Transplantation proceedings
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Organs from brain dead patients are the main source for transplantation. However, in most societies, including Iran, the family consent rate for organ donation is low necessitating improvements in public knowledge. Because teachers' knowledge has an important role to educate the next generations, this study assessed their knowledge and attitudes about brain death and organ donation. ⋯ Our findings show that although most teachers had heard or read about brain death and organ donation, and approved of organ donation after death, a lack of exposure to patients with chronic diseases and a distrust of organ donation networks were greater among teachers with a lower desire to participate in this effort. Therefore, building trust in brain death diagnostic systems is necessary together with relevant educational programs.
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Living donor kidney transplantation offers many advantages to the recipients. Longer allograft survival, fewer postoperative complications, and better renal function are some of the benefits of receiving living donor kidneys compared to deceased donor organs. However, the consequences to the donor in terms of renal function are not as well defined. ⋯ The percentage decline in eGFR was not different among the different age groups; however, donors older than 50 years had a postdonation eGFR of 55.1 mL/min versus 60.9 mL/min in those less than 50 years old (P=.03), reflecting lower eGFR predonation (older 84.7 mL/min vs younger 95.2 mL/min, P=.02). The percent decline in eGFR did not change with time after donation (0-1 month 37%, 1-12 months 34%, >1 year 30%). eGFR declines abruptly post-kidney donation in all patients but remains stable and improves afterwards. AA women and older donors are more prone to reduction in eGFR post-kidney donations.
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Family refusal is an important factor that limits the number of organ donations. Some studies from different centers have reported various reasons for family decisions of organ donation refusal. This study evaluated the reasons for organ donation refusal by family members covered in our organ procurement organization. ⋯ Family members play an important role in the final decision for organ donation. The general public should be encouraged to register their donation preferences in the case of brain death.
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Patients who have chronic renal disease present challenges to anesthesiologists because of the sequelae of the underlying disease. Postoperative pain is usually mild to moderate after renal transplantation and is a concern because of underlying co-morbidities and variable responses of the graft. Effective postoperative pain management contributes to a a successful outcome after renal transplantation. ⋯ Our results suggest that analgesia with morphine patient-controlled analgesia was an effective method to achieve control of postoperative pain in this population with few side effects.
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Major surgery is associated with intraoperative and postoperative bleeding, generally treated with homologous blood transfusions, which carry the risk of infection, allergic reactions, or incompatibility as well as a number of organizational and economic problems. Transfusion strategies and steps to minimize perioperative bleeding are needed. ⋯ Autologous transfusion techniques include blood collection, both intraoperatively, as described by Orr, and postoperatively, as introduced by Borghi in 1984, which enables the continuous monitoring of postoperative bleeding. Blood collection can also be performed during emergency surgery, reducing the rate and costs of homologous transfusions.