Organ Procurement and Transplantation Assessing Current Policies and the Potential Impact of the DHHS Final Rule (1999) / Chapter Skim
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6 Organ Failure and Patient Survival
6 Organ Failure and Patient Survival
Pages 91-122
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From page 91... ...
The effects of solid organ ischemic times on transplant outcomes has not been rigorously evaluated in the past. The committee reviewed existing literature and made judgments based on this information that are in general agreement with current practices.
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From page 92... ...
An approximate 4.2 percent reduction in primary graft nonfunction, achieved by eliminating severely steatotic (i.e., "fatty") livers, reducing ischemic times, and using selected patients has been reported to reduce the need for retransplantation due to primary nonfunction or initial poor function (D'Allesandro et al., 1998~.
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From page 93... ...
An important distinction must be made, for purposes of this analysis, between what might be labeled "maximal achievable cold ischemic time" (i.e., the longest duration of cold storage to which an ideal organ can be exposed and still have some measurable chance of functioning when reanastomosed to a blood supply) and "medically acceptable ischemic time" (i.e., the duration of cold ischemia that has been associated in clinical experience with an appropriate and acceptable percentage of acute and long-term organ survival)
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From page 94... ...
TABLE 6-1 Summary of Literature on Cold Ischemic Time for Solid Organs Medically Acceptable Cold Ischemic Time* (simple cold storage using appropriate preservation fluids)
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From page 95... ...
Promulgation and enforcement of minimum performance guidelines should help optimize graft survival of the overall population. Given the critical nature of this system, all involved parties should be monitored for quality control and quality assurance and for compliance with recommended methods and processes.
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From page 96... ...
POSTTRANSPLANT PATIENT SURVIVAL In an effort to better understand the determinants of organ failure and posttransplant survival, the committee examined posttransplant mortality data for liver transplant recipients who were transplanted in 1998 and 1999, using the data provided to this committee by UNOS. Attention was restricted to this more current period because of the change by I3NOS in 1998 to the definitions of medical urgency status categories.
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From page 97... ...
There are significant medical differences between solid~organ~and~: bone marrow transplantations, as well apse many differences in~the processes of dor~or recruitment and Organ procurement. However there are also sig , nificant commonalities in making ~ a scarce human resource available to critically ill individuals in airepro~ducible~,~ effective, Waned sate fashion Many of the issues that concern access for the socioeconom~ically und~erserved as well as the particular biologic issues that influence organ availability for minority populations are common to both groups.
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From page 98... ...
Although the committee did not find comparable research for liver transplantation, it did find that the 1997 Report of Center Specific Graft and Patient Survival Rates, produced by UNOS (UNOS, 1997) , contains a table showing that several of the transplant centers doing 25 or fewer liver transplants had 1-year graft survival rates significantly lower than expected, given the health status of their patients (see Fig.
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From page 99... ...
OR GAN FAILURE AND PA TIENTSUR VITAL 99 viewed existing literature and made judgments based on this information that are in general agreement with current practices. Data analysis also supports the previously reported association between volume and outcome in this case, larger OPOs are associated with decreased mortality rates following transplantation.
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From page 103... ...
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From page 119... ...
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From page 121... ...
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