Development of the National Transplant Program Has Significantly Decreased but Not Ended Transplant Tourism in Montenegro.

Organ transplantation has prolonged and improved the lives of many patients around the world. However, a widespread shortage of donors remains the main factor that has led to organ trafficking and transplant tourism. To stop transplant tourism and to provide optimal treatment for its citizens with end-stage renal disease, Montenegro started performing renal transplantations in September 2012. Thirty-five transplantations have been performed since that time, 34 from living donors and only 1 from a deceased donor. This practice has significantly decreased but not ended transplant tourism in Montenegro.

Intra-abdominal hypertension: pulmonary and cerebral complications.

Intra-abdominal hypertension causes many physiologic changes, primarily by reducing thoracic compliance and secondarily causing organ failure, which is the body's normal response to trauma or acute inflammatory response. Compartment syndrome as a cause of abdominal hypertension has adverse effects on the circulation, threatening the function and viability of tissues. Intra-abdominal hypertension with the clinical picture of compartment syndrome is a reperfusion injury that is a cyclic event. Elevated intra-abdominal pressure due to whatever mechanism affects all intra-abdominal viscera, including the abdominal wall. Due to edema reducing thoracic compliance, producing severe encephalopathy and leading to severe ischemia with generation of significant quantities of reactive oxygen free radicals as well peroxidation products released from the intestine, liver and spleen. Elevated intracranial pressure causes encephalopathy and the risk of neuronal damage due to the sharp decrease in cerebral perfusion pressure. Elevated intracranial pressure is due to restriction of outflow from the lumbar venous plexus. The etiology of the sudden increase in capillary permeability remains unclear. Decompressive laparotomy leads to a rapid improvement in pulmonary parameters and oxygen delivery. The clinical state after decompression is an example of ischemia-reperfusion injury requiring therapy with inotropes and other agents to improve cardiac, respiratory, renal and cerebral hemodynamics with life saving effects.

Pathophysiology of abdominal compartment syndrome.

For over a century, raised intra-abdominal compartment syndrome (ACS) has been known. The physiology and clinical results of this syndrome produce significant morbidity and quite high mortality rates. Increased intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines as well as other peritoneal and retroperitoneal structures, including the pulmonary, cardiovascular, renal, splanchnic, and central nervous systems. The most effective prevention of ACS is early recognition and preemptive interventions, as well the choice of appropriate abdominal closures with constant care and surveillance in intensive care units.