Best practices to optimize utilization of the National Living Donor Assistance Center for the financial assistance of living organ donors

Living organ donors face direct costs when donating an organ, including transportation, lodging, meals, and lost wages. For those most in need, the National Living Donor Assistance Center (NLDAC) provides reimbursement to defray travel and subsistence costs associated with living donor evaluation, surgery, and follow-up. While this program currently supports 9% of all US living donors, there is tremendous variability in its utilization across US transplant centers, which may limit patient access to living donor transplantation. Based on feedback from the transplant community, NLDAC convened a Best Practices Workshop on August 2, 2018, in Arlington, VA, to identify strategies to optimize transplant program utilization of this valuable resource. Attendees included team members from transplant centers that are high NLDAC users; the NLDAC program team; and Advisory Group members. After a robust review of NLDAC data and engagement in group discussions, the workgroup identified concrete best practices for administrative and transplant center leadership involvement; for individuals filing NLDAC applications at transplant centers; and to improve patient education about potential financial barriers to living organ donation. Multiple opportunities were identified for intervention to increase transplant programs' NLDAC utilization and reduce financial burdens inhibiting expansion of living donor transplantation in the United States.

Observation of strong oscillations of areal mass in an unsupported shock wave

An experimental study of hydrodynamic perturbation evolution in a strong unsupported shock wave, which is immediately followed by an expansion wave, is reported. A planar solid plastic target rippled on the front side is irradiated with a 350-450 ps long laser pulse. The perturbation evolution in the target is observed using face-on monochromatic x-ray radiography during and for up to 4 ns after the laser pulse. The theoretically predicted large oscillations of the areal mass in the target are observed for the first time. Multiple phase reversals of the areal mass modulation are detected.

Basic hydrodynamics of Richtmyer-Meshkov-type growth and oscillations in the inertial confinement fusion-relevant conditions

In inertial confinement fusion (ICF), the possibility of ignition or high energy gain is largely determined by our ability to control the Rayleigh-Taylor (RT) instability growth in the target. The exponentially amplified RT perturbation eigenmodes are formed from all sources of the target and radiation non-uniformity in a process called seeding. This process involves a variety of physical mechanisms that are somewhat similar to the classical Richtmyer-Meshkov (RM) instability (in particular, most of them are active in the absence of acceleration), but differ from it in many ways. In the last decade, radiographic diagnostic techniques have been developed that made direct observations of the RM-type effects in the ICF-relevant conditions possible. New experiments stimulated the advancement of the theory of the RM-type processes. The progress in the experimental and theoretical studies of such phenomena as ablative RM instability, re-shock of the RM-unstable interface, feedout and perturbation development associated with impulsive loading is reviewed.

Stability of a shock-decelerated ablation front

Experimental study of a shock-decelerated ablation front is reported. A planar solid plastic target is accelerated by a laser across a vacuum gap and collides with a lower-density plastic foam layer. While the target is accelerated, a fast Rayleigh-Taylor (RT) growth of the seeded single-mode perturbation at the ablation front is observed. After the collision, the velocity of the ablation front is seen to remain constant. The reshock quenches the RT growth but does not trigger any Richtmyer-Meshkov growth at the ablation front, which is shown to be consistent with both theory and simulations.

Instability of a planar expansion wave

An expansion wave is produced when an incident shock wave interacts with a surface separating a fluid from a vacuum. Such an interaction starts the feedout process that transfers perturbations from the rippled inner (rear) to the outer (front) surface of a target in inertial confinement fusion. Being essentially a standing sonic wave superimposed on a centered expansion wave, a rippled expansion wave in an ideal gas, like a rippled shock wave, typically produces decaying oscillations of all fluid variables. Its behavior, however, is different at large and small values of the adiabatic exponent gamma. At gamma > 3, the mass modulation amplitude delta(m) in a rippled expansion wave exhibits a power-law growth with time alpha(t)beta, where beta = (gamma - 3)/(gamma - 1). This is the only example of a hydrodynamic instability whose law of growth, dependent on the equation of state, is expressed in a closed analytical form. The growth is shown to be driven by a physical mechanism similar to that of a classical Richtmyer-Meshkov instability. In the opposite extreme gamma - 1 << 1, delta(m) exhibits oscillatory growth, approximately linear with time, until it reaches its peak value approximately (gamma - 1)(-1/2), and then starts to decrease. The mechanism driving the growth is the same as that of Vishniac's instability of a blast wave in a gas with low . Exact analytical expressions for the growth rates are derived for both cases and favorably compared to hydrodynamic simulation results.

Direct observation of mass oscillations due to ablative Richtmyer-Meshkov instability in plastic targets

We report the first direct experimental observation of the ablative Richtmyer-Meshkov instability. It manifests itself in oscillations of areal mass that occur during the shock transit time, which are caused by the "rocket effect" or dynamic overpressure characteristic of interaction between the laser absorption zone and the ablation front. With the 4-ns-long Nike KrF laser pulse and our novel diagnostic technique (monochromatic x-ray imaging coupled to a streak camera) we were able to register a peak and a valley of the areal-mass variation before the observed onset of the Rayleigh-Taylor growth.

Direct observation of feedout-related mass oscillations in plastic targets

"Feedout" means the transfer of mass perturbations from the rear to the front surface of a driven target. When a planar shock wave breaks out at a rippled rear surface of the target, a lateral pressure gradient drives sonic waves in a rippled rarefaction wave propagating back to the front surface. This process redistributes mass in the volume of the target, forming the feedout-generated seed for ablative Rayleigh-Taylor (RT) instability. We report the first direct experimental observation of areal-mass oscillation associated with feedout, followed by the onset of exponential RT growth.