Prog Transplant
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Mechanical circulatory support devices such as ventricular assist devices have become the approved and accepted treatment option to improve survival and quality of life in patients with advanced heart failure refractory to medical therapy. Patients as a result are living longer and presenting to emergency medical services, primary care facilities, emergency departments, and critical care units more frequently. ⋯ We present a comprehensive overview of the types of mechanical assist devices, their complications, and an algorithmic approach to the emergency management in the patients with mechanical circulatory support. A systematic method is crucial in prompt and early recognition of emergencies to ensure appropriate management of these patients.
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To review the components of the Congressional mandate for risk evaluation and mitigation strategies (REMS) managed by the Food and Drug Administration and assess their impact on health care providers practicing within the organ transplant arena. ⋯ REMS are another step in the evolution of the development and marketing of pharmaceutical agents. Use of REMS in solid-organ transplant is becoming common. Transplant clinicians must provide required patient education and become involved with other aspects of REMS implementation to reduce the serious risks of pharmaceuticals and to improve patients' outcomes.
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Little systematic research has been conducted to understand pain among persons with end-stage liver disease, especially among liver transplant candidates. Appropriate pain assessment and management are important areas of consideration as treatment options are limited. ⋯ Pain is a significant problem among liver transplant candidates, and current pain treatments are perceived to be relatively ineffective. Increased understanding is needed to safely and effectively evaluate and treat such medically complicated patients.
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Resources are currently targeted at increasing organ and tissue donation rates from emergency departments in Australia. Health care professionals' beliefs and personal attitudes regarding organ and tissue donation are known to influence professional attitudes and practice. ⋯ Although Australian emergency department clinicians are generally positive toward organ and tissue donation, some groups could potentially benefit from education to change their beliefs and attitudes about organ and tissue donation further.
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Since 1998, lung transplants have increased almost 75%, making lung transplant the fastest growing form of organ transplant in the United States. However, the supply of transplantable lungs continues to fall short of the demand. Strategies for expanding the lung donor pool by increasing the number of older donor lungs used has been effective, although these donors do not meet typical clinical selection criteria based on age. ⋯ The following case study illustrates how an "every organ, every time" attitude combined with a technique to communicate clinical information resulted in the successful transplant of 72-year-old donor lungs into a bilateral lung recipient. Since the case outlined in this study, the organ procurement organization has successfully recovered and transplanted an additional 2 lungs from a 74-year-old and 1 lung from a 76-year-old, 2 of the oldest lung donors in the United States. This case demonstrates that although many older donor lungs are deemed unsuitable by clinical selection criteria, an extended criteria population offers an untapped resource for donor organs.