Organ procurement
Organ procurement (also known as surgical recovery) is a surgery to take out organs or tissues so they can be used again, usually for organ transplants.[1]
Procedures
changeIf the organ donor is a human, most countries require the donor to be legally dead (like brain death or heart death) before organ transplantation. Some organs can be donated from living donors such as one kidney or a segment of the liver.[2]
Organs can't be taken if the heart has stopped beating for too long. So, brain death is preferred because the organs still receive blood until they are removed. The American Academy of Neurology made guidelines in 2010 to confirm brain death. These guidelines include being in a coma with a known cause, having no brain stem reflexes, and not breathing.[3]
Donation after cardiac death (DCD) happens when organs are removed some minutes after the life support is turned off for those patients with some remaining brain activity. The family is asked about organ donation once they have come to a decision regarding stopping life support. There is a 2–5-minute wait to make certain the heart does not start beating again before quickly taking the organs.[4][5]
Organ matching, which is done to minimize organ rejection, would be the next step if consent is given. In the United States, this is handled by groups such as the United Network for Organ Sharing.[6]
Sometimes, teams have to work together for multiple-organ donations. Some models using pigs are also developed to reduce the use of lab animals.[7] Multiple-organ procurement models are also developed from slaughtered pigs to reduce the use of laboratory animals.[8]
The quality of the organ is checked. If the heart has stopped beating too long, the organ cannot be used for transplantation.[7]
Preservation and transport
changeAfter organs are taken from a donor, they are quickly sent to the recipient for transplantation or kept for later study. The sooner the transplant occurs, the better the outcome. During transport, the organ is either kept in a cold solution or connected to a machine that pumps a cold solution through it.[9][10][11][12] This transport time is known as “cold ischemia time.” Hearts and lungs should be transplanted within 6 hours.[13] The livers can be preserved for up to 24 hours,[13] but surgeons usually try to use them sooner.[9] In the case of the kidneys, a longer cold ischemia time may delay the functions and hence it sometimes requires temporary dialysis until the kidney starts working.[14]
New methods are being developed to improve organ preservation. One approach is quickly recovering organs from donors.[15] Another common approach involves the use of machines to perfuse cold or warm fluids through the organs. This is commonly done for kidneys and has been used in hearts and lungs. In livers, both cold and warm approaches are utilized and seem beneficial.[16]
Research is ongoing to improve these methods and find new ways to preserve organs longer and better.[17][18]
References
change- ↑ "Tissue and Organ Harvesting". Retrieved 2014-01-11.
- ↑ "Living Organ Donation | organdonor.gov". www.organdonor.gov. Retrieved 2023-11-15.
- ↑ Principles of critical care. Hall, Jesse B.,, Schmidt, Gregory A.,, Kress, John P. (Fourth ed.). New York. 2015-06-02. ISBN 978-0071738811. OCLC 906700899.
{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link) - ↑ Sade, Robert M. (August 2011). "Brain death, cardiac death, and the dead donor rule". Journal of the South Carolina Medical Association (1975). 107 (4): 146–149. ISSN 0038-3139. PMC 3372912. PMID 22057747.
- ↑ Sade, Robert M. (2017-01-31). "Brain death, cardiac death, and the dead donor rule". Journal of the South Carolina Medical Association (1975). 107 (4): 146–149. ISSN 0038-3139. PMC 3372912. PMID 22057747.
- ↑ Steinbrook, Robert (2007). "Organ Donation after Cardiac Death". New England Journal of Medicine. 357 (3): 209–213. doi:10.1056/NEJMp078066. PMID 17634455.
- ↑ 7.0 7.1 An improved technique for multiple organ harvesting, TE Starzl, C Miller, B Broznick, Surg Gynecol Obstet. 1987 October; 165(4): 343–348.
- ↑ Multiple-organ harvesting for models of isolated hemoperfused organs of slaughtered pigs. C Grosse-Siestrup, C Fehrenberg, H von Baeyer. Dept. and Facilities of Experimental Animal Sciences, Humboldt University of Berlin, Germany
- ↑ 9.0 9.1 Cite error: The named reference
:0was used but no text was provided for refs named (see the help page). - ↑ Organ transport methods
- ↑ "First clinical heart transplant performed using Stig Steen's new method". News Powered by Cision. 12 September 2017.
- ↑ Kimblad, Per Ola; Sjöberg, Trygve; Massa, Giorgio; Solem, Jan-Otto; Steen, Stig (1991). "High potassium contents in organ preservation solutions cause strong pulmonary vasocontraction". The Annals of Thoracic Surgery. 52 (3): 523–528. doi:10.1016/0003-4975(91)90917-F. PMID 1898141.
- ↑ 13.0 13.1 Cite error: The named reference
:1was used but no text was provided for refs named (see the help page). - ↑ Lager, Donna J. (2013-01-01), Lager, Donna J.; Abrahams, Neil A. (eds.), "9 - Pathology of Kidney Transplantation", Practical Renal Pathology, Philadelphia: W.B. Saunders, pp. 183–202, doi:10.1016/b978-0-443-06966-6.00011-8, ISBN 978-0-443-06966-6, retrieved 2023-11-16
- ↑ Cascales-Campos, Pedro A.; Ferreras, David; Alconchel, Felipe; Febrero, Beatriz; Royo-Villanova, Mario; Martínez, María; Rodríguez, José M.; Fernández-Hernández, Juan Á; Ríos, Antonio; Pons, José A.; Sánchez-Bueno, Francisco (January 2020). "Controlled donation after circulatory death up to 80 years for liver transplantation: Pushing the limit again". American Journal of Transplantation. 20 (1): 204–212. doi:10.1111/ajt.15537. ISSN 1600-6143. PMID 31329359. S2CID 198136656.
- ↑ Nasralla, David; Coussios, Constantin C.; Mergental, Hynek; Akhtar, M. Zeeshan; Butler, Andrew J.; Ceresa, Carlo D. L.; Chiocchia, Virginia; Dutton, Susan J.; García-Valdecasas, Juan Carlos; Heaton, Nigel; Imber, Charles; Jassem, Wayel; Jochmans, Ina; Karani, John; Knight, Simon R.; Kocabayoglu, Peri; Malagò, Massimo; Mirza, Darius; Morris, Peter J.; Pallan, Arvind; Paul, Andreas; Pavel, Mihai; Perera, M. Thamara P. R.; Pirenne, Jacques; Ravikumar, Reena; Russell, Leslie; Upponi, Sara; Watson, Chris J. E.; Weissenbacher, Annemarie; et al. (2018). "A randomized trial of normothermic preservation in liver transplantation". Nature. 557 (7703): 50–56. Bibcode:2018Natur.557...50N. doi:10.1038/s41586-018-0047-9. PMID 29670285. S2CID 4990879.
- ↑ Clavien, Pierre-Alain; Dutkowski, Philipp; Mueller, Matteo; Eshmuminov, Dilmurodjon; Bautista Borrego, Lucia; Weber, Achim; Muellhaupt, Beat; Sousa Da Silva, Richard X.; Burg, Brian R.; Rudolf von Rohr, Philipp; Schuler, Martin J.; Becker, Dustin; Hefti, Max; Tibbitt, Mark W. (31 May 2022). "Transplantation of a human liver following 3 days of ex situ normothermic preservation". Nature Biotechnology. 40 (11): 1610–1616. doi:10.1038/s41587-022-01354-7. ISSN 1546-1696. PMID 35641829. S2CID 249234907.
- ↑ Bryant, Saffron J.; Awad, Miyah N.; Elbourne, Aaron; Christofferson, Andrew J.; Martin, Andrew V.; Meftahi, Nastaran; Drummond, Calum J.; Greaves, Tamar L.; Bryant, Gary (22 June 2022). "Deep eutectic solvents as cryoprotective agents for mammalian cells". Journal of Materials Chemistry B. 10 (24): 4546–4560. doi:10.1039/D2TB00573E. ISSN 2050-7518. PMID 35670530.