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Background
The aim of this study was to analyze the value of the unadjusted CUSUM graph of liver surgical injury and discard rates in organ procurement in the Netherlands.
Methods
Unadjusted CUSUM graphs were plotted for surgical injury (C event) and discard rate (C2 event) from procured livers accepted for transplantation for each local procurement team compared with the total national cohort...
We explore the efficiency and distributive implications of a multilateral bargaining model with endogenous production of the surplus under two different timings: ex ante and ex post bargaining. Both timings are commonly observed in business partnerships and alliance formations. The theoretical predictions confirm an intuitive economic tenet: in ex post bargaining, effort is considered sunk and opportunistic...
Background: Closing the donor body is the last surgical step during organ procurement. The fluid from the thorax and the abdominal cavity is removed. The last inspection of the cavities and remaining organs is done. The body is filled with absorbing materials and closed properly, following the same surgical rules as that followed after every operation. Leakage...
Background: A tense or competitive atmosphere in the operating room and unprofessional communication skills between members of the thorax and abdominal organ retrieval teams may lead to donor instability, inadequate organ preservation or surgical injury. During organ procurement, thorax and abdominal teams, which are involved in the organ procurement, have to...
Background: Organ procurement is the lifeblood of organ transplantation. A tense competitive atmosphere in the operating room and unprofessional communication skills between transplant coordinator and the members of organ retrieval team(s) may lead to inadequate preservation or surgical injury to the organs. At this stage, all mistakes, which have been made, can make...
Background: The hepatoduodenal ligament extends between the liver and the first portion of the duodenum and is continuous with the right border of the hepatogastric ligament. It contains the common bile duct, hepatic artery and portal vein as well as the hepatic plexus and the lymph nodes. Recognising abnormal arterial vascularisation and creating the landmarks...
Background: After external and internal organ cooling and preservation, the first thoracic organs are procured. During lung retrieval, the anaesthetist must be present in the OR. Procured organs are packed according to the international or national rules and put on ice in special transport boxes. To safeguard the organ recipient, at the end of the procedure, even if...
Background: Every organ and the tool-kit coming from organ procurement have to be packed according to the Eurotransplant or National Transplant Organization regulations. The packed organs are placed in an icebox and fully covered with non-sterile, melting ice. Correct packing, without air around every organ, allows good cooling, an optimal temperature during...
Background: Generally, inspection of abdominal organs should include liver, pancreas, stomach, small bowel, colon, and pelvis. In women, attention should be paid to the pelvis with careful inspection of the ovaries and uterus. During organ inspection, attention should be also given to the enlarged lymph nodes in the iliac fossa, small bowel mesentery, para-aortic region, hepatoduodenal ligament,...
Background: Superior mesenteric artery (SMA) and infrarenal major vessel dissection is the next step after the Cattel–Braasch manoeuvre, which consists of dissection, in the retroperitonem, of the following vessels and structures: infrarenal aorta, inferior vena cava (IVC), SMA, inferior mesenteric artery (IMA), inferior mesenteric vein (IMV), celiac trunk and plexus...
Background: Having arrived at the donor hospital, the procurement team has to observe a prescribed protocol in organ procurement. First, the TC should introduce the surgeons to the operating room personnel. One of the surgeons has to check, together with scrub nurse(s), the readiness of the operating room (OR) and explain the operating technique. In the meantime, the...
Background: Small bowel procurement demands both experience and surgical skill from the surgeon. There are few regional teams in Europe, which are sufficiently experienced in small bowel dissection and procurement. The small bowel, in most cases, is retrieved by the recipient centre team experienced in the field of small bowel retrieval and transplantation. There are...
Background: Where all organs were accepted and, after inspection, are found to be suitable for transplantation, the following sequence of abdominal organ procurement is recommended: small bowel, pancreas, liver, kidneys. The small bowel is the most sensitive organ for ischemia; therefore, it is retrieved first. The second organ to be procured from the abdomen is the pancreas followed...
Background: By filling the operation report and quality forms, the procurement surgeon fulfils the national or international rules for organ procurement. All findings and decisions that were taken during organ procurement have to be documented. Information must be clear to everybody who was involved in organ procurement and transplantation. ...
Background: The tool-kit plays a very important role during organ harvesting and transplantation. It consists of the arteries and the veins removed during organ procurement. The tool-kit is used for the reconstruction of different vessels for both the retrieved organ as well as for the vessels of the recipient. The quality of the procured tool-kit is very important...
Background: Placing the bowels in the physiological position in the abdomen, mobilisation of the left liver lobe, followed by lesser omentum inspection (left aberrant hepatic artery), abdominal oesophagus dissection and cutting the right crus of the diaphragm are the steps that have to be taken to access the supraceliac abdominal aorta. Freed and marked, the supraceliac...
Background: Following major vessel cannulation, decide with the thoracic surgeon upon the timing of thoracic and abdominal organ perfusion. The sequence for cold perfusion where multi-organ procurement is envisaged is first the thoracic organs and next the abdominal ones. Both thoracic and abdominal surgeons together with the transplant coordinator must ascertain adequate quality of the thoracic and...
Background: Before abdominal aorta and IVC cannulation, come to an arrangement with the thoracic team about the cannulation. In most cases, where the thoracic organs are procured, the major thoracic vessels are cannulated first followed by the second, abdominal ones. The transplant coordinator(s) and the anaesthetist have to be present in the operating room during...
Background: The Cattel–Braasch manoeuvre is based on the anatomical observation that the small mesentery is attached to the posterior abdominal wall along a short oblique line of fusion. The Cattel–Braasch manoeuvre begins at the common bile duct and ends at the ligament of Treitz. It allows you to mobilise the whole duodenum, pancreas head, small bowel and the right...
Background: After thoracic and abdominal organ dissection, a preservation solution is chosen and preparation for organ perfusion is started. Cold preservation solution is taken from the transport box or refrigerator and afterwards, the surgeon, together with the transplant coordinator and the scrub nurse, prepares the abdominal aorta perfusion system and also, if necessary, the inferior...
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