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KEY POINTS

KEY POINTS

  • Solid organ transplantation is the treatment of choice for end-organ dysfunction in many organs and provides advantages in survival and improved quality of life.

  • The use of organs from HIV- and hepatitis C virus–infected donors along with advancements in organ preservation will help to narrow the gap between organ supply and demand.

  • The Organ Procurement and Transplantation Network is the organization that oversees these activities.

  • Trauma and acute care surgeons play a pivotal role in early management of potential organ donors.

  • The transplant team does not manage the donor in donation after cardiac death until the patient dies.

  • Brain death is associated with a series of events that affect every organ system, but especially the cardiovascular and respiratory systems.

  • The early adoption of aggressive donor management protocols will allow maximization of organ utilization and expansion of the donor pool.

  • Unmanned aircraft systems are a promising modality for more efficient and safe organ transportation.

INTRODUCTION

Advances in the field of immunosuppression, organ preservation, surgical techniques, and critical care have resulted in significant improvements in the outcomes of transplant recipients (Fig. 54-1). Indeed, in most cases, solid organ transplantation provides a survival advantage and improved quality of life when compared with standard medical therapies. It has become the treatment of choice for end-stage kidney, liver, islet, intestine, heart, and lung failure. With improved medical treatments and improved transplant outcomes, increased demand for transplantation has resulted, yielding longer waitlists. As such, there is a woeful disparity between the number of patients who require transplants and the number of available donor organs. According to the Organ Procurement and Transplantation Network (OPTN) official website (http://optn.transplant.hrsa.gov), a new patient is being added to the transplant waiting list every 10 minutes, and on average, 20 people die on the waiting list every day. Currently in the United Sates, there are 124,370 patients on the transplant waiting list (Fig. 54-2).

FIGURE 54-1

Patient survival among all transplant recipients, 2008 to 2012, by organ. (Reproduced from Organ Procurement and Transplantation Network. OPTN/SRTR annual report 2017. https://optn.transplant.hrsa.gov. Accessed June 2019.)

FIGURE 54-2

Total number of patients on the waiting list in the United States and the number of donors and transplants from 1991 to 2017. **Includes both living and deceased donors. (Reproduced from Organ Procurement and Transplantation Network. https://optn.transplant.hrsa.gov. Accessed June 2019.)

Major innovations in organ replacement sciences have occurred in the past decade. Living and deceased donor allogenic transplants, however, remain the favored approach for patients with organ failure. Indeed, innovative approaches such as bioengineering and organ regeneration are still in experimental stages.1 Xenotransplantation has seen a resurgence of interest, perhaps as a result of clustered regularly interspaced ...

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