Survey on attitudes and knowledge on the organ recovery from deceased donors in Roman Catholic nuns and priests.

UNLABELLED: Deceased donors (DD) organ recovery rate in Poland has never been satisfactory but over the years kidney transplantation from deceased donors has reached the level of 26 transplants/pmp. In 2007 due to a number of reasons, a dramatic fall of organ recovery rate from deceased donors (DD) occurred. The survey on public attitude toward organ transplantation carried out in the same year showed a large reduction of the public trust toward medical profession. Since then, the number of kidney transplantations has never come back to its level from 2006, regardless of a positive attitude toward organ transplantation. The attitude and knowledge survey was recently carried out in 100 physicians and 100 nurses employed in one large district hospital. The results of the attitude survey among the hospital staff showed that the level of knowledge among nurses corresponded to their age and the time since graduation. Younger nurses showed much more appreciation and knowledge toward recovery of organs from the deceased donors. Survey among physicians indicated some hesitation toward recognition of the brain death. In the present paper results of the survey on attitude and knowledge toward organ transplantation among nuns (98 nuns), priests (100 priests) and students (98 students) of the Theological School living in the same area are presented. Despite quite high (>60%) acceptance of the deceased donation, one third of questioned population showed lack of knowledge not only on existing legal regulations, but also of important documents issued by the Catholic Church. CONCLUSIONS: Improvement of transplantation program in Poland requires extensive educational program among various parts of the society: most importantly among physicians, nurses and priests. The Partnership for Transplantation program has been directed to achieve these goals.

Partnership for transplantation: a new initiative to increase deceased organ donation in Poland.

Despite the long-standing history of transplantation, the shortage of organs has remained its most restrictive factor. In 2010, the number of actual deceased organ donors in Poland was 13.5/million population (pmp). However, a huge difference in organ recovery rates is evident between various regions, eg, 32 pmp, in western Pomerania compared with 1-3 pmp in southern districts. A substantial number of patients who die while awaiting organ transplantations could be saved were effective programs able to overcome barriers in deceased organ donation. Such programs, eg, the European Donor Hospital Education Program, Donor Action, European Training Program on Organ Donation, United States Collaborative in Donation were introduced several years ago, but after transient improvements there has not been real progress. A new comprehensive program-Regional Partnership for Transplantation-was initiated a year ago in 4 districts of southern Poland by the Polish Union for Transplantation Medicine. The letter of intent to activate the donation program was signed by the local administration, the president of the local medical school, president of the Physician's Chamber, transplant centers, the Polish Union for Transplantation, and the Polish Transplant Coordinating Center. The plan of action included training of in-hospital coordinators, visits to all regional hospitals in company of a representative of the hospital founding body, examination of the real donation pool and the need for participation in a donation program training and education of the hospital staff in legal and organizational aspects of donation, brain death recognition, and various aspects of donor care. In addition, the program included communication skills workshops for intensive care unit physicians (with participation of 2 actors, an experienced anesthesiologist, and a psychologist), lectures for high school and university students and for hospital chaplains as well as alumni of higher seminaries. The preliminary results (after the first year) showed 40%-70% increases in activity of the local hospitals in the organ donation process.

Intraoperative blood flow measurements in organ allografts can predict postoperative function.

A reliable method to recognize the extent of ischemia/reperfusion injury in transplantation is needed in order to tailor the immunosuppressive scheme to the needs of a damaged organ. This study sought to assess the correlation between the total and the parenchymal blood flow into a transplanted kidney (n = 71) or liver (n = 15) shortly after revascularization with the early function of the organ after transplantation. The total blood flow in the renal artery in kidney recipients or in the hepatic artery and portal vein in liver recipients was measured by an electromagnetic flowmeter. The parenchymal blood flow (in several parts of the transplanted organ) was assessed using a laser-Doppler flowmeter. Two measurements were always taken after revascularization (5 to 60 minutes apart). Vascular resistance (VR) as calculated by the difference between the mean arterial pressure (MAP) and the central venous pressure (CVP) was correlated with immediate kidney or liver function parameters. Neither total renal blood flow (RBF) nor VR was different between the immediate function (IF) and delayed graft function (DGF) groups of kidney transplant patients. However, the cortical (parenchymal) blood flow was significantly greater in the IF than the DGF group at 5 minutes: 29.98 +/- 6.13 mL/min/100 g vs 23.56 +/- 6.46 mL/min/100 g (P < .001). The difference was even more significant at 35 minutes: 33.94 +/- 7.47 mL/min/100 g vs 15.47 +/- 3.34 mL/min/100 g (P < .0001). Among liver transplant patients, the results suggested a correlation between hepatic arterial blood flow and early graft viability and function. The most reliable predictor of early graft function was the portal blood flow, which correlated with the volume of secreted bile as well as the bilirubin, and transaminase levels and coagulation profile. Further studies must confirm the value of measurements of total and parenchymal blood flow in organ transplant recipients.

Attitudes of black South Africans concerning organ donation.

The availability of donor organs was analyzed following the placement of a transplant coordinator in Ga-Rankuwa Hospital's kidney transplant program. From February 1, 1992, to January 6, 1994, 44 brain-dead potential donors were identified. In 20 of those cases, relatives could not be reached to acquire consent for donation of cadaveric organs. In the remaining 24 cases, an intensive care resident together with a transplant coordinator obtained consent for 9 potential donors. Over the same period, 119 (80%) of living-related potential donors who had been approached stated that they were willing to donate a kidney. This outcome suggests that among blacks, altruism is a positive factor for acquiring consent for organ donation. Public education is required to correct ignorance, misconception, and cultural beliefs regarding cadaveric donation.

The use of ELISA and nonradioactive DNA hybridization assays for the detection of human cytomegalovirus.

A hybridization assay using a biotinylated DNA probe was compared to both ELISA and direct isolation methods for detecting human cytomegalovirus (HCMV). The biotin labeled HCMV AD 169 HindIII-O-DNA fragment was used in a dot-blot assay to screen for the presence of HCMV in 186 urine specimens obtained from kidney transplant patients. The biotinylated HCMV HindIII-O probe could detect 3 log10 TCID50 units of HCMV. Urine specimens were also examined for the presence of HCMV by either ELISA or direct isolation of virus in tissue culture. The HindIII-O fragment detected 12 of 20 culture positive samples (sensitivity, 60%). There were 5 samples which were probe positive and cell culture negative (specificity, 97%). The ELISA assay also detected 12 of 20 culture positive samples (sensitivity, 60%). Eight samples were ELISA positive, cell culture negative (specificity, 95%). Seven specimens were positive by all three criteria. Five specimens which were both ELISA positive and probe positive were cell culture negative. The ELISA positive, probe positive, culture negative specimens originated from patients who gave a culture positive specimen within 10 days of the original sample. The combination of probe and ELISA assays detected 16 of the 20 culture positive specimens (sensitivity, 80%). The combined use of biotinylated DNA probes and ELISA allows the detection of HCMV in urine specimens with good sensitivity and specificity.

The influence of thymosin (TEX) on antigen-induced primary and secondary antibody responses of mice.

Thymosin (TFX) administered in mice does not alter their primary IgM humoral responses, while it significantly increases the number of IgG plaque-forming cells and IgM PFC during the secondary response. In the thymectomized mice, thymosin partially restores primary and secondary IgM responses, but IgM production remains low.

Mechanism of sympathetic activation during prolonged physical exercise in dogs. The role of hepatic glucoreceptors.

It seems likely that depletion of body carbohydrates may account for the rise in the sympathetic activity during prolonged exercise, since glucose given during or before exercise reduces the increase in plasma catecholamines. The aim of the present study was to find out whether the increase in plasma noradrenaline (NA) in response to exercise can be reduced by 1. increasing of the amount of carbohydrate available for metabolism without producing hyperinsulinemia and 2. by inhibition of afferent activity from hepatic glucoreceptors. The study was performed on dogs which exercised whilst receiving either the intravenous fructose infusion (2.2 mmol/min) or a slow glucose infusion (0.25 mmol/min) which was given either via the portal or a peripheral vein. Fructose infusion reduced the muscle glycogen depletion during exercise and reduced the increase in plasma NA and glycerol concentrations without altering the blood glucose or insulin levels. The exercise-induced increases in plasma NA and glycerol concentrations were significantly smaller with intraportal than with peripheral glucose infusion but there were no differences between these two cases in the concentration of glucose in the systemic circulation. These findings indicate that the reduction of the plasma NA response to physical effort under conditions of increased carbohydrate availability cannot be attributed to the inhibitory effect of insulin on sympathetic activity and provide evidence for the participation of hepatic glucoreceptors in the control of the sympathetic activity during exercise.

Chylomicron triglyceride metabolism in resting and exercising fed dogs.

The turnover of circulating triglycerides (TG) was determined in dogs during rest, following ingestion of food that included corn oil, and in the final period of a 1-h treadmill exercise of moderate intensity (72-84 m/min). In all cases the loss of [14C]TG from the plasma followed a first-order process. The fractional removal rate constant at rest was 26.5 +/- 1.9% (SE) n = 10) of the circulating pool size per minute, and it was increased slightly to 33.8 +/- 3.6% (n = 7) per minute during exercise. The uptake of plasma TG-derived fatty acids (5 min postinjection) was increased (P less than 0.05) in working muscle, whereas the TG uptake in fat tended to decrease. Further, the percent of TG-derived fatty acids found in the muscle's acylglyceride pool was less (90.0 +/- 3.6 vs. 53.5 +/- 1.8%), while that in the muscle's free fatty acid pool was greater (12.3 +/- 36.1 +/- 4.7%) in working compared with resting muscle. Thus the fourfold greater quantity of plasma TG-derived fatty acids found in the working muscle's free fatty acid pool could account for the entire increased TG uptake caused by exercise. This suggests that, in the fed state, circulating TG could represent a potential source of fatty acids for beta-oxidation in working muscle. However, the importance of plasma TG-derived fatty acids as an energy substrate during muscle use in a postprandial state has yet to be determined quantitatively.

Metabolic and temperature responses to physical exercise in thyroidectomized dogs.

The purpose of the present work was to further elucidate the role of thyroid hormones in the control of body temperature and metabolism during physical exercise. Changes in rectal temperature (Tre), some parameters of exercise-metabolism and in the plasma noradrenaline (NA) levels were examined in eight dogs performing submaximal treadmill exercise to exhaustion before and after thyroidectomy (THY). The metabolic 'responses to adrenaline (A) infusion were also compared in intact and THY dogs. During the exercise performed by THY dogs Tre increases were markedly attenuated, plasma FFA level increases were reduced and the pattern of plasma NA changes was modified in comparison with control runs. The reduced exercise-induced FFA mobilization in THY dogs might be attributed to a lower activation of the adrenergic system in the later stage of exercise and to the weaker lipolytic action of catecholamines. The attenuated Tre increases during exercise performed by THY dogs and the exercise-hyperthermia described previously in dogs treated with thyroid ormones suggest that an optimum level of thyroid hormones is necessary to induce typical changes in body temperature during physical exercise.

Normal values of glycogen content in the dog skeletal muscle and liver.

Glycogen content was measured in the dog quadriceps femoris muscle and liver tissue under resting conditions after 24 h fasting period, using small tissue samples taken by a needle biopsy technique. The glycogen content in the quadriceps femoris ranged from 35.3 to 60.2 mM glucosyl units per kg of wet muscle with a mean of 50.0 +/- (SE) 1.2. The mean value of the liver glycogen content was 235.0 +/- 19.4 mM glucosyl units per kg of wet liver tissue with the average 121.1--316.1 mM glucosyl units per kg of wet tissue. It was calculated that approximately 127 mM glucosyl units of the glycogen is stored in the dog liver.

Liver and muscle glycogen content after glucose infusion in dogs.

The purpose of the present work was to determine the changes in the liver and muscle glycogen content during and after glucose infusion to elucidate tissue distribution of glucose in dogs. Glucose was infused intravenously during 2 hours in a dose of 1.7 mM . kg-1 . min-1. At designated time intervals venous blood samples were taken for determinations of glucose concentration, and the liver as well as muscle tissue samples were taken using a needle biopsy technique for determination of glycogen content. Liver glycogen content was increased significantly already at 30 th min of glucose infusion, and 60 min after termination of the infusion, it was by 53.1 +/- 0.58 and 174.3 +/- 48.3 mM glucosyl units per kg of wet liver higher than the initial value. Muscle glycogen content was also increasing progressively during the whole period of glucose infusion, and 1 h after termination of the infusion it was by 30.8 +/- 2.5 mM glucosyl units per kg of wet muscle above the initial value. It was calculated that 24.7 per cent of the glucose infused to dogs was stored as liver glycogen and 63.4 per cent as muscle glycogen.