Transplantation proceedings
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Many studies from around the world have reported different reasons why families refuse organ donation. In Quebec, however, there are no known data on the subject. To enable us to better communicate with families, a research project was conducted from January to December 2007 in hospital centers with personnel who specialize in supporting families. ⋯ When these wishes are not known, the partners of older donors refuse in greater numbers, primarily for familial or circumstantial reasons. Refusal based on religion or ethnicity is rare. Some families approached before neurologic death is diagnosed do not wish to wait until all the criteria for neurologic death are met.
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At present, organ transplantation activity in Poland is located in the middle among European Union countries. There are appropriate law regulations, well-organized legal structures, well-educated transplant teams, good transplantation results, and case registries. There are 24 organ transplant teams in 20 centers, including 46 programs. ⋯ Every year almost 1500 organs are procured from about 500 cadaveric heart-beating donors (9-14 per million people [pmp]) with 50 from living donors: 800 to 1000 kidneys (21-28 pmp); over 200 livers (5-6 pmp); and 60 to 100 hearts (1.6-2.7 pmp). National transplant registries are maintained in Poltransplant including a central registry of refusals (the policy of presumed consent with registered objection on donation after death is implemented), waiting lists, a cadaveric and living donor registry, and a transplant registry. There are still some actions that should be undertaken to strengthen the transplantation system in Poland, to increase organ availability, to enhance the efficiency and accessibility of transplantation systems, and to improve quality and safety: namely, increasing deceased donations to their full potential, appointing transplant coordinators in every hospital where there is the potential for organ donation, promoting quality improvement programs, and promoting living donation.
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Endosonography (EUS), which merges endoscopic and ultrasound examinations, is a useful modality to display abnormal vessels that develop in the intrinsic circulation, frequently called "deep" varices. If these pathological veins exceed of 5 mm diameter, they significantly increase the risk of bleeding among patients with cirrhosis. In the most recent pilot study EUS proved useful to assess children for orthotopic liver transplantation (OLT). ⋯ EUS offers a precise evaluation of portal hypertension in OLT candidates. "Deep" potentially dangerous varices, which are undetected with routine endoscopy, were noted in a significant proportion of patients. The role of EUS in prioritizing subjects for OLT must be evaluated in a prospective study.
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Chronic heart failure and airway obstruction produce overlapping syndromes. Existent criteria for the diagnosis and grading of airway obstruction based on spirometry results may be inadequate in the presence of coexistent cardiac failure. The cardiac component of pulmonary function tests (PFT) can be measured in patients undergoing orthotopic heart transplantation (OHT). ⋯ Chronic heart failure contributed to significant FEV1 reduction, which limits the usefulness of PFT for diagnosis and grading of airway obstruction. FEV1%FVC, the main diagnostic criterion of chronic obstructive lung disease, seems to be an index independent of concomittant heart function impairment.