Prog Transplant
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To examine attitudes toward death criteria and their relation to attitudes and behaviors regarding organ donation. ⋯ Both general and ethical education may serve to guide policy and facilitate family member requests and informed consent dialogues. Furthermore, helping families to understand and accept not only medical and legal criteria for determining death, but also ethical criteria for withdrawing life support may help them be more comfortable with their decisions.
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Serum concentrations of thyroid hormones tetraiodothyronine and triiodothyronine commonly are low after head injury and brain death. Thyroid hormone replacement therapy, however, is a controversial part of donor management. ⋯ No publications support the routine administration of thyroid hormone for all donors. "Rescue" replacement in support of cardiac inotropic function is supported by some studies, but the experimental design of those investigations is not optimal. Thyroid hormone replacement and its dosing should be decided by organ procurement organizations as part of treatment protocols.
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Significant systemic changes occur following neurologic insult and subsequent brain death. If left untreated, the hemodynamic instability and neuroendocrine alterations that ensue may significantly affect the quality of the donor organs, and contribute to posttransplant allograft dysfunction. A number of pharmacologic interventions are often implemented in an attempt to stabilize donor hemodynamics and optimize organ perfusion, thereby increasing the number and quality of cadaveric donor organs available for transplantation. This review provides a summary of these interventions, with an emphasis placed on hormonal resuscitation, which involves utilizing such agents as thyroxin, vasopressin, insulin, and corticosteroids.
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Solid-organ transplantation is often the last alternative in many patients with end-stage organ disease. Although advances in immunosuppressive regimens, surgical techniques, organ preservation, and overall management of transplant recipients have improved graft and patient survival, infectious complications remain problematic. ⋯ Proper prophylactic and treatment strategies are imperative in the face of chronic immunosuppression, nosocomial and community pathogens, emerging drug resistance, drug-drug interactions, and medication toxicities. This review summarizes the pathophysiology, incidence, prevention, and treatment strategies of common posttransplant infections.
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This article explores the role of ethics and regulation in human research conducted by organ procurement agencies; basic ethical principles for human research are outlined. Organ procurement agencies are not required to observe federal regulations; however, voluntary adherence will ensure that procurement research is conducted according to current standards of ethical practice. ⋯ Even if studies qualify for exempt status, there is a moral presumption that informed consent should be sought, unless certain narrow conditions for waiver of consent are satisfied. Finally, when future research utilizing organ procurement records is anticipated, procurement coordinators should provide sufficiently detailed information to families about such plans to permit their advance informed consent to research activities.