Organ and tissue procurement in the acute care setting: principles and practice--Part 2

In this two-part series on organ and tissue procurement in the acute care setting, the procurement problem, cost-benefit analysis, organizational development and framework, approach to surviving relatives, public attitudes, and brain death certification were discussed in part 1 (January 1990). Part 2 examines evaluation, selection, maintenance, and management of the organ-tissue donor. It concludes with a discussion of disease transmission, controversial issues, and financial considerations relevant to the procurement process in the acute care setting.

Organ and tissue procurement in the acute care setting: principles and practice--Part 1

The specialty of organ transplantation has grown tremendously during the past decade. With the advent of cyclosporine, artificial organs, and organ-assist devices, the possibility of suitable patients with end-stage organ disease becoming successful transplant recipients has increased dramatically. Consequently, the need for donor organs has risen. The greatest source of potential organ-tissue donors exists in the acute care setting (ie, emergency departments and intensive care units). To meet the need for this increasing demand, emergency physicians must become familiar with the techniques of procurement. Part 1 defines the problem of procurement and presents financial, historic, organizational, legal, and psychosocial aspects of organ-tissue procurement. A synopsis of brain death concludes the discussion. Part 2 (February 1990) presents aspects of the evaluation, selection, maintenance, and management of the organ-tissue donor. Disease transmission and controversial issues in organ-tissue procurement also are discussed.

Mozart's requiem--liver transplantation in 1988

Liver transplantation is one of the most spectacular of surgical achievements. It is a demanding and expensive procedure, requiring great surgical skill and a great depth of supporting services. Precisely because it is a procedure at the leading edge of medicine, more and more units in developed countries are pressing to be allowed to carry it out. But there are many moral and ethical problems, some of which can be usefully examined using a "Mozart model" as proposed by Starzl.

Medicare and Medicaid programs; organ procurement and transplantation network rules and membership actions--HCFA. General notice

This notice sets forth the Secretary's interpretation of certain provisions of section 1138 of the Social Security Act. That section requires Medicare and Medicaid participating hospitals that perform organ transplants to be members of and abide by the rules and requirements of the Organ Procurement and Transplantation Network (OPTN) as established by section 372 of the Public Health Service Act. Section 1138 also requires that for organ procurement costs attributable to payments to an Organ Procurement Organization (OPO) to be paid by Medicare or Medicaid, the OPO must be a member of and abide by the rules and requirements of the OPTN. No other entity (for example, a histocompatibility laboratory) is required to be a member of or abide by the rules of the OPTN under the provisions of the statute. This notice states that no rule, requirement, policy, or other issuance of the OPTN will be considered to be a "rule or requirement" of the Network within the meaning of section 1138 unless the Secretary has formally approved that rule. It also provides that no action of the OPTN to deny an applicant or member membership status in the OPTN will be considered effective under section 1138 unless the Secretary has ratified that action.

Medicare program; payment for kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries--HCFA. Final rule

These final regulations exclude from Medicare payments made to organ procurement organizations the costs associated with kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries. In addition to reducing Medicare expenditures by eliminating Medicare subsidization of the costs of kidneys sent to foreign countries or transplanted in patients other than Medicare beneficiaries, we intend these regulations to increase the availability of kidneys to Medicare beneficiaries who are suitable transplant candidates. This could result in medical and social benefits for transplanted patients, and reductions in Medicare expenditures because kidney transplantation is more cost-effective than maintaining beneficiaries on kidney dialysis.

Combination harvesting procedure for liver and whole pancreas

Combination harvesting procedures for the liver and whole pancreas can be carried out successfully in most instances, but this requires agreement between the liver and pancreas teams concerning the vascular supply for the grafts. If one donor team is in charge of both organs, the procedure has considerable economical advantages. Even if one organ is not suitable, partial success is sufficient to compensate for the effort and costs.