyposis (CRSwNP). The aim of this study was to identify the contribution of S. aureus exotoxin as allergen in the development of nasal polyp.
Exotoxins* ; Humans ; Immunoglobulin E* ; Mucous Membrane ; Mucus* ; Nasal Polyps ; Shock, Septic ; Sinusitis ; Staphylococcus aureus* ; Staphylococcus* ; Statistics as Topic* ; Turbinates

BACKGROUND/AIMS: Pancreas transplantation (PT) as the ultimate treatment for insulin-dependent diabetes has been the subject of debate clinically. Marked improvements in patient and graft survival, and decreases in postoperative morbidity have been achieved due to technical refinements, improved immunosuppressants, and better postoperative management. Here, we report our 18-year experience with PT performed at our institute. METHODS: All recipients who underwent deceased donor or living donor PT between July 1992 and December 2009 were included. We reviewed the medical records, including operation records, progress, and laboratory findings during follow-up. Graft and patient survival were analyzed using the Kaplan-Meier method. RESULTS: In total, 119 cases of pancreas transplantation were performed between July 1992 and December 2009 at our institute. Indications for pancreas transplantation were type I diabetes in 93 (78.2%) patients and type II diabetes in 16 (13.4%) patients. The transplanted pancreas was obtained from a deceased donor in 108 cases (90.8%) and a living donor in 11 cases (9.2%). Median follow-up duration was 39.3 months posttransplantation (range 0~176 months). Overall graft survival rates at 1, 5, and 10 years were 81.6%, 63.4%, and 57.1%, respectively. Following the introduction of tacrolimus as an immunosuppressant in 1999, graft survival at 1, 5, and 10 years was 89.1%, 72.9%, and 66.2%, and overall patient survival at 1, 5, and 10 years was 93.0%, 86.0%, and 86.%, respectively. CONCLUSIONS: Considering the quality of life and long-term patient survival, PT is an effective treatment strategy in non-obese diabetic patients requiring insulin regardless of the type of diabetes.
Follow-Up Studies ; Graft Survival ; Humans ; Immunosuppressive Agents ; Insulin ; Korea ; Living Donors ; Medical Records ; Pancreas ; Pancreas Transplantation ; Quality of Life ; Tacrolimus ; Tissue Donors ; Transplants

A 46-year-old diabetic woman visited our hospital with generalized edema and high blood pressure. An appropriately sized noninvasive blood pressure cuff was placed on her right arm above the elbow to measure blood pressure. While we were checking her blood pressure, we noticed small red petechial spots distal to the cuff involving her entire right forearm. Her blood pressure was 170/96 mmHg. The laboratory findings showed no abnormality of anticoagulation. The rest of the patient's extremities were not affected. The petechiae on the right arm resolved spontaneously after ten days. The most likely explanation for these petechiae is acute dermal capillaryrupture, which is called the Rumpel- Leede phenomenon. Acute dermal capillary rupture appears as petechiae in an area following application of vascular constriction such as application of tourniquet to draw blood specimen or use of blood pressure cuff due to capillary fragility or abnormal platelets in numbers or in function. This situation has been reported previously in the literature as the Rumpel-Leede phenomenon in association with prolonged noninvasive BP monitoring. In the patient described herein, increased venous pressure from blood pressure measurement and capillary fragility associated with diabetes mellitus may have increased the risk of acute dermal capillary rupture.
Arm ; Blood Platelets ; Blood Pressure ; Capillaries ; Capillary Fragility ; Constriction ; Diabetes Mellitus ; Diabetic Nephropathies ; Edema ; Elbow ; Extremities ; Female ; Forearm ; Humans ; Hypertension ; Middle Aged ; Purpura ; Rupture ; Tourniquets ; Venous Pressure

To overcome the shortage of available organ in children, living-related liver transplantation(LRLT) has been introduced in Asan Medical Center since 1994. However, the use of graft livers across ABO blood groups is unavoidable since the organ donor is usually one of the recipient's parents in LRLT cases. In ABO-incompatible liver transplants from brain dead donors, the incidences of perioperative mortality, arterial thrombosis, and irreversible rejection and the rate of retransplantation have been reported to be greater. But recent reports from LRLT showed that 1-year survival rate of ABO incompatible cases were approximately 80%. So we started ABO incompatible LRLTs at our institute since Feb, 1996. Three cases of ABO incompatible LRLT have been performed thereafter, 2 with fulminant hepatitis and 1 with cirrhosis. Plasma pheresis or exchange transfusion was done to decrease isohemagglutinin perioperatively. Immunosuppression consisted of a quadruple-drug treatment in one, FK506 and steroid in two. The follow-up periods were 2, 4 and 13 months respectively. One child died of acute respiratory distress syndrome with normal graft function on 51st postoperative day. Two children are alive with good health, but one of them suffers S2 segment bile duct stricture, which is under the management with PTBD. The present results suggest that ABO incompatilbe LRLTs can be performed to overcome the shortage of the liver in children using a combination of the preioperative plasma pheresis and immunosuppression.
Bile Ducts ; Blood Component Removal ; Blood Group Antigens* ; Brain Death ; Child ; Chungcheongnam-do ; Constriction, Pathologic ; Fibrosis ; Follow-Up Studies ; Hepatitis ; Humans ; Immunosuppression ; Incidence ; Liver Transplantation* ; Liver* ; Mortality ; Parents ; Plasma ; Respiratory Distress Syndrome, Adult ; Survival Rate ; Tacrolimus ; Thrombosis ; Tissue Donors ; Transplants