Procurement, Preservation and Allocation of Vascularized Organs

Procurement, Preservation and Allocation 01 Vascularized Organs

Edited by

G.M. Collins California Pacific Medical Center, Department of Transplantation, San Francisco, California, USA

J.M. Dubernard Transplantation Pavillon V, H6pital Edouard Herriot, Lyon, France

W. Land Division of Transplant Surgery, Department of Surgery, Klinikum Grosshadern, University of Munieh, Munieh, Germany

G.G. Persijn Eurotransplant Foundation, Leiden, The Netherlands

Springer-Science+Business Media, BV

Library of Congress Cataloging-in-Publication Data Procurement, preservation, and allocation of vascularized organs /

edited by G.M. Collins ... [et al.]. p. cm.

Inc1udes bibliographical references and index. ISBN 978-94-010-6280-0 ISBN 978-94-011-5422-2 (eBook) DOI 10.1007/978-94-011-5422-2 1. Donation of organs, tissues, etc. 2. Preservation of organs,

tissues, etc. I. Collins, G.M. [DNLM: 1. Organ Procurement. 2. Organ Preservation. 3. Tissue

Donors. WO 660 P964 997] RDI29.5.P754 1997 617.9'5 - dc21 DNLMlDLC for Library of Congress 96-38863

ISBN 978-94-010-6280-0

Printed on acid-free paper

All Rights Reserved © 1997 Springer Science+Business Media Dordrecht Originally published by Kluwer Academic Publishers in 1997 Softcover reprint of the hardcover 1 st edition 1997 No part ofthe material protected by this copyright notice may be reproduced or utilized in any fonn orby any meam, electronic or mechanical, inc1uding photocopying, recording or by any infonnation storage and retrieval system, without written permission from the copyright owner.

Contents

Preface

List of Contributors

SECTION I: DONOR CONDITIONING AND SURGERY

Living kidney donation: preoperative evaluation and preparation for surgery N. Lefrancois, 1.L. Touraine

2 Kidney recovery from living related donors X. Martin, P. Cloix, M. Dawahra, 1.M. Dubernard

3 Anaesthesia and resuscitation of the genetically related living donor in liver transplantation D. Gille, O. Boillot, M.e. Graber, P. Sagnard, e. Beaude, B. Chabrol, e. Kopp, D. Long, B. Delafosse, G. Bagou

4 Living-related liver transplantation (LRL T) N. Habib, X. Rogiers, e.E. Broelsch

5 Diagnosis of brain death G.-E. Chatrian

6 Selection of multi visceral cadaveric organ donors M.E. Wachs, L. Ascher

7 Management of the cadaver donor in the intensive care unit M.J. Lindop

8 Donor conditioning in organ procurement D. Novitzky

9 Perioperative management of cadaveric donor D. Dorez, 1.J. Colpart, A. Mercatello

10 Multiple organ procurement X. Martin, P. Cloix, M. Dawahra, 1. Ninet, l.M. Dubernard

11 The contribution of the non-heart-beating donor to the solution of the shortage of kidneys G. Kootstra, M.H. Booster, R.M.H. Wijnen, H. Banke, E. Heineman

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SECTION II: ORGAN PRESERVATION

12 Biochemistry and cell physiology of organ preservation J.H. Southard

13 Preservation by simple hypothermia V. Marshall

14 Pulsatile preservation in renal transplantation M.L. Henry

15 Endothelial cell damage and Kupffer cell activation in reperfusion injury to livers stored for transplantation J.J. Lemasters, R.C. Thurman

16 Pharmacological agents in organ preservation D. Anaise

17 Kidney preservation C.M. Collins

18 Liver preservation: historical review of preservation techniques N. V. Jamieson

19 Heart and lung preservation w.N. Wicomb

20 Small bowel preservation F.J. Rodriguez-Quilantdn, L.H. Toledo-Pereyra

21 Pancreas preservation D.E.R. Sutherland, K. Moudry-Munns, A. Cruessner

SECTION III: ALLOCATION AND LOGISTICS

22 Principles of kidney allocation J.M.J. De Meester, C.C. Persijn

23 Principles of liver allocation in Eurotransplant U. Jost, B. Ringe

24 Principles of heart allocation A. Haverich

25 Kidney allocation in highly sensitized patients F.H.J. Claas

26 Principles of lung allocation K.D. McNeil, J. Wallwork

CONTENTS

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131

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CONTENTS

27 Organization and logistics in organ exchange B. Haase-Kromwijk, 1.M.l. De Meester, G.G. Persijn

28 Costs of transplantation F. Th de Charro, A. de Wit

29 The role of the transplant coordinator C. Wight

30 Organ availability in Europe: problems and results G.G. Persijn, B. Cohen

31 Donor hospital development in non-university hospitals L. Roels

32 Kidney preservation and graft outcome: Eurotransplant experience 1.M.J. De Meester, 1.M.A. Smits, G.G. Persijn

33 Primary dysfunction after orthotopic liver transplantation R.l. Ploeg

34 Results of intestinal transplantation R. Margreiter

35 Cardiac transplant survival in relation to preservation M.M. Koerner, G. Tenderich, H. Posival, S. Wlost, H. Gromzik, R. Koerfer

SECTION IV: ETHICS AND LEGISLATION IN ORGAN DONATION

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36 Voluntarism and coercion in living organ donation 295 R.A. Sells

37 Reimbursement, 'rewarded gifting', financial incentives and commercialism in living organ donation 301 A.S. Daar, Th. Gutmann, W. Land

38 Intemationallegislation in living organ donation 317 T. Guotmann, B. Gerok

39 Psychological aspects in living organ donation 325 K.A. Schnee wind

40 Brain death 331 H. Angstwurm

41 A survey of religious attitudes towards organ donation and transplantation A.S. Daar

42 Philosophical arguments for accepting the brain death criterion D. Birnbacher

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43 Legal and judicial aspects of postmortem organ donation B.M. Dickens

CONTENTS

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44 The dilemma of organ allocation: the combination of a therapeutic modality for an ill individual wit'} the distribution of a scarce valuable public (health) good 359 W. Land

45 Living unrelated kidney transplantation 367 G. Thiel

Index 375

Preface

At the brink of the third millennium organ transplanta­tion will become routine and the results will be so ex­cellent that every patient in need of a transplant deserves to be transplanted. How to provide every patient with his or her organ and how to guarantee that the organ is in a superb condition? That is the challenge for all of us privileged to work in this magnificent field of medicine.

In this book, an international team of experts has laid down their intellectual knowledge on the process that precedes successful transplantation: Procurement, Preservation and Allocation. In four sections important aspects of this preamble of the actual transplantation are dealt with.

Section 1 concerns donor conditioning and surgery, Section 2 the organ preservation, Section 3 allocation and logistics, while in Section 4 the important aspects of ethics and legislation in organ donation are covered. Experts from all over the world have contributed to this book, which therefore gives a unique overview of the topics from different angles. In particular, the section on allocation provides the reader with infor-

mati on how, in the case of shortage, a fair allocation of the scarce organs can be achieved. This is a very timely subject that continues to be discussed between doctors and between laymen.

This book serves the needs of several groups of specialists working with transplant patients. Firstly, the doctors who are directly involved in the care of the multi-organ donor, and who have to collaborate to do the best for their recipients. Heart surgeons might like to learn from liver surgeons and vice versa. Secondly, the paramedical specialist who is involved in the treat­ment of transplant patients and their families will find in this book many answers to questions. Students can also use it as a source for general information.

This book will be of great help in defining the material to be studied in educational courses and I hope it will find its way to the library shelf of every transplant program.

G. Kootstra Maastricht, March 20, 1997

List of Contributors

Dr. D. Anaise 1001 West San Martin TUCSON, AZ 85704 USA

Dr. H. Angstwurm Neurologer Klinik Universitat Miinchen Ziemssentrasse 1 D-80336 MUNCHEN Germany

Dr. Nancy L. Ascher Department of Transplantation University of California San Francisco 505 Parnasus A venue n. 886 SAN FRANCISCO, CA 94143-0780 USA

Dr. G. Bagou Service d' Anesthesie Reanimation VII H6pital Edouard Herriot 69437 LYON Cedex 03 France

Dr. C. Baude Service d' Anesthesie Reanimation H6pital Edouard Herriot Pavilion V 69437 LYON Cedex 03 France

Dr. Dieter Birnbacher Universitat Dortmund Fachbereich 14 D-44221 DORTMUND Germany

Dr. O. Boillot Unite de Transplantation Hepatique Federation des Specialites Digestives H6pital Edouard Herriot F-69437 LYON Cede x 03 France

Dr. G.E. Chatrian Professor Emeritus Division of Electroencephalography and Clinical Neurophysiology Department of Neurology, University of Washington School of Medicine Seattle, W A. USA

Dr. P. Cloix Service d'Urologie et Chirurgie de Transplantation H6pital Edouard Herriot Place d' Arsonval 69437 LYON Cedex 03 France

Dr B. Cohen Eurotransplant Foundation P.O. Box 2304 2301 CH LEIDEN The Netherlands

Dr. G.M. Collins Chairman, Department of Transplantation California Pacific Medical Center 2340 Clay Street, Suite 251 SAN FRANCISCO, CA 94115 USA

Dr. lJ. Colpart Coordination Center Regionale et hospitalier H6pital Edouard Herriot F-69437 LYON CEDEX 03 France

Dr. A.S. Daar Department of Surgery P.O. Box 35 AI-Khod I 23-MUSCAT Sultanate of Oman

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Dr. M. Dawahra Service d'Urologie et Chirurgie de Transplantation H6pital Edouard Herriot Place d' Arsonval 69437 LYON Cedex 03 France

Dr. F. Th. De Charro Eurotransplant Foundation P.O. Box 2304 2301 CH LEIDEN The Netherlands

Dr. B. Delafosse Service d' Anesthesie Reanimation V H6pital Edouard Herriot 69437 LYON Cedex 03 France

Dr. Ronald M. Ferguson Department of Surgery Ohio State University 327 Means Hall 1654 Upham Drive COLUMBUS, OH 43210 USA

Ms Patricia Franklin 44 Axtell Road Kidlington OXFORD UK

Dr. D. Gille Unite de Transplantation Hepatique Federation des Specialites Digestives H6pital Edouard Herriot 69437 LYON Cedex 03 France

Dr. M.C. Graber PavilIon H. H6pital Edouard Herriot 69437 LYON Cedex 03 France

Dr. Thomas Gutmann Leopold Wenger-Institut flir Rechtsgeschichte (Abt.B) Universitat Mtinchen Prof-Huber-Platz 2 D-80539 MUNCHEN Germany

LIST OF CONTRIBUTORS

Drs B. Haase-Kromwijk St. Eurotransplant Nederland Postbus 2304 2301 CH LEIDEN The Netherlands

Professor Axel Haverich Medizinische Hochschule Hannover Klinik fur Thorax-, Herz - und Gefasschirurgie Konstanty Gutschowstrasse 8 0-30625 HANNOVER Germany

Dr. E. Heineman Afdeling Chirurgie Academisch Ziekenhuis Maastricht P.O. Box 5800 6202 AZ MAASTRICHT The Netherlands

Dr. M.L. Henry Ohio State University Department of Surgery Division of Tansplantation 259 Means Hall, 1654 Upham Drive COLUMBUS, OH 43210-1228 USA

Dr. N.V. Jamieson Department of Surgery Addenbrooke's Hospital Hills Road CAMBRIDGE CB2 2QQ UK

Dr. Uwe lost U ni versi tat Leipzig Bereich Medizin Transplantationsburo Liebigstrasse 20a 0-04103 LEIPZIG Germany

Dr. G. Kootstra Department of Surgery Academisch Ziekenhuis Maastricht Heelkunde P.O. Box 5800 6202 AZ MAASTRICHT The Netherlands

LIST OF CONTRIBUTORS

Dr. C. Kopp Service d' Anesthesie Reanimation IV Hopital Edouard Herriot 69437 LYON Cedex 03 France

Dr M.M. Koerner Herz-& Diabeteszentr. Nordhein-Westfalen Univ. Klin d. Universitat Bochum Klinik flir Thorax und Kardiovaskularchirurgie Georgstrasse II D-32545 BAD OEYNHAUSEN Germany

Professor W. Land Head of Division Transplantation Surgery Klinikum Grosshadern University of Munich Marchioninistrasse 15 D-81366 MUNCHEN Germany

Dr N. Lenfrancois Service de Medicine de La Transplantation Hospital E. Herriot Place d' Arsonval F-69437 LYON France

Dr. 1.1. LeMasters Laboratory of Cell Biology Department of Cell Biology and Anatomy The University of North Carolina Campus Box 7090, 236 Taylor Hall CHAPEL HILL, NC 27599-7090 USA

Dr. D. Long Service d' Anesthesie Reanimation IV Hospital E. Herriot Place d' Arsonval F-694377 LYON France

Dr K. McNeil Transplant Unit Papworth Hospital Pap worth Everard CAMBRIDGE CB3 8RE UK

Dr. MJ. Lindop Department of Anaesthesia Addenbrookes Hospital CAMBRIDGE CB2 2QA UK

Dr. R. Margreiter Department of Transplant Surgery University Hospital Anichstrasse 35 A-6020 INNSBRUCK Austria

Dr. V. Marshall Department of Surgery Monash University Prince Henry's Hospital St. Kilda MELBOURNE, VICTORIA 3004 Australia

Dr. X. Martin

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Service d'Urologie et de Chirurgie de Transplantation Pavilion V Hopital Edouard Herriot Place d' Arsonval 69437 LYON Cedex 03 France

Dr. 1.MJ. De Meester St. Eurotransplant Nederland Postbus 2304 2301 CH LEIDEN The Netherlands

Dr. A. Mercatello Centre d'acceuil de la mort cerebrale Service d'anesthesie et reanimation Pavilion P Hopital Edouard Heriot 69437 LYON Cedex 03 France

Dr. 1. Ninet Hopital Louis Pradel F-69500 BRON France

Dr. D. Novitzky The University of South Florida College of Medicine, Dept. of Surgery Harbourside Medical Tower, Suite 730 4 Columbia Drive TAMPA, FL 33606 USA

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Dr. G.G. Persijn Eurotransplant Foundation P. O. Box 2304 2301 CH LEIDEN The Netherlands

Dr. Rutger J. Ploeg Department of Surgery University Hospital Groningen P.O Box 30 001 9700 RB GRONINGEN The Netherlands

Dr. Leo Roels CPTC The Leuven Colloborative Group for Transplantation Heerestraat 49 B-3000 LEUVEN Belgium

Dr. X. Rogiers UniversiUit Hamburg Chirurgische Klinik Martinistrasse 52 D-20246 HAMBURG Germany

Dr. P. Sagnard Pavillon D Hopital Edouard Herriot F-69437 LYON Cedex 03 France

Professor Klaus A. Schneewind Institut fUr Psychologie Universitat MUnchen Leopoldstrasse 13 D-80802 MUNCHEN Germany

Dr. Robert A. Sells Director Renal Transplant Unit Royal Liverpool University Hospital Prescot Street LIVERPOOL, L 7 8XP UK

Dr. I.M.A. Smits St. Eurotransplant Nederland Postbus 2304 2301 CH LEIDEN The Netherlands

LIST OF CONTRIBUTORS

Dr. I.H. Southard Department of Surgery University of Wisconsin H4/332 Clinical Science Center 600 Highland Avenue MADISON, WI 53792-3236 USA

Professor D.E.R. Sutherland Department of Surgery Box 280UMHC University of Minnesota 420 Delaware Street S.E. Minneapolis, MN 55455 USA

Professor G. Thiel Abteilung fUr Nephrologie U ni versiUitskliniken Kantonspital Basel Peters graben 4 CH-4031 Basel Switzerland

Dr. Luis H. Toledo-Pereyra The Michigan Transplant Institute at Borgess Medical Center 1521 Gull Road KALAMAZOO, MI 49001 USA

Dr. M.E. Wachs Department of Transplantation University of California San Francisco 505 Parnasus Avenue, n 886 SAN FRANCISCO, CA 94143-0780 USA

DrJ. Wallwork Cambridge Transplant Unit Papworth Hospital Papworth Everard CAMBRIDGE CB3 8RE UK

Dr. A. de Wit Stichting Renine pia Erasmus Universiteit Faculteit Rechtsgeleerdheid Postbus 1738 3000 DR ROTTERDAM The Netherlands

LIST OF CONTRIBUTORS

Dr. W.N. Wicomb Department of Transplantation California Pacific Medical Center 2340 Clay Street, Suite 251 SAN FRANCISCO, CA 94115 USA

Celia Wight Donor Action Secretariat The White House 67 London Road Harston CAMBRIDGE CB2 5QJ UK

Dr. R.M.H. Wijnen Catharina Ziekenhuis Eindhoven Michel Angeloolaan 2 5623 EJ EINDHOVEN The Netherlands

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