Prog Transplant
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Thromboelastography is a test of blood coagulation used to evaluate all components of clot formation and possible abnormal clot dissolution. It supplements traditional laboratory testing by demonstrating the integration of coagulation factors, platelets (number and function), and other factors during coagulation. Analysis of abnormalities demonstrated by thromboelastography can guide organ procurement coordinators in titrating appropriate quantities of fresh frozen plasma, cryoprecipitate, or platelet transfusions during treatment of coagulation in adult donors.
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Many biological signals must be measured and interpreted accurately to titrate therapy properly during donor care. Although the technological aspects of intravascular pressure monitoring are usually delegated to bedside nursing colleagues, organ procurement coordinators should be familiar with those devices and methods. ⋯ Transducer leveling and zeroing plus maintenance of the hydraulic tubing system between the transducer and bedside monitor are especially important. These variables may greatly influence the accuracy of the displayed pressures and, therefore, must be considered during donor assessment as treatment is considered.
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Most organ procurement organization professionals and transplant surgeons intuitively know that meeting donor management goals improves organ allocation and transplant outcomes. In this era of evidence-based medicine, it is important to know whether the data support this assumption. ⋯ Results were broken down by donor type: standard-criteria donation, expanded-criteria donation, and donation after cardiac death. For all 6 organ procurement organizations combined, the data for all of 2008 show a substantial and statistically significant improvement in number of organs transplanted per donor for standard criteria donation and total donors when goals are met, with a smaller degree of improvement (although not statistically significant) in the number of organs transplanted per donor for expanded-criteria donation and donation after cardiac death when goals are met.
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Demographic factors and factors from donors' medical and social history influence the number of organs transplanted per donor. The goal for organ procurement organizations is 4.30 organs transplanted per standard criteria donor. ⋯ Demographic factors and other factors in donors' medical and social histories significantly reduced the number of organs transplanted per donor. An algorithm that uses all potential demographic factors and factors related to medical and social history nested within each other could be developed to predict number of organs transplanted.
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Editorial Biography Historical Article
Courage and character, leaders and legends: an interview with Maria Siemionow, MD, PhD, DSc.