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2005, Number 3

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Cir Cir 2005; 73 (3)

Experiences with the en bloc multiorgan procurement technique

Gala-López BL, Copo-Jorge JA, Soliva-Domínguez R, Savío-López MA, Pérez-Prado J, Goyenechea-Hernández F

Language: Spanish
References: 63
Page: 193-198
PDF size: 77.01 Kb.


ABSTRACT

Introduction: The pressing need to obtain organs for transplantation demands an optimal usage of donors. Surgical techniques based on rapid multiorganic retrieval gain vital importance especially when hemodynamically unstable donors are involved.
Objective: To highlight the advantages of this technique and evaluate our experience after 2 years of implementation.
Material and methods: A longitudinal, prospective non-controlled study was performed, including 34 multiorganic retrievals using the Total Abdominal Evisceration (TAE) technique. Information on demographic characteristics, surgical times, anatomical variations and final fate of organs is gathered.
Results: Thirty four organ retrievals were performed using TAE techniques. Included donors had a mean age of 47 years and a mean weight of 66 kg. Dissection time range was 35 ± 10 min, bloc retrieval was performed in 20 ± 8 min and dissection at backbench range was 100 ± 30 min. All anatomic variations were detected and were present in 46.9 % of cases. Over 70 % of livers retrieved by TAE resulted in minimal preservation injury. Only one presented primary non-function after transplantation, directly related to hemodynamic instability.
Conclusions: The TAE technique for multiorgan retrieval allows adequate harvesting of organs for transplantation with favorable preservation. It is a valid alternative for transplant groups.


REFERENCES

  1. 1. Rosenthal JT, Shaw BW Jr, Hardesty RL, Griffith BP, Starzl TE, Hakala TR. Principles of multiple organ procurement from cadaver donors. Ann Surg 1983;198(5):617-621.

  2. 2. Taber S. Renal replacement therapy. 6-2. Other aspects of renal transplantation-donor procurement, preservation and alternative rejection therapy. Nurs Times 1982;78(22):935-939.

  3. 3. Starzl TE, Hakala TR, Shaw BW Jr, et al. A flexible procedure for multiple cadaveric organ procurement. Surg Gynecol Obstet 1984; 158(3):223-230.

  4. 4. Starzl TE, Miller C, Broznick B, Makowka L. An improved technique for multiple organ harvesting. Surg Gynecol Obstet 1987;165 (4):343-348.

  5. 5. Lerut J. Multiorgan procurement Acta Chir Belg 1987;87(3):177-183.

  6. 6. Van Thiel DH, Schade RR, Hakala TR, Starzl TE, Denny D. Liver procurement for orthotopic transplantation: an analysis of the Pittsburgh experience. Hepatology 1984;4(Suppl 1):66S-71S.

  7. 7. de Ville de Goyet J, Reding R, Hausleithner V, Lerut J, Otte JB. Standardized quick en bloc technique for procurement of cadaveric liver grafts for pediatric liver transplantation. Transpl Int 1995; 8(4):280-285.

  8. 8. Imagawa DK, Olthoff KM, Yersiz H, et al. Rapid en bloc technique for pancreas-liver procurement. Improved early liver function. Transplantation 1996;61(11):1605-1609.

  9. 9. Kollar A, Stratta RJ, Grandas OH, Kizilisik T. Alternative technique to cannulate the descending aorta for abdominal organ procurement in a hemodynamically unstable patient. Prog Transplant 2001; 11(1):67-69.

  10. 10. Nakazato PZ, Concepción W, Bry W, et al. Total abdominal evisceration: an en bloc technique for abdominal organ harvesting. Surgery 1992;111(1):37-47.

  11. 11. Nakazato PZ, Itasaka H, Concepcion W, Lim J, Esquivel C, Collins G. Effects of abdominal en bloc procurement and of a high sodium preservation solution in liver transplantation. Transplant Proc 1993; 25(1 Pt 2):1604-1606.

  12. 12. Boillot O, Benchetrit S, Dawahra M, Porcheron J, Martin X, Fontaumard E. Early graft function in liver transplantation: comparison of two techniques of graft procurement. Transplant Proc 1993;25(4):2626-2627.

  13. 13. Colectivo de autores. Trasplante de órganos. En: Anuario estadístico del Ministerio de Salud Pública de Cuba, 2003. La Habana: Editorial Pueblo y Educación; 2004. pp. 127-131.

  14. 14. Arranz J, Soriano A, Garcia I, et al. Association between anatomopathologic graft disorders during reperfusion and vena cava sIL-2r in orthotopic liver transplantation. Transplant Proc 2003; 35:1880-1883.

  15. 15. Angelescu M, Hofmann W, Zapletal C, et al. Histomorphological analysis of preservation injury as determinant of graft quality in clinical liver transplantation. Transplant Proc 1999;31:1074-1076.

  16. 1. Kessler D, McClellan M. Do doctors practice defensive medicine? Q J Econ 1996;111(2):353-390.

  17. 2. Mirallas MJA. Medicina defensiva y consentimiento informado en rehabilitación. Rehabilitación 2003;37(2):65-66.

  18. 3. Lifshitz A. En defensa de la clínica. Acta Pediat Mex 1999;20(4):165-167.

  19. 4. Campbell T. Medical interviewing and the biopsychosocial model. Fam Pract 1998;47(5):339-340

  20. 5. McQuade JS. The medical malpractice crisis reflections on the alleged causes and proposed cures. J R Soc Med 1991;84:408-411.

  21. 6. Rivero-Serrano O. Los riesgos de la medicina defensiva en una sociedad en proceso de cambio. Rev CONAMED 1999;3(13):7-11. http://www.imbiomed.com/1/1/articulo=8113&id (accesado el 21/07/2004).

  22. 7. U.S. Congress, Office of Technology Assesment. Defensive Medicine and Medical Malpractice. OTA-H-602. Washington, DC: U.S. Government Printing Office;July 1994.

  23. 8. Baldwin LM. Hart LG. Lloyd M. Fordyce M. Rosenblatt R. Defensive medicine and obstetrics. JAMA 1995;2674:1606-1610.

  24. 9. Summerton N. Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ 1995;310(6971): 27-29.

  25. 10. Passmore K. Leung WC. Defensive practice among psychiatrists: a questionnaire survey. Postgrad Med J 2002;78:671-673.

  26. 11. Cusack D. Ireland: breakdown of trust between doctor and patient. Lancet 2000;356:1431-1432.

  27. 12. Dubay L, Kaesner R, Waidmann T. The impact of malpractice fears on cesarean section rates. J Health Econ 1999;18:491–522.

  28. 13. Amon E, Winn HN. Review of the professional medical liability insurance crisis: lessons from Missouri. Am J Obstet Gynecol 2004; 190(6):1534-1538.

  29. 14. Borges W. Living in fear. Physicians face mounting liability insurance crisis. Tex Med 2002;98(5):34-40.

  30. 15. Rosenblatt RA, Detering B. Changing patterns of obstetric practice in Washington State: the impact of tort reform. Fam Med 1988; 20(2):101-107.

  31. 16. Ladimer I. Alternative dispute resolution in health care. In: Sanbar SS, Gibofsky A, Fireston MH, Le Blang TR, eds. Legal medicine. 3rd. ed. St. Louis: CV Mosby & Co; 1995.

  32. 17. Appelbaum PS, Grisso T. Assessing patients’ capacities to consent to treatment. BMJ 1998;319:1635-1637.

  33. 18. Drew P, Chatwin J, Collins S. Conversation analysis: a method for research into interactions between patients and health care professionals. Health Expectations 2001;4:58-72.

  34. 19. Walter R, Kasperski J. The benefits of a trusting physician patient relationship. J Fam Pract 2002;50(4):329-331.

  35. 20. Palmisano D. Health care in crisis. Circulation 2004;109(24):2933-2935.

  36. 21. Birbeck GL, Gifford DR, Song J, Belin TR, Mittman BS, Vickrey BG. Do malpractice concerns, payment mechanisms, and attitudes influence test-ordering decisions? Neurology 2004;62(1):119-121.

  37. 22. Gracia GS, Laborda CE. Responsabilidad. En: De Lorenzo MR, coord. Responsabilidad legal del profesional sanitario. Madrid: Asociación Española de Derecho Sanitario; 2000. pp. 173-280.

  38. 23. Tena TC, Sánchez GJ, Rivera CA, Hernández GL. La práctica de la medicina y la responsabilidad médica. Algunas reflexiones en torno. Rev Med IMSS 2003;41(5):407-409.

  39. 24. De Lorenzo R. Responsabilidad legal del profesional sanitario. Madrid: Edicomplet; 2000. pp. 191-200.

  40. 25. Berger JE. Professional liability overage for residents and fellows. Pediatrics 2000;106(3):605-609.

  41. 26. Sarmiento A. Complications and litigation. Clin Orthop 2004;(420): 319-321.

  42. 27. Maughan PJ. Medical negligence and the law. Br J Surg 2001;88(7): 899-900.

  43. 28. Segovia EJ. La medicina de la desconfianza. SEMERGEN 2003; 29(7):384.

  44. 29. Grepperud S. Medical errors: responsibility and informal penalties. Harvard Health Pol Rev 2004;5(1):89-95.

  45. 30. Tracy TF Jr, Crawford LS, Krizek TJ, Kern KA. When medical error becomes medical malpractice: the victims and the circumstances. Arch Surg 2003;138(4):447-454.

  46. 31. Brasel KJ, Layde PM, Hargarten S. Evaluation of error in medicine: application of a public health model. Acad Emerg Med 2000;7:1298-1302.

  47. 32. Anderson RE. Billions for defense: the pervasive nature of defensive medicine. Arch Intern Med 1999;159(20):2399-2402.

  48. 33. Secretaría de Salud (México). Directorio Sectorial de Unidades Médicas. Disponible en: http://www.salud.gob.mx/apps/htdocs/estadisticas/Unidades_Medicas/DirUMb.htm

  49. 34. Hernández-Sampieri R, Fernández CC, Baptista LP. Metodología de la investigación. 2ª ed. México: McGraw Hill; 1991. pp. 57-60.

  50. 35. Kerlinger FN, Lee HB. Investigación del comportamiento. Métodos de investigación en ciencias sociales. 4ª ed. México: McGraw Hill; 2002. pp. 541-560.

  51. 36. Kereiakes DJ, Willerson J. Health care on trial: America’s medical malpractice crisis. Circulation 2004;109:2939-2941.

  52. 37. Cline R, Pepine C. Medical malpractice crisis: Florida’s recent experience. Circulation 2004;109:2936-2938.

  53. 38. Jourdan S, Rossi M, Goulding J. Italy: medical negligent as a crime. Lancet 2000;356: 1268-1269.

  54. 39. Cusack D. Ireland: breakdown of trust between doctor and patient. Lancet 2000;356:1431-1432.

  55. 40. New Zealand Government. Available from public access computer systems at http://www.moh.gout.nz (accessed 02.18.04).

  56. 41. United Kingdom Health Department. Available from public access computer systems at http://www.doh.gov.uk/dhhome.htm (accessed 20.18.04).

  57. 42. Berger JE. Professional liability coverage for residents and fellows. Pediatrics 2000;106(3):605-609.

  58. 43. Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM. Physician-patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997;277:553-559.

  59. 44. Tena Tamayo C, Hernández Orozco F. La Comunicación humana en la relación médico-paciente. 1ª ed. Mexico: ed. Prado; 2004 (en prensa).

  60. 45. Martínez H, Moreno R. Análisis de algunos modelos de aprendizaje humano desde la perspectiva del patrón de acciones comparativas. Rev Mex Analisis Conducta 1995;21(1):67-91.

  61. 46. Lefevre FV, Waters TM, Budetti PP. A survey of physician training programs in risk management and communication skills for malpractice prevention. J Law Med Ethics 2000;28(3):258-266.

  62. 47. Charles SC, Wilbert JR. Franke KJ. Sued and nonsued physicians’ self-reported reactions to malpractice litigation. Am J Psychiatry 1985;142:437-440.

  63. 48. Ruíz Reyes G. Ética y laboratorio clínico. Rev CONAMED 2001;10 (21):2024.




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