Prog Transplant
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Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive living related kidney transplantation (LRKT) and their views on the potential value of health care professionals trained to address barriers are unknown. OBJECTIVE, SETTING, AND PARTICIPANTS: To collect pilot data for evaluating perceived barriers to preemptive LRKT and to inform the development of a culturally sensitive intervention to improve families' consideration of LRKT. In 4 structured group interviews of African American and non-African American patients (2 groups) with progressing chronic kidney disease and their family members (2 groups), participants' perceived barriers to initiating LRKT discussions and their views regarding the value of social workers to support discussions were explored. ⋯ Families identified several barriers to discussing preemptive LRKT that could be addressed by social workers. Further research must be done to determine whether social workers need to tailor interventions to address families' cultural differences.
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The Uniform Determination of Death Act and the American Academy of Neurology's Guidelines for Determination of Death define procedures for diagnosis of brain death before organ procurement for transplantation, including clinical assessment and apnea test. Autotriggering of mechanical ventilators can occur in both brain dead and living patients. A case is reported in which procurement was delayed because ventilator self-cycling was confused for brainstem-mediated respiratory effort. Background knowledge to effectively troubleshoot ventilator self-cycling is offered so that unnecessary delays in brain death testing can be avoided.
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In late 2009, Gift of Life Michigan facilitated a donation after cardiac death lung recovery resulting in the first set of donation after cardiac death lungs to be utilized by a Michigan transplant center. Although placing lungs obtained via donation after cardiac death is more difficult because of a multitude of factors, the transplant coordinators, in conjunction with the transplant center, overcame several obstacles in order to transplant the lungs with good outcomes so far. Lung donation after cardiac death is becoming a more acceptable method of decreasing the length of the transplant waiting list as more data are becoming available.
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Case Reports
Capnocytophagia canimorsus sepsis in an asplenic heart transplant candidate with a left ventricular assist system.
Fulminant septic shock associated with Capnocytophagia canimorsus bacteremia developed in a 54-year-old asplenic man, a heart transplantation candidate who was supported with a HeartMate II left ventricular assist system, after he experienced a dog bite. He improved after administration of broad-spectrum antibiotics, which were narrowed to ampicillin/sulbactam for a prolonged 6-week course, and subsequently recovered fully.
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Editorial Biography Historical Article
Women in transplantation: an interview with Patricia Adams, MD.