I had an opportunity to visit U.S. Naval Tissue Bank and observed tissue procurement and preservation by freeze-drying method and its clinical application while I stayed in the Naval Hospital, Bethesda in 1954. The freeze-dried tissues, especially bone graft, has shown excellent bone repair experimentally and clinically. Recently the mechanisms of osteoinduction have observed by many researchers and isolated the substance, bone morphogenetic protein, and clarified the interaction between BMP and the determined or inducible osteoprogenitor cells.
Bone Morphogenetic Proteins ; Methods ; Tissue and Organ Procurement ; Tissue Banks ; Transplants

OBJECTIVETo summarize the experience of donor liver procurement and preparation in liver transplantation.

METHODSOne hundred and twenty-six cases of donor liver and kidney procurement and 105 cases of donor liver preparation from August, 2004 to December, 2006 were analyzed. The 105 donor liver grafts were all used for orthotopic liver transplantation.

RESULTSThe warm ischemia time of the graft ranged from 1 to 8.5 min with a mean of 4 min. The time of graft procurement ranged from 19 to 28 min (mean 22.5 min). Donor liver preparation lasted for 38 to 102 min in the 105 cases, with a mean of 51 min. The cold ischemia time of the donor liver was 5.5 to 13 h (mean 8 h). Anatomical variations were identified in 8 of the donor liver grafts.

CONCLUSIONSCold perfusion of the donor liver and repair of the hepatic artery are important procedures in donor liver procurement and preparation. Hemorrhage due to the donor graft should be prevented and the procedures should be performed in close cooperation with the recipient operation.

Adult ; Female ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Organ Preservation ; methods ; Tissue Donors ; Tissue and Organ Procurement ; methods ; Young Adult

Humans ; Kidney Transplantation ; economics ; Presumed Consent ; Reimbursement, Incentive ; Tissue Donors ; supply & distribution ; Tissue and Organ Procurement ; methods ; standards ; Transplants ; ethics

Kidney transplantation is the preferred treatment for eligible end-stage renal disease patients. However, the supply of donated kidneys has been consistently insufficient to meet the transplantation requirements of the population. In this paper, I discuss the feasibility of several policy options that engage potential donors or key individuals in a Singapore context, including financial and non-financial incentives for deceased/living organ donors and their families, improving actualisation rates of both donation after brain death, donation after cardiac death through quality improvement programmes and remuneration schemes, and a media platform for directed organ donation. I conclude by highlighting the most feasible policies to be considered.
Altruism ; Health Policy ; Humans ; Kidney ; surgery ; Kidney Failure, Chronic ; surgery ; Kidney Transplantation ; methods ; Living Donors ; Nephrectomy ; Quality Improvement ; Singapore ; Tissue Donors ; Tissue and Organ Harvesting ; Tissue and Organ Procurement

Kidneys of paediatric deceased donors were previously considered suboptimal for older recipients. An 18-month-old deceased donor was made available via Singapore's Medical (Therapy, Education and Research) Act. To the best of our knowledge, she is the youngest local donor. We herein report a case of successful kidney transplantation, using the en bloc technique, to a 15-year-old girl with renal failure secondary to bilateral cystic dysplastic kidney.
Adolescent ; Age Factors ; Female ; Humans ; Infant ; Kidney Diseases, Cystic ; surgery ; Kidney Transplantation ; methods ; Renal Insufficiency ; surgery ; Tissue Donors ; Tissue and Organ Procurement ; methods

Donor shortage is a major limitation in organ transplantation. Several studies have reported that extracorporeal membrane oxygenation (ECMO)-assisted organ donation can be successfully completed without inducing warm ischemia in patients with brain death. The present report described clinical experience of three patients (23-yr old man, 32-yr old man, and 41-yr old woman) who underwent ECMO for the evaluation of brain death and organ donation. They donated six kidneys, three livers, and one both lungs without warm ischemia by ECMO. Six kidney recipients successfully recovered normal status without hemodialysis and two liver recipients survived with normal liver functions, but one liver recipient and one lung recipient died 3 and 15 days after transplantation. Our report strongly encourages ECMO-assisted organ donation from brain death patients with refractory cardiopulmonary collapse to achieve improved organ transplantation.
Adult ; *Brain Death/diagnosis ; *Extracorporeal Membrane Oxygenation ; Female ; Heart Arrest ; Humans ; Male ; Middle Aged ; Organ Transplantation ; *Tissue Donors ; Tissue and Organ Harvesting ; Tissue and Organ Procurement/*methods ; Treatment Outcome ; Young Adult

OBJECTIVE: To better understand the pre-operation evaluation of donor kidneys from extended criteria donation after cardiac death and to improve the management during and after renal transplantation. METHODS: Both of the donor kidneys were from the donor who underwent liver transplantation 5 years ago in the Center of Organ Transplantation of Central South University. The donor was admitted because of liver function deterioration which led to hepatic coma, brain death, hepatorenal syndrome and cardiac death sequentially. Deceased donor score (DDS) and "zero point" kidney biopsy were applied to evaluate the donor kidney. After thorough examination of the donor and the renal function, renal transplantation was performed on 2 recipients. RESULTS: The recipients were followed up by 6 months, both of whom developed pulmonary infection and relieved after treatments. The kidney grafts functioned well and no surgical complication and no acute rejection occurred during the follow-up. CONCLUSION Proper evaluation of the donor organs ensures the safety of renal transplantation with kidneys from cardiac death donors who underwent liver transplantation, which is an important way to increase the number of organs for transplantation, yet the long-term effects need further observation.
Adult ; Death ; Follow-Up Studies ; Heart Arrest ; Humans ; Kidney Transplantation ; Liver Transplantation ; Male ; Middle Aged ; Tissue Donors ; Tissue and Organ Procurement ; methods

Donation after brain death followed by circulatory death (DBCD) is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs (25-30 kg) were allocated randomly into donation after brain death (DBD), donation after circulatory death (DCD) and DBCD groups. Brain death was induced by augmenting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were collected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [(0.56±0.30)%] and DBCD [(0.50 ± 0.11)%] groups was much lower than that in DCD group [(3.78±0.33)%] (P<0.05). And there was no significant difference between DBD group and DBCD group (P>0.05)). The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.
Allografts ; Animals ; Apoptosis ; Brain Death ; China ; Death ; Heart Arrest ; Hepatocytes ; pathology ; ultrastructure ; Humans ; In Situ Nick-End Labeling ; Liver ; pathology ; ultrastructure ; Liver Transplantation ; methods ; Microscopy, Electron ; Organ Preservation ; methods ; Swine ; Tissue Donors ; Tissue and Organ Procurement ; methods

This study investigated the feasibility and effects of organ bath to be used for detection of bronchial function of non-heart-beating donor (NHBD) lung after 1-h warm ischemia. Sixteen Swedish pigs were divided into two groups randomly: heart-beating donor (HBD) group and NHBD with 1-h warm ischemia (NHBD-1 h) group. The bronchial rings whose lengths and inner diameters were both 1.5 mm were obtained from isolated left lungs of all the pigs. Acetylcholine, arachidonic acid natrium and papaverine were used to test and compare the contractile and relaxant function of bronchial smooth muscles and epithelium-dependent relaxation (EpiDR) response between HBD and NHBD-1 h groups. The results showed that there was no significant difference in the values of bronchial precontraction between HBD and NHBD-1 h groups (5.18+/-0.07 vs 5.10+/-0.11 mN, P>0.05). No significant difference in the values of EpiDR responses between HBD and NHBD-1 h groups (1.26+/-0.05 vs 1.23+/-0.07 mN, P>0.05) was observed either. During the process of EpiDR induction, the rings had no spontaneous relaxation in two groups. In addition, papaverine solution completely relaxed the bronchial smooth muscles of all bronchial rings. It was concluded that after warm ischemia for 1 h, the contractile and relaxant abilities of bronchial smooth muscles, and the epithelium-dependent adjustment both kept intact. Organ bath model could be a liable and scientific way to evaluate the bronchial function of NHBD lung.
Biological Factors/metabolism ; Bronchi/metabolism ; Bronchi/*physiology ; Heart Arrest/*metabolism ; Heart Arrest/physiopathology ; Lung Transplantation ; Models, Biological ; Muscle Relaxation/physiology ; Organ Preservation/*methods ; Random Allocation ; Reperfusion Injury/prevention & control ; Swine ; Tissue and Organ Procurement ; Warm Ischemia/*methods

Multidetector row computed tomography (MDCT) provides anatomical information about the kidney and other internal organs. Presently, the suitability of 64-channel MDCT to assess the kidney of healthy micropigs was evaluated. Morphological evaluations of the kidney and the major renal vessels of six healthy micropigs were carried out using MDCT, recording kidney volume and the diameter and length of renal arteries and veins. The mean diameters and lengths of the renal artery were 0.44 +/- 0.05 and 4.51 +/- 0.55 cm on the right side and 0.46 +/- 0.06 and 3.36 +/- 0.27 cm on the left side, respectively. The mean diameters and lengths of the renal vein were 1.44 +/- 0.52 and 4.22 +/- 1.29 cm on the right side and 1.38 +/- 0.17 and 5.15 +/- 0.87 cm on the left side, respectively. The mean volume of the right kidney was 79.3 +/- 14.5 mL and of the left kidney was 78.0 +/- 13.9 mL. The data presented in this study suggest that the MDCT offers a noninvasive, rapid, and accurate method for the evaluation of the renal anatomy in living kidney donors. It also provides sufficient information about extra-renal anatomy important for donor surgery and determination of organ suitability.
Animals ; Kidney/*anatomy & histology/blood supply ; Kidney Transplantation/methods/*veterinary ; Male ; Renal Artery/*anatomy & histology ; Renal Veins/*anatomy & histology ; Swine ; Swine, Miniature/*anatomy & histology ; Tissue and Organ Procurement/methods ; Tomography, X-Ray Computed/methods/*veterinary