Progress in Transplantation

Little information is available in the medical and nursing literature concerning organ recovery from brain-dead, pregnant individuals. Many healthcare professionals might rule out such patients as potential donors, especially if childbirth is a possibility. This article presents an actual case study in which the birth of a healthy infant and recovery of organs from the mother were successful. It also reviews the available literature and discusses factors related to organ placement.

This article discusses one organ procurement organization's procedure for facilitating correspondence between donor families and recipients while respecting the needs and rights of all involved. From 1992 to 1995, a total of 542 donor family and recipient correspondences were facilitated. Recipients wrote more than 80% of the letters, with the number of donor family correspondence increasing each year. Trends are discussed including the percentage of correspondence initiated by donor families and recipients, reasons for correspondence not being forwarded by the organ procurement organization, the time frame in which correspondence occurred, and the number of families who requested personal contact.

Previous research has established that organ procurement professionals who talk with families about donation have strong personal preferences concerning the donation of specific organs and tissues. This study examines possible reasons for such preferences and compares them with those of hospital personnel who talk with families about donation. The findings suggest that preferences among procurement personnel closely resemble those of hospital personnel, but procurement professionals' reasons reflect a slightly higher rate of self-interest. Aversions among procurement personnel differ from those of hospital personnel. Procurement personnel have fewer aversions to donating eyes and skin and more aversions to bone, and their aversions are more likely to reflect professional experience with particular donations. The findings suggest the need for changes both in the way donation options are offered to families and the way hospital and procurement personnel are educated.

This descriptive, qualitative study examines manifestations of the Chronic Illness and Recovery models among clinical transplant coordinators. Data collected through focused group interviews revealed that the Chronic Illness model fosters patient dependency, education about the illness itself, a perception that transplantation does not change the chronic nature of illness, a view of patients as socioeconomically disadvantaged and dependent on the transplant center, and the use of reactive approaches to care. In contrast, the Recovery model encourages patient independence, limits coordinators' protective feelings toward patients, provides education for life tasks, perceives patients as socioeconomically advantaged people capable of managing their own lives, and conducts patient care in a proactive manner.

Herbal medicine and health food supplements have become increasingly popular. However, many of these pharmacologically active compounds remain poorly understood. Patients with chronic and life-threatening conditions often use alternative therapies while receiving conventional medical care, and this population is at increased risk for complications and adverse drug interactions due to poor health and complex drug regimens. Patients awaiting or who had received solid organ transplants were surveyed about their use of herbal medicines and health food supplements. Twenty percent of respondents acknowledged experience with these products, which they used to prolong the function of a failing organ or to obtain relief from fatigue and insomnia. Transplant staff often were unaware of their patients' use of these treatments, despite patients' claims to the contrary. The potential for unexpected drug interactions, toxicity, and other adverse reactions resulting from the use of herbal medicines or supplements must be recognized and identified by transplant teams.

The prognosis for patients with pulmonary hypertension is extremely poor. Predictors of poor prognosis among these patients include a cardiac index less than 2.8 L/m/m², a mean pulmonary artery pressure higher than 50 mm Hg, a mean right atrial pressure more than 10 mm Hg, and PaO₂ less than 70 mm Hg. Balloon atrial septostomy was performed as a palliative procedure in six patients with pulmonary hypertension to limit further deterioration while they awaited lung transplantation. The goal of balloon atrial septostomy was to increase cardiac output while limiting the reduction in systemic oxygen saturation to less than 10% of baseline. This procedure may prove to be a valuable adjunct to reduce morbidity and mortality from right ventricular failure for pulmonary hypertension candidates awaiting lung transplantation.

Live-donor kidney transplants accounted for only 27% of all kidney transplants performed in the United States in 1995. Prolonged hospitalization, pain, extended convalescence, and related socioeconomic concerns associated with traditional open-donor nephrectomy surgery may discourage potential donors, contributing to a low percentage of live kidney donors. To remove such disincentives, the laparoscopic live-donor nephrectomy procedure was introduced. In this study, the postdischarge course of 10 laparoscopic nephrectomy donors was compared with that of 27 open nephrectomy donors over the same time period. Laparoscopic nephrectomy donors experienced significantly shorter hospitalizations, less pain, felt able to return to work and normal routines sooner, and needed significantly less assistance during the recuperation period than did open nephrectomy donors. The laparoscopic nephrectomy procedure may decrease many of the concerns of potential donors, thus making live kidney donation more attractive and increasing the kidney supply.

There are numerous causes of fulminant hepatic failure including acetaminophen, viral etiologies, acute fatty liver of pregnancy, ischemic hepatitis, and acute Budd-Chiari syndrome. One of the rare causes of fulminant hepatic failure is toxic mushroom poisoning. This article describes one case in which ingestion of a toxic mushroom, Amanita phalloides, caused a patient severe liver damage ultimately requiring organ transplantation. Early identification of liver dysfunction and referral to a liver transplant center for evaluation may be critical to save such a patient's life.

The focus of posttransplant care and clinical research has been on the management of rejection and short-term side effects associated with immunosuppressive therapy. Long-term side effects have only recently been recognized as potential health problems in liver transplant recipients. The aim of this pilot study was to determine the feasibility of using the Healthier People Version 4.0 Health Risk Appraisal as a tool for identifying existing and potential risk factors for premature disease and death among asymptomatic liver transplant recipients and to describe health risks in adult liver transplant recipients. The sample consisted of 50 adult first-time liver transplant recipients. It was found that this tool highlights health risks affecting life expectancy and pinpoints risks that an individual can control. It also provides practitioners with information necessary to design appropriate prevention and health promotion strategies to assure better health and quality of life for patients following liver transplantation.

This article is the second in a series of three focused on steps in the development of a research proposal. This second article presents the steps of research design, sampling, data collection procedures, and types of data collection instruments. The discussion of the steps focuses the reader on helpful hints pertinent to each step. Additional references are provided for a more detailed discussion of the process.