The role of the transplant coordinator on tissue donation in Turkey.

While solid organs represent the dramatic and lifesaving aspect of donation after death, the transplantation of tissues from donors after death is a much larger-scale activity that benefits enormous numbers of patients, usually in a life-enhancing rather than a lifesaving manner. Some types of tissue transplantation, such as heart valve and cornea transplantation, have been established for many decades and are reasonably well understood by health professionals and the public. Many other types of tissue donation, such as bone, skin, tendons, etc, are much less well known but nonetheless result in beneficial treatment for large numbers of patients. Skin is used to prevent fluid loss and infection following a major burn; bone is used to improve the clinical success of a range of orthopedic operations, such as joint replacements, spinal fusions, and reconstructions following trauma or tumor. In the United States more than 20,000 donors provided cadaveric tissue in 1999, compared to 6,000 in 1994. We ask all families of brain-dead donors for consent for tissue donation. Between January 1, 1999, and January 3, 2003, we had 58 actual cadaveric donors, procuring three skins, 15 tendons, six bones, 13 heart valves, and 40 corneas. We performed three skin, 40 tendon, and three bone transplants as well as storing other tissues. One donor can give health to 50 different recipients. In general, the argument runs for a transplant coordinator "if you can do it, then you must." We can save lives and present a better quality of life with solid organ and tissue donation.

Monitoring of rat skin flap lschemia by bioelectrical impedance measurements.

In the current study the authors evaluated McFarlane flap viability by bioelectrical impedance measurements. Opposition to the flow of an alternative electrical current through tissue is called bioelectrical impedance. In 30 rats, a cranially pedicled, 11 x 4-cm McFarlane flap was designed on the dorsum. The flap was divided into 11 virtual zones. Bioelectrical impedance values of these zones was measured using a hand-made bioelectrical impedance meter. Measurements were acquired before flap elevation (control values) and after flap elevation (experimental values) at hour 0, hour 1, hour 2, hour 3, hour 4, hour 5, hour 6, day 1, day 2, day 3, and day 7. Bioelectrical impedance decreased first at 11 cm, which was the most distal part of the flap at 1 hour after flap elevation. Three hours after flap elevation and later, the distal half of the flap persistently displayed lower bioelectrical impedance values than the control, and eventually these zones became necrotic. This study showed that the average bioelectrical impedance value of healthy rat skin was 1,773 kOhm. After flap elevation, all zones with bioelectrical impedance values of 1,650 kOhm or less became necrotic absolutely. Bioelectrical impedance measurements are safe, fast, noninvasive, and cheap compared with other techniques used to predict flap necrosis. In the rat McFarlane flap, it is possible to detect the nonsurviving part of the flap 3 hours after flap elevation. This method could be applied to certain clinical conditions to determine the correct level of debridement.