Transplantation crisis at the time of economic recession in Greece.

OBJECTIVES: Aim of the study was to assess the effect of economic recession on organ donation and transplantation in Greece. METHODS: Retrospective data (2002-2016) provided by the Hellenic Transplant Organization (HTO), International Registry in Organ Donation and Transplantation, Eurotransplant, Scandiatransplant, National Health Service Blood and Transplant (NHSBT), and United Network of Organ Sharing (UNOS) databases were analyzed. HTO database was divided into the precrisis (2002-2008) and crisis (2009-2016) era. Donation and transplantation rates between the two periods were compared. Trend estimation analysis was applied on the latter period. RESULTS: Since 2009, organ donation significantly declined without significant change in the reported brain deaths. Overall solid organ transplantations decreased (319.63 ± 70.4 from 460 ± 55.25 transplants/year, P = 0.001). Kidney transplantation rates declined (139.38 ± 29.7 from 209.43 ± 20.9 transplants/year, P = 0.000), with dramatic reduction in both deceased (99 ± 27.5 from 136.43 ± 131.4 transplants/year, P = 0.030) and living donor kidney transplantations (40.38 ± 6.1 from 73 ± 12.5 transplants/year, P = 0.000). Liver, heart, and lung transplant rates were not significantly affected; however, they have been low throughout both periods. Convertion to donation has not been affected by the crisis. Time series logistic regression of the crisis period demonstrated declining trends in organ donation, total solid organ transplantation, and deceased donor kidney, liver, and lung transplantation. In 2015, Greek organ donation rates were inferior to Eurotransplant, Scandiatransplant, NHSBT, UNOS, and Italy. CONCLUSIONS: There has been a temporal correlation between the economic recession and organ donation and transplantation crisis in Greece. Irrespective of the cause, measures should be taken to reverse this in order to avert the increased morbidity and mortality on the transplant waiting list.

Primum Non Nocere: Organ Donation After Electrocution and Transplantation of Electricity-Damaged Livers: Report of 2 Cases.

Liver transplantation remains the treatment of choice for patients with end-stage liver disease. However, allograft availability continues to be a problem, and extending the criteria for organ acceptance is key. Deceased donors after electrical accidents, as well as electricity-traumatized allografts, are not common but should be considered suitable. This study describes 2 cases of heart-beating organ donors with electrical injury to the liver. In 1 case, the electric shock was the cause of death; in the second case, the injury was caused by defibrillation at organ procurement. Both allografts had sustained sizeable electrical injury, and both resulted in excellent early posttransplant outcomes. These cases demonstrate that electrocution is not a contraindication to donation and that electricity-traumatized allografts may remain transplantable after careful assessment. Education of all staff in the management of such donors can optimize utility of such allografts.

Perforated endometrial appendicitis in pregnancy.

BACKGROUND: Endometriosis is a common disorder in women of reproductive age. A rare localization is the appendix, which, in most cases, is an incidental finding during appendectomies. The incidence of symptomatic appendiceal endometriosis or endometrial appendicitis might be increased in pregnancy. Moreover, endometrial appendicitis in pregnancy is more likely to present in an advanced stage, given the physiologic changes characterizing the gravid abdomen. MATERIALS AND METHODS: Description of a case of a pregnant woman presenting to the A&E with acute peritonitis attributable to advanced appendicitis. She underwent emergency laparotomy with appendectomy. The biopsy specimen was examined by the pathology laboratory of the same hospital. RESULTS: The laparotomy revealed perforated appendicitis. The histopathology report described acute endometrial appendicitis.