Skin Closure After No-Touch Saphenous Vein Harvest: Strategies to Minimize Wound Complications

ABSTRACT The no-touch saphenous vein with surrounding pedicle tissue harvesting technique preserved endothelium and vessel wall integrity and demonstrated improved long-term saphenous vein conduit patency that was comparable to internal thoracic artery conduit patency. Despite improved saphenous vein conduit patency rates, there is a possibility that no-touch saphenous vein harvest may increase wound complication rates by increased tissue disruption, including venous and lymphatic channels. Comprehensive strategies to minimize leg wound complications after no-touch saphenous vein harvest are discussed.

Protocol for Harvest, Transport and Storage of Human Osteochondral Tissue / Protocolo para captação, transporte e preservação de tecido osteocondral humano

Abstract Objective To elaborate a protocol for the harvest, transport, and preservation of human osteochondral tissue for use in tissue banks (TBs). Methods Osteochondral fragments measuring 2 cm3 of 5 corpse donors aged between 15 and 45 years old were analyzed. The samples were stored in cell preservation medium containing: human albumin, Iscove's and vancomycin preserved at 4ºC. The concentration of proteoglycans in the extracellular medium was quantified by the use of Safranin-O, while tissue structural analysis was assessed by histological study with hematoxylin-eosin stained slides. The images obtained were analyzed according to the histological scores of Mankin and the score proposed by the OsteoArthritis Research Society International. The samples were analyzed with 0, 15, 30 and 45 days of preservation. Results The osteochondral fragments studied showed a progressive decrease in proteoglycan concentration with increased preservation time. After 30 days of preservation, structural changes were identified with discontinuity of the cartilage surface layer. According to the results obtained by the Mankin score, there was a statistically significant difference between 15 and 30 days of tissue preservation. Conclusion The protocol described defined knee transport immersed in Lactated Ringer at a controlled temperature of 10º C until its arrival at the TB. After processing, the preservation solution was composed of Iscove's serum-free cell culture medium supplemented with 10% human albumin and 100 µg/ml vancomycin. The tissue was preserved at a temperature of 4ºC until the moment of transplantation characterizing the fresh preservation.

Resumo Objetivo Elaborar um protocolo para a captação, transporte e preservação de tecido osteocondral humano para utilização em banco de tecidos (BT). Métodos Foram analisados fragmentos osteocondrais com dimensão de 2 cm3 de 5 doadores cadáveres com idades entre 15 e 45 anos. As amostras foram armazenadas em meio de preservação celular contendo: albumina humana, Iscove's e vancomicina preservados à temperatura de 4ºC. A concentração de proteoglicanos no meio extracelular foi quantificada pelo uso de Safranina-O, enquanto a análise estrutural do tecido foi avaliada através de estudo histológico com lâminas coradas em hematoxilina-eosina. As imagens obtidas foram analisadas segundo os escore histológicos de Mankin e o escore proposto pela OsteoArthritis Research Society International. As amostras foram analisadas com 0, 15, 30 e 45 dias de preservação. Resultados Os fragmentos osteocondrais estudados apresentaram diminuição progressiva na concentração de proteoglicanos com o aumento do tempo de preservação. Após 30 dias de preservação, foram identificadas alterações estruturais com descontinuidade da camada superficial da cartilagem. Segundo os resultados obtidos pelo escore de Mankin, houve diferença com significância estatística entre 15 e 30 dias de preservação do tecido. Conclusão O protocolo descrito definiu o transporte de joelho em bloco imerso em Ringer Lactato em temperatura controlada a 10ºC até sua chegada ao BT. Após o processamento, a solução de preservação foi composta por meio de cultura celular sem soro Iscove's suplementado com albumina humana a 10% e vancomicina 100 µg/mL. O tecido foi preservado à temperatura de 4ºC até o momento do transplante caracterizando a preservação a fresco.

Training in recovery, perfusion and packaging of organs for transplants: profile of professionals and analysis of post-course learning / Capacitação em extração, perfusão e acondicionamento de órgãos para transplantes: perfil dos profissionais e análise de aprendizagem pós-curso

ABSTRACT Objective To understand the profile of professionals working in organ harvesting, and analyze the learning results of those trained before and after the course on recovery, perfusion and packaging of organs for transplants. Methods A retroprospective, quantitative, analytical-descriptive study about the Course on Recovery, Perfusion and Packaging of Liver and Kidney, in the period from 2012 to 2014. Pre- and post-tests, with ten questions were used to assess knowledge about organ harvesting. The association of knowledge with applied content was verified by the McNemar test. Results Of the total of 334 participants, 187 (56.0%) were physicians, 104 (31.1%) nurses, and 43 (12.9%) scrub nurses. The majority of participants was male (58.4%), mean age of 39.1 years, 50% had graduated 5 to 10 years before, and 50.4% had less than one-year experience in organ harvesting. In knowledge assessment, there was an increase in the weighted mean, from 6.1 in the pre-test to 7.9 in the post-test. A significant increase in learning was observed in the post-test in 50% of scrub nurses, 33.3% in nurses 20% in physicians. Conclusion The professionals were starting work in organ harvesting, and most were from Southeastern, Northeastern and Northern regions. In terms of learning, the course contributed to enhancing knowledge of the multiprofessional health team, and represented better learning standard.

RESUMO Objetivo Conhecer o perfil dos profissionais que atuam em captação de órgãos e analisar o resultado da aprendizagem daqueles treinados antes e após o curso de extração, perfusão e acondicionamento de órgãos para transplantes. Métodos Estudo retroprospectivo, quantitativo, analítico-descritivo do Curso de Extração, Perfusão e Acondicionamento de Fígado e Rim, no período de 2012 a 2014. Utilizaram-se o pré e o pós-teste estruturado em dez questões, que avaliaram o conhecimento sobre captação de órgãos. A associação do conhecimento com o conteúdo aplicado foi verificada pelo teste McNemar. Resultados Do total de 334 participantes, 187 (56,0%) eram médicos, 104 (31,1%) enfermeiros e 43 (12,9%) instrumentadores. Houve predominância do sexo masculino (58,4%), com média de idade de 39,1 anos. Tinham entre 5 a 10 anos de formados 50% da amostra, e 50,4% tinham menos de 1 ano de experiência na área de captação de órgãos. Na avaliação do conhecimento, houve elevação na média geral ponderada de 6,1, no pré-teste, para 7,9, no pós-teste. Observou-se aumento significativo da aprendizagem no pós-teste em 50% nos instrumentadores, 33,3% nos enfermeiros e 20% nos médicos. Conclusão Os profissionais eram iniciantes na área de captação de órgãos e, em sua maioria, oriundos das Regiões Sudeste, Nordeste e Norte. No quesito de aprendizagem, o curso contribuiu para o aumento do conhecimento da equipe multiprofissional em saúde, representando ganho no padrão de aprendizagem.

Distribuição do tecido ocular no Estado de São Paulo: análise por razões de descarte de córneas / Ocular tissue distribution in the State of São Paulo: analysis on corneal discarding reasons / Distribución del tejido ocular en el estado de Sao Paulo: análisis sobre razones de descarte corneal

Objetivo identificar os motivos da recusa de córneas. Método estudo transversal, retrospectivo, descritivo e correlacional, composto por 5.560 córneas ópticas. As informações foram extraídas do banco de dados da Central de Notificação, Captação e Doação de Órgãos (CNCDO), bem como de prontuários de doadores. A estatística descritiva foi utilizada para a análise das variáveis categóricas e testes específicos, com nível de significância de 5% para avaliar as associações entre as variáveis. Este estudo atendeu aos aspectos éticos da pesquisa científica. Resultados 60% dos doadores eram do sexo masculino e 40% morreram por problemas circulatórios. Os principais motivos de recusa informados pelas equipes de transplante são a idade do doador e a contagem de células endoteliais. Para cada ano adicionado à idade do doador, há uma redução de 1% na chance de que essa córnea seja usada para transplante, e para cada acréscimo de 100 células por mm2 aumenta as chances de que essa córnea seja usada em 9%. Conclusão a principal causa de recusa na aceitação do tecido corneano está relacionada à idade e à contagem de células endoteliais.

Objective to identify the reasons for refusal of corneas. Method this was a cross-sectional, retrospective, descriptive and correlational study composed of 5,560 optical corneas. The information was taken from the notification, organ procurement and distribution centers database as well as donor records. Descriptive statistics were used for the analysis of categorical variables and specific tests with a significance level of 5% for assessing the associations between variables. This study met the ethical aspects of scientific research. Results 60% of the donors were male and 40% died by circulatory problems. The main reason for refusal as informed by transplant teams is the donor's age and the endothelial cell count. For each year added to the donor's age, there is a 1% decrease in the chance that this cornea will be used for transplantation, and the increase of 100 cells per mm2 increases the chances that this cornea will be used by 9%. Conclusion the main cause of refusal in the acceptance of corneal tissue is related to the age and the endothelial cell count.

Objetivo identificar los motivos para el rechazo de córneas. Método estudio transversal, retrospectivo, descriptivo y correlacional, compuesto por 5.560 córneas ópticas. La información se obtuvo de la bases de datos de Centros de Notificación, Obtención de Órganos y Distribución, así como de los registros de los donantes. Se utilizaron estadísticas descriptivas para analizar las variables categóricas y pruebas específicas con un nivel de significación de 5%, para evaluar las asociaciones entre variables. Este estudio contempla los aspectos éticos de una investigación científica. Resultados el 60% de los donantes eran hombres y el 40% falleció por problemas circulatorios. La principal razón del rechazo, informada por los equipos de trasplante, es la edad del donante y el recuento de las células endoteliales. Por cada año agregado a la edad del donante, existe una disminución de 1% en la probabilidad de que la córnea pueda ser utilizada para trasplante; el aumento de 100 células por mm2 aumenta la posibilidad de que esta córnea será usada por 9%. Conclusión la principal causa de rechazo en la aceptación del tejido corneal está relacionada con la edad y el recuento de células endoteliales.

Protective effect of salvianolate against bile duct injury after dcd donor liver transplantation / 解放军医学杂志

Objective To investigate the protective effect of salvianolate against bile duct injury after donation after cardiac death (DCD) liver transplantation and its clinical application prospect. Methods Sixty recipients of DCD liver transplantation were randomly divided into two groups with 30 cases in each group. Salvianolate (250mg/d) was given daily for 14 days after operation in treatment group, and the same amount of normal saline was given in control group. The therapeutic regimen of anti-rejection and anti-infection is the same between the two groups. The incidence of early graft dysfunction (EAD), and the serous levels of total bilirubin (TB), alkaline phosphatase (ALP), γ-glutamyltransferase (GGT), total bile acid (TBA) 1 month, 6 months and 12 months after liver transplantation were compared between the two groups. Also, the platelets (PLT), prothrombin time (PT), activated partial prothrombin time (APTT) and fibrinogen (FIB) were compared between the two groups at 2 weeks after operation. Results There was no significant difference in baseline parameters between the two groups (P>0.05). Compared with the control group, the incidence of EAD was decreased in treatment group, but there was no significant difference [10.0%(3/30) vs. 23.3%(7/30), P=0.166]. The serous levels of TB, ALP, GGT and TBA in treatment group were lower than those in control group 1 month, 6 months and 12 months after operation: [TB: 1 month, (28.5±17.0)μmol/L vs. (39.8±20.1)μmol/L, P=0.025; 6 months, (24.5±10.6)μmol/L vs. (33.3±16.4) μmol/L, P=0.018; 12 months, (19.8±9.5)μmol/L vs. (26.4±14.1)μmol/L, P=0.037, ALP: 1 month, (147.3±76.9)U/L vs. (187.6±70.9)U/L, P=0.039; 6 months, (163.0±61.4)U/L vs. (198.1±51.6)U/L, P=0.020; 12 months, (167.9±59.9)U/L vs. (200.2±56.2)U/L, P=0.036, GGT: 1 month, (83.9±49.5)U/L vs. (113.6±61.1)U/L, P=0.043; 6 months, (130.9±48.7)U/L vs. (169.7±77.0)U/L, P=0.023; 12 months, (154.7±45.1)U/L vs. (182.5±59.8)U/L, P=0.047, TBA: 1 month, (6.6±2.1)μmol/L vs. (8.0±2.4)μmol/L, P=0.016; 6 months, (9.5±2.2)μmol/L vs. (12.1±3.4)μmol/L, P=0.001; 12 months, (12.5±2.7)μmol/L vs. (5.6±3.8)μmol/L, P=0.001]. However, there was no significant difference in PLT, PT, APTT and FIB between two groups [PLT: (148.6±88.6)×109/L vs. (152.8±74.4)×109/L, P=0.843; PT: (12.9±1.1)s vs. (13.0±1.1)s, P=0.617; APTT: (34.6±3.7)s vs. (34.9±3.4)s, P=0.716; FIB: (3.4±0.6)g/L vs. (3.2±0.6)g/L, P=0.270, repectively]. Conclusions Salvianolate has a protective effect against bile duct injury after DCD liver transplantation, and does not increase the risk of postoperative bleeding.

An iliac-crest-preserving iliac wing bone graft harvesting technique / 中华骨科杂志

Objective@#To evaluate the clinical application effects of an iliac-crest-preserving iliac wing bone graft harvesting technique and the bone regenerative ability of the donor site after harvesting.@*Methods@#From January 2016 to June 2017, a series of 39 patients including 28 men and 11 women aged between 16 and 59 y (35±13 y in average) were prospectively collected to treat bone defects using the iliac-crest-preserving iliac wing bone graft harvesting technique. The patient cohort included 38 ipsilateral and 1 bilateral bone harvests taken from 15 femoral fracture non-unions, 8 tibial fracture non-unions, 11 femoral head necroses (hip preserving surgery), 1 tuberculosis deriving hip arthritis with bone defect (total hip arthroplasty), 2 hip prosthesis loosenings (revision), and 2 proximal femoral benign tumors. All patients were treated through comprehensive surgeries containing autologous iliac bone grafting. The surgical time, blood loss, bone graft volume, 24 h post-operative visual analogue scale (VSA) at the iliac surgical site, complications, and bone regeneration of the donor site were documented and evaluated.@*Results@#In the 39 patients (40 sides), the average surgical time was 25±4 min, average blood loss was 79±23 ml, average bone graft volume was 27±6 cm3. The average 24 h post-operative VAS at the iliac surgical site was 1.8±0.7 points. The VSA at the 6 week later and thereafter were 0 in all patients. The iliac incisions in 38 patients (39 sides) were healed uneventfully. However, seroma at the iliac surgical site emerged in 1 patient at the 6th post-operative day in the manner of serous exudation and was treated successfully with non-operative measures. None infections and lateral femoral cutaneous nerve injuries took place. Iatrogenic non-displaced iliac crest fractures happened in the very first 2 patients when taking the crest as a pivot to pry up the graft, which united without special cure at the 3 month post-operative. This complication was completely avoided when shifting the pivot to the anterior pillar containing the anterior iliac spines. None pelvic fractures and heterotopic ossifications took place. Post-operative radiographical examinations revealed that the bone defects at the donor site shrank through bone regeneration, that mamillary or canine-tooth-shaped bone formation occurred in some of the cases, and that none complete bone regeneration took place to eliminate the bone defect at the donor. There were 12 patients in whom pre- and post-operative computed tomographic scans necessitated by the disease were prescribed, which facilitated the measuring of the bone defect at the donor site. The measurement of 13 sides revealed that the bone defects were decreased more or less: the average immediate post-operative bone defect was 25.7±6.5 cm2, the average 12 month post-operative bone defect was 12.7±5.3 cm2.@*Conclusion@#The iliac wing bone graft harvesting technique suggested here is safe and less invasive, in the premise of preserving the iliac crest and retaining the figure of the surgical site, it can harvest a large amount of iliac wing bone graft and reserve the bone regenerative ability of the donor site

An iliac-crest-preserving iliac wing bone graft harvesting technique / 中华骨科杂志

Objective To evaluate the clinical application effects of an iliac-crest-preserving iliac wing bone graft harvesting technique and the bone regenerative ability of the donor site after harvesting.Methods From January 2016 to June 2017,a series of 39 patients including 28 men and 11 women aged between 16 and 59 y (35± 13 y in average) were prospectively collected to treat bone defects using the iliac-crest-preserving iliac wing bone graft harvesting technique.The patient cohort included 38 ipsilateral and 1 bilateral bone harvests taken from 15 femoral fracture non-unions,8 tibial fracture non-unions,11 femoral head necroses (hip preserving surgery),1 tuberculosis deriving hip arthritis with bone defect (total hip arthroplasty),2 hip prosthesis loosenings (revision),and 2 proximal femoral benign tumors.All patients were treated through comprehensive surgeries containing autologous iliac bone grafting.The surgical time,blood loss,bone graft volume,24 h post-operative visual analogue scale (VSA) at the iliac surgical site,complications,and bone regeneration of the donor site were documented and evaluated.Results In the 39 patients (40 sides),the average surgical time was 25±4 min,average blood loss was 79±23 ml,average bone graft volume was 27±6 cm3.The average 24 h post-operative VAS at the iliac surgical site was 1.8±0.7 points.The VSA at the 6 week later and thereafter were 0 in all patients.The iliac incisions in 38 patients (39 sides) were healed uneventfully.However,seroma at the iliac surgical site emerged in 1 patient at the 6th post-operative day in the manner of serous exudation and was treated successfully with non-operative measures.None infections and lateral femoral cutaneous nerve injuries took place.Iatrogenic non-displaced iliac crest fractures happened in the very first 2 patients when taking the crest as a pivot to pry up the graft,which united without special cure at the 3 month post-operative.This complication was completely avoided when shifting the pivot to the anterior pillar containing the anterior iliac spines.None pelvic fractures and heterotopic ossifications took place.Post-operative radiographical examinations revealed that the bone defects at the donor site shrank through bone regeneration,that mamillary or canine-tooth-shaped bone formation occurred in some of the cases,and that none complete bone regeneration took place to eliminate the bone defect at the donor.There were 12 patients in whom pre-and post-operative computed tomographic scans necessitated by the disease were prescribed,which facilitated the measuring of the bone defect at the donor site.The measurement of 13 sides revealed that the bone defects were decreased more or less:the average immediate post-operative bone defect was 25.7±6.5 cm2,the average 12 month post-operative bone defect was 12.7±5.3 cm2.Conclusion The iliac wing bone graft harvesting technique suggested here is safe and less invasive,in the premise of preserving the iliac crest and retaining the figure of the surgical site,it can harvest a large amount of iliac wing bone graft and reserve the bone regenerative ability of the donor site.

Eye bank procedures: donor selection criteria / Procedimentos em banco de olhos: critério de seleção do doador

ABSTRACT Eye banks use sterile procedures to manipulate the eye, antiseptic measures for ocular surface decontamination, and rigorous criteria for donor selection to minimize the possibility of disease transmission due to corneal grafting. Donor selection focuses on analysis of medical records and specific post-mortem serological tests. To guide and standardize procedures, eye bank associations and government agencies provide lists of absolute and relative contraindications for use of the tissue based on donor health history. These lists are guardians of the Hippocratic principle "primum non nocere." However, each transplantation carries risk of transmission of potentially harmful agents to the recipient. The aim of the procedures is not to eliminate risk, but limit it to a reasonable level. The balance between safety and corneal availability needs to be maintained by exercising prudence without disproportionate rigor.

RESUMO Os bancos de olhos utilizam procedimentos estéreis na manipulação dos olhos, medidas antissépticas para a descontaminação da superfície ocular e critério rigoroso de seleção do doador. Essa seleção é feita por meio do prontuário médico e de testes sorológicos específicos post mortem. Para orientá-la e uniformizá-la, as associações de bancos de olhos e órgãos governamentais fornecem listas de contraindicações absolutas e relativas de uso do tecido, baseadas nas condições prévias de saúde do doador. Essas listas são as guardiãs do princípio de Hipócrates "primum non nocere" e, como tal, são conservadoras. Entretanto, cada transplante traz o risco de transmissão de agentes potencialmente nocivos ao receptor. O objetivo não é eliminar esse risco, mas limitá-lo a um nível razoável. Existe um equilíbrio entre a segurança e a disponibilidade de córneas. A sabedoria está em manter esse equilíbrio, exercendo a prudência sem rigor exagerado.

Vascular Augmentation in Renal Transplantation: Supercharging and Turbocharging

The most common anatomic variant seen in donor kidneys for renal transplantation is the presence of multiple renal arteries, which can cause an increased risk of complications. Accessory renal arteries should be anastomosed to the proper source arteries to improve renal perfusion via the appropriate vascular reconstruction techniques. In microsurgery, 2 kinds of vascular augmentation methods, known as ‘supercharging’ and ‘turbocharging,’ have been introduced to ensure vascular perfusion in the transferred flap. Supercharging uses a distant source of the vessels, while turbocharging uses vascular sources within the same flap territory. These technical concepts can also be applied in renal transplantation, and in this report, we describe 2 patients who underwent procedures using supercharging and turbocharging. In one case, the ipsilateral deep inferior epigastric artery was transposed to the accessory renal artery (supercharging), and in the other case, the accessory renal artery was anastomosed to the corresponding main renal artery with a vascular graft (turbocharging). The transplanted kidneys showed good perfusion and proper function. No cases of renal failure, hypertension, rejection, or urologic complications were observed. These microsurgical techniques can be safely utilized for renal transplantation with donor kidneys that have multiple arteries with a lower complication rate and better outcome.

A New Technique for Conchal Cartilage Harvest

The goal of auricular cartilage harvest is to obtain a sufficient amount for reconstruction and to minimize the change in ear shape. The cartilage can be harvested by a posterior or anterior approach, and each method has advantages and disadvantages. The posterior approach presents the advantage of scar concealment, but there are limits to the amount of cymba cartilage that may be harvested. In contrast, the anterior approach may cause a noticeable scar. However, as cartilage is collected, the anterior approach provides a view that facilitates the preservation ear structure. In addition, it is possible to obtain a greater amount of cartilage. From January 2014 to December 2015, we harvested auricular cartilage graft material in 17 patients. To prevent the development of trapdoor scars or linear scar contracture, short incisions were made on the superior border of the cymba and cavum. Two small and narrow incisions were made, resulting in suboptimal exposure of the surgical site, which heightens the potential for damaging the cartilage when using existing tools. To minimize this, the authors used a newly invented ball-type elevator. All patients recovered without complications after surgery and reported satisfaction with the shape of the ear.

Effect of lima harvesting technique on postoperative drainage in off-pump CABG

Abstract Objective: We investigated the effects of pedicled and semiskeletonized left internal mammary artery (LIMA) harvesting techniques on postoperative drainage in patients subjected to off-pump CABG, ignoring other advantages or disadvantages of those techniques. Methods: The present study comprises a total of 160 subjects that underwent coronary artery bypass surgery in our clinic. Data were collected consecutively and retrospectively. An attempt was made to have similar groups in terms of demographic characteristics. Patients that underwent off-pump coronary artery bypass surgery by two surgical teams which differed only in LIMA harvesting technique were dichotomized and compared according to these techniques. The first group (Group 1) consisted of patients in whom LIMA was harvested with surrounding tissues using the pedicled technique. The second group (Group 2) consisted of patients in whom LIMA was harvested using the semiskeletonized technique, with the veins separated from surrounding connective tissues. Results: The mean amount of drainage in the first 24 hours was 706.1±234.2 ml vs. 591±258.8 ml (Group 1 vs. Group 2; P=0.005), the mean amount of drainage in the second 24 hours was 270±133.6 ml vs. 189.4±140.4 ml (Group 1 vs. Group 2; P<0.001), and the mean amount of total drainage was determined to be 976.1±306.9 ml vs. 781.2±335.5 ml (Group 1 vs. Group 2; P<0.001). Conclusion: It was observed that semiskeletonized LIMA presents reduced amount of postoperative drainage in the first and second 24-hour periods and total amount of drainage than pedicled LIMA, independent of pleural integrity.

Captação do fígado do doador para o transplante: uma proposta de protocolo para o enfermeiro / Liver harvesting from the donor to the transplantee: a proposed protocol for nurses / Captación del hígado del donante para el trasplante: una propuesta de protocolo para el enfermero

Objetivo: Propor um modelo de protocolo assistencial para o enfermeiro da captação do fígado para transplante. Métodos: Pesquisa descritiva, de natureza qualitativa, realizada em Fortaleza, no período de junho a agosto de 2014. Foram realizadas entrevistas e observação do trabalho dos enfermeiros em hospital de referência do Ceará. Os dados foram trabalhados por meio da análise temática e subsidiaram a construção da proposta piloto do protocolo, apreciado pelos enfermeiros para versão final. Resultados: O estudo permitiu a construção de um protocolo, apresentando ações específicas, que permeiam o procedimento de captação, especificamente a etapa da retirada do órgão, dinamizando as intervenções e tornando os procedimentos mais seguros e uniformes no processo captação-transplante de fígado. Conclusões: A proposta de um protocolo referente à captação do fígado para transplante é um modelo de sistematização da assistência com potencial para instrumentalizar as ações do enfermeiro no programa captação-transplante.

Objective: To propose a clinical protocol model for nurses in liver harvesting for transplant. Methods: A descriptive study,qualitative in nature, held in Fortaleza, in the period from June to August 2014. Interviews were carried out and observing the workof nurses in a referral hospital in Ceará. The data was processed through the thematic analysis and provided the construction ofthe proposed Protocol pilot, analysed by nurses for the final version. Results: The study allowed the construction of a protocol,with specific actions that permeate the harvesting procedure, specifically the stage of organ removal, streamlining interventionsand making them safer and more uniform in the liver harvest-transplantation process. Conclusions: The proposal of a protocolconcerning liver harvesting for transplant is a systematization assistance model with the potential to codify the actions of thenurse in the harvesting and transplantation process.

Objetivo: Proponer un modelo de protocolo clínico para enfermeros para el proceso de captación de hígado para trasplante.Métodos: Investigación descriptiva, cualitativa, realizada en Fortaleza, entre Junio y Agosto de 2014. Fueron realzadas entrevistasy observación del trabajo de los enfermeros en un hospital de referencia en Ceará. Los datos fueron procesados a través delanálisis temático y subsidiaron la construcción de la propuesta piloto del protocolo, apreciado por los enfermeros para la versiónfinal. Resultados: El estudio permitió la construcción de un protocolo, con acciones específicas sobre el procedimiento decaptación, específicamente la etapa de extracción del órgano, dinamizando las intervenciones y haciéndolas más seguras yuniformes en el proceso captación-trasplante. Conclusión: La propuesta de un protocolo relativo a la captura del hígado paratrasplante es un modelo de sistematización de la asistencia con potencial para instrumentalizar las acciones del enfermero enel programa captación-trasplante.

In-house coordination project for organ and tissue procurement: social responsibility and promising results / Projeto de coordenação intra-hospitalar para doação de órgãos e tecidos: responsabilidade social e resultados promissores / Proyecto de coordinación intrahospitalaria para la donación de órganos y tejidos: responsabilidad social y resultados prometedores

Abstract Objectives: to report the results of evaluation regarding changes in the number of potential donor referrals, actual donors, and conversion rates after the implementation of an in-house organ and tissue donation for transplantation coordination project. Methods: epidemiological study, both retrospective and transversal, was performed with organ donation data from the Secretariat of Health for the State and the in-house organ donation coordination project of a beneficent hospital. The data was compared using nonparametric statistical Mann-Whitney test, and the Student's t-test, considering a significance level of 5% (p <0.05). Results: there were statistically significant differences (p < 0.05), before and after the implementation of the project on the number of potential donor notification/month (3.05 - 4.7 ), number of actual donor/month (0.78 to 1.60) and rate of conversion ( 24.7 to 34.8 %). The hospitals 1, 2, 7 and 8 had significant results in potential donor, actual donor or conversion rate. Conclusion: the presence of an in-house coordinator is promising and beneficial, the specialist is important to change the indicators of efficiency, which consequently reduces the waiting lists for organ transplants.

Resumo Objetivos: apresentar os resultados da avaliação em relação às mudanças no número de potenciais doadores, doadores efetivos, e as taxas de conversão após a implementação do projeto de coordenação intra-hospitalar para doação de órgãos e tecidos para transplante. Métodos: estudo epidemiológico, retrospectivo e transversal, que foi realizado com os dados da doação de órgãos da Secretaria de Saúde do Estado e o projeto de coordenação interna de doação de órgãos de um hospital beneficente. Os dados foram comparados utilizando estatísticas não paramétricas de Mann-Whitney, com nível de significância de 5% (p <0,05) e o teste t de Student, considerando um nível de significância de 5% (p <0,05). Resultados: houve diferença estatisticamente significativa (p <0,05) antes e depois da implementação do projeto sobre o número de notificação de potencial doador /mês (3,05 - 4,7), número de doadores efetivos/mês (0,78 - 1,60) e a taxa de conversão (24,7 - 34,8%). Os hospitais 1, 2, 7 e 8 tiveram resultados significativos com potenciais doadores, doadores efetivos e taxas de conversão. Conclusão: a presença de um coordenador intra-hospitalar é promissora e benéfica e o especialista é importante para mudar os indicadores de eficiência, o que consequentemente reduz as listas de espera para transplantes de órgãos.

Resumen Objetivos: presentar los resultados de la evaluación en relación a los cambios en el número de posibles donantes, donantes efectivos, y las tasas de conversión después de la puesta en práctica de un proyecto de coordinación intrahospitalaria para la donación de órganos y tejidos para trasplantes. Métodos: un estudio epidemiológico, retrospectivo y transversal, se llevó a cabo con los datos de la donación de órganos de la Secretaría de Salud del Estado y el proyecto de coordinación intrahospitalaria para la donación de órganos de un hospital de beneficencia. Los datos se compararon mediante la prueba no paramétrica estadística de Mann-Whitney y la prueba t de Student, considerando un nivel de significancia del 5% (p <0,05). Resultados: hubo diferencias estadísticamente significativas (p <0,05), antes y después de la ejecución del proyecto sobre el número de notificaciones de posibles donantes / mes (3,05 - 4,7), el número de donantes efectivos / mes (0,78 a la 1,60) y la tasa de conversión (un 24,7 a la del 34,8%). Los hospitales 1, 2, 7 y 8 tuvieron resultados significativos en donantes posibles, donantes efectivos o tasa de conversión. Conclusión: la presencia de un coordinador de la entidad es prometedor y beneficioso, el especialista es importante para cambiar los indicadores de eficiencia, lo que consecuentemente reduce las listas de espera para trasplantes de órganos.

Intra-hospital organ and tissue donation coordination project: cost-effectiveness and social benefits / Projeto de coordenação intra-hospitalar de doação de órgãos: custo-efetividade e benefícios sociais

OBJECTIVE To evaluate the viability of a professional specialist in intra-hospital committees of organ and tissue donation for transplantation. METHODS Epidemiological, retrospective and cross-sectional study (2003-2011 and 2008-2012), which was performed using organ donation for transplants data in the state of Sao Paulo, Southeastern Brazil. Nine hospitals were evaluated (hospitals 1 to 9). Logistic regression was used to evaluate the differences in the number of brain death referrals and actual donors (dependent variables) after the professional specialist started work (independent variable) at the intra-hospital committee of organ and tissue donation for transplantation. To evaluate the hospital invoicing, the hourly wage of the doctor and registered nurse, according to the legislation of the Consolidation of Labor Laws, were calculated, as were the investment return and the time elapsed to do so. RESULTS Following the nursing specialist commencement on the committee, brain death referrals and the number of actual donors increased at hospital 2 (4.17 and 1.52, respectively). At hospital 7, the number of actual donors also increased from 0.005 to 1.54. In addition, after the nurse started working, hospital revenues increased by 190.0% (ranging 40.0% to 1.955%). The monthly cost for the nurse working 20 hours was US$397.97 while the doctor would cost US$3,526.67. The return on investment was 275% over the short term (0.36 years). CONCLUSIONS This paper showed that including a professional specialist in intra-hospital committees for organ and tissue donation for transplantation proved to be cost-effective. Further economic research in the area could contribute to the efficient public policy implementation of this organ and tissue harvesting model.

OBJETIVO Avaliar a viabilidade de profissional especialista em comissões intra-hospitalares de doação de órgãos e tecidos para transplantes. MÉTODOS Estudo epidemiológico, retrospectivo e transversal (2003 a 2011 e 2008 a 2012), realizado com dados de doação de órgãos para transplantes no estado de São Paulo. Foram avaliados nove hospitais (hospitais 1 a 9). Foram avaliadas, por regressão logística, diferenças em número de notificações de morte encefálica e doadores efetivos (variáveis dependentes) após a entrada do profissional especialista (variável independente) na comissão intra-hospitalar de doação de órgãos e tecidos para transplantes. Para avaliação do faturamento hospitalar, foram calculados o salário-hora de médico e enfermeiro, conforme legislação da Consolidação das Leis do Trabalho, o retorno e o prazo do retorno do investimento. RESULTADOS Após a entrada de enfermeiro especialista na comissão, as notificações de morte encefálica e o número de doadores efetivos aumentaram no hospital 2 (4,17 e 1,52, respectivamente). No hospital 7, o número de doadores efetivos também aumentou de 0,005 para 1,54. E, após entrada de enfermeiro especialista, o faturamento hospitalar aumentou em 190,0% (variação de 40,0% a 1.955%). O custo mensal para 20 horas semanais do enfermeiro foi R$940,00 e, do médico, R$8.330,00. O retorno do investimento foi de 275%, em curto prazo (0,36 anos). CONCLUSÕES A inserção de profissional especialista nas comissões intra-hospitalares para captação de doação de órgãos e tecidos para transplantes mostra-se custo-efetiva. Novos estudos econômicos na área podem contribuir com uma política pública eficiente de implantação desse modelo de captação de órgãos e tecidos para transplantes.

Construction strategy of human organ donation social mission system in China / 中国组织工程研究

BACKGROUND:By analyzing the current difficulties faced by human organ transplantation and social factors which lead to organ transplant donor shortage in China, people are found to be generaly lack of knowledge about organ transplant and donation process. OBJECTIVE: To make a tentative probe into the construction of organ donation social mission system on four aspects, namely the importance, ethical principles, current situation and countermeasures, and to provide scientific advice and information for organ donation publicity and education. METHODS: Articles about organ donation and organ transplantation were retrieved from CQVIP, CNKI, Wanfang, PubMed, Medline System from January 2005 to November 2014 with the key words of “organ donation, organ transplantation, shortage of donor, body donation, education system” in both Chinese and English. After secondary manual retrieval of organ donation coordinator, literature were included if they involved organ donation coordinator and organ donation and transplantation related policies and regulations. This paper put forward countermeasures for the construction of human organ donation social mission system in China based on the literature induction. RESULTS AND CONCLUSION:This paper describes the necessity of organ donation education system, systematicaly analyzes the existing problems for current organ donation education problems and ethical principles that should be folowed, and explore the construction strategy of human organ donation social mission system in China. The way to relieve tension of organ transplant donor and expand donor sources is to win broad support and understanding of citizens, which can ensure the sustainable development of organ donation work. So, it is very important to build the human organ donation social mission system.

Harnessing of corneas captured and processed for transplantation in an ocular tissue bank of North-eastern Brazil / Aprovechamiento de las córneas capturada y procesada para trasplante en un banco de tejidos oculares del Noreste / Aproveitamento das córneas captadas e processadas para transplante em um banco de tecidos oculares do Nordeste

The aim of this study was to describe the harnessing of corneas captured and processed for transplantation in an ocular tissue bank in north-eastern Brazil. This was a transverse and retrospective study, with a sample group of 612 individuals whose corneas were donated and captured between January/2007 and July/2012. This study was approved by the Research Ethics Committee under number 007.0.294.000-10, and research was based on an instrument consisting of social, demographic and clinical data of the donors. Of the 1209 corneas captured, 868 were used and 341 were discarded. Of the 612 donors, the corneas of 597 (97.5%) were captured from both eyes, being that 423 (70.9%) of these corneas were used. Further studies are required on the reasons for discarding corneas and clarifications as to the conduct of professionals when processing corneas, considering the increase in the quantity of donors and the elevated number of discarded ocular tissue.

El objetivo fue describir el aprovechamiento de las córneas capturada y procesada para trasplante en un banco de tejidos oculares del noreste. Estudio transversal y retrospectivo, con una muestra de 612 personas que tenían sus córneas donadas y capturados entre enero/2007 a julio/2012. Después de la aprobación del Comité de Ética de Investigación de número 007.0.294.000-10, se utilizó un instrumento que consiste en datos sociodemográficos y clínicos de los donantes. De las 1.209 córneas capturadas, 868 se utilizaron y 341 se desecharon. De los 612 donantes, 597 (97,5%) tenían capitación de las córneas de los dos ojos, entre estos, se utilizaron 423 (70,9%). Necesidad de ser de más estudios sobre las causas de los vertidos de la córnea y aclaraciones a la conducta de los profesionales en el procesamiento de estos, al ver el aumento en la cantidad de donantes y el elevado número de desechados de los tejidos oculares.

Objetivou-se descrever o aproveitamento das córneas captadas e processadas para transplante em um banco de tecidos oculares do Nordeste. Estudo transversal e retrospectivo, com amostra de 612 pessoas que tiveram suas córneas doadas e captadas, entre janeiro de 2007 a julho de 2012. Após a aprovação pelo Comitê de Ética em Pesquisa, de número 007.0.294.000-10, utilizou-se um instrumento composto por dados sociodemográficos e clínicos dos doadores. Das 1.209 córneas captadas, 868 foram utilizadas e 341 descartadas. Dos 612 doadores, 597 (97,5%) tiveram captação das córneas dos dois olhos e, dentre estas, 423 (70,9%) foram utilizadas. Necessita-se de mais estudos sobre causas de descartes de córneas e esclarecimentos quanto à conduta dos profissionais no processamento destas, visto o aumento da quantidade de doadores e o número elevado de descartes de tecidos oculares.

Practice and thinking of quality management of organ procurement organization / 中国组织工程研究

BACKGROUND:With the introduction of related policies on organ procurement and distribution, the organ procurement and standards of the organ procurement have a clear operational criteria, as wel as how to al ocate organs. But the work processes and organizational positioning on organ procurement organization are not enough elaborated and normal. OBJECTIVE:To analyze the experience of Guangzhou General Hospital of Guangzhou Military Command as the organ procurement organization units in quality management, timely review working progress and explore areas for improvement, which provide the corresponding countermeasures for enhancing quality management and establishing the efficient and professional organ procurement organization. METHODS:A computer-based online search in CNKI database and PubMed database was performed with the keywords of“organ donation, organ transplantation, Organ Procurement Organization, quality management”in English and Chinese by screening titles and abstracts. RESULTS AND CONCLUSION:According to relevant laws and regulations, Guangzhou General Hospital of Guangzhou Military Command formulates a standard evaluation standard and sets up the team, thus achieving the reunification of the responsibilities and powers. At the same time, they improve the relevant organ donation,acquisition, preservation, registration, and design different quality management plans according to these different aspects. In addition, In addition, the hospital hold regular coordinator training and make it standardization. Through a series of quality management measures, the hospital organ procurement organization has gradual y regularized and achieved some results. It is recommended to further strengthen scientific research, achieve the unification of efficiency and effectiveness of scientific research;improve the awareness of the hospital leaders, consummate the mechanism of organ procurement;focus on personnel training, improve the professional quality of the organization members;enhance information management, achieve multi-disciplinary col aboration;build quality evaluation system, achieve the whole process of quality management;emphasize on medical ethics, and promote the harmony between the hospital and the patient.

Análise da qualidade das córneas doadas e do intervalo entre óbito, enucleação e preservação após a implantação de novas normas técnicas e sanitárias em Banco de Olhos Universitário / Comparative analysis of the donor cornea quality and of the interval between death and preservation before and after new sanitary and technique rules in a University Eye Bank

OBJETIVO: Comparar o intervalo entre o óbito e a enucleação (ΔT-O-E), entre a enucleação e a preservação (ΔT-E-P) e a qualidade da córnea antes e após a implantação de novas normas técnicas e sanitárias baseadas na Resolução RDC 347. MÉTODOS: Estudo retrospectivo em que foram avaliados os prontuários dos doadores de córnea do Banco de Tecidos Oculares da Santa Casa de São Paulo, 2 anos antes e 2 anos depois da implementação de novas normas sanitárias. RESULTADOS: Foi observado aumento do número absoluto de 205 para 374 doadores após as mudanças adotadas. Não foi observada diferença estatisticamente significante no Δt-O-E e ΔT-E-P antes e após as mudanças implantadas. Do total de 1.105 córneas doadas, foi observado 388 córneas doadas antes das mudanças e 717 córneas doadas após as mudanças implementadas. Foi observado aumento estatisticamente significante da graduação da qualidade da córnea doada de 1,76 ± 0,90 para 1,94 ± 0,88 após a implementação das novas normas da Resolução. CONCLUSÃO: Após as mudanças técnicas e sanitárias exigidas pela Resolução 347, houve grande aumento no número de córneas doadas, captadas e preservadas. O Banco de Tecidos Oculares não diminuiu os ΔT O-E e ΔT E-P. A qualidade da córnea apresentou-se inferior após as mudanças realizadas no setor.

PURPOSE: To compare the interval between death and enucleation (ΔT-O-E), between enucleation and preservation (ΔT-E-P) and the quality of the cornea before and after the implantation of new technique and sanitary rules. METHODS: A retrospective study that evaluated the records of cornea donors in Sao Paulo's Santa Casa Eye Tissue Bank 2 years before and 2 years after the implementation new sanitary rules. RESULTS: An increase was observed in the absolute number of 205 to 374 donors following the adopted changes. There was no statistically significant difference in Δt-O-E and ΔT-E-P before and after the implemented changes. Of the total of 1,105 donor corneas, 388 donor corneas were observed before the changes and 717 donor corneas after the implemented changes. We observed a statistically significant increase in grading of donor cornea quality from 1.76 ± 0.90 to 1.94 ± 0.88 after the implementation of new standards of resolution. CONCLUSION: After the changes required by Resolution 347, there was a large increase in the number of donated, taken and preserved corneas. The BTO has not diminished the ΔT O-E and ΔT E-P. Cornea quality presented itself lower after the new rules.

Banco de dentes humanos: uma análise bioética / Human teeth bank: a bioethics analysis

Banco de dentes humanos (BDH) é uma instituição sem fins lucrativos, vinculada a uma instituição de ensino com o propósito de suprir as necessidades acadêmicas, fornecendo dentes humanos para pesquisa, treinamento laboratorial e restauraçães biológicas. O presente trabalho resultou de levantamento bibliográfico relativo àáimplantação, objetivos, funcionamento, aspectos éticos, tendências e elo do BDH com a bioética contemporânea. A bioética ajuda a odontologia a fazer uma reflexão sobre o tema, conciliando os avanços tecnológicos com os princípios éticos, traçando caminhos para o uso dos órgãos dentais sem ofensa àá dignidade humana. Pode-se concluir que o BDH mostra-se como o modelo mais adequado para suprir a necessidade por dentes, ao mesmo tempo em que cumpre as exigências legais, éticas e de biossegurança, evitando o comércio ilegal

Seleção de córneas para transplantes / Corneal selection for transplants

O transplante de córnea é singular, pelo fato de ser habitualmente realizado em pessoas com deficiência visual, mas com expectativa de vida, mobilidade e convivência social preservadas. Um enxerto mal-sucedido pode levar à cegueira real ou ao sofrimento permanente, motivado por dor ou desconforto ocular. Um dos fatores fundamentais do sucesso do mesmo é o uso de córneas de boa qualidade. A seleção dessas córneas assenta-se em três princípios: inocuidade, transparência e vitalidade. Cada um deles é analisado detalhadamente neste trabalho.

Corneal transplantation is singular because it is habitually performed on persons with visual deficiency but with preserved life expectancy, mobility and social life. A graft not well succeeded may cause real blindness and permanent misery due to pain and discomfort. One of the fundamental determinants of the success of corneal transplantation is the use of corneas of good quality. The selection of these corneas is based on three rules: innocuousness, transparency and vitality. Each one of these concepts is considered in detail in this work.