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Biomedical subjects

D Hasman

Publications and source records attributed to D Hasman.

10 recordsLinked to original sources
PubMed2002

[Initial experience with transplantation of a kidney from a non-beating heart donor (NHBD)].

The authors present their initial experience with transplantations of the kidneys from a donor with a non-beating heart (NHBD). This programme was developed because of the permanently declining number of cadaverous kidney donors with a beating heart. Since January 2002 the authors collected a total of three kidneys from NHBD 3 kidneys of which were used for transplantation. The first two started to function immediately, the third one restored its function three weeks after transplantation. The viability and suitability of use of kidneys from NHBD is evaluated with regard to vascular resistance and flow of the perfusion fluid through the kidneys when using a perfusion pump and by means of totalglutathione-S-transferase (tGST) assessed at intervals in the perfusion fluid. The values of the above parameters are limiting between the 6th and 8th hour after the onset of instrumental perfusion of the collected kidneys when the perfusion values should be within the range of 30-50 ml/min/100 g and the vascular resistance should be < 0.7 mmHg and tGST < 100 U/l. For immunosuppression the authors use during the fist days after transplantation basiliximab, rapamycin and corticoids, later in case of satisfactory function of the graft they add cyclosporin A. The initial results of renal transplantation from NHBD are promising and the programme will be developed further.

Cadaver↗
PubMed2001

[Ethical problems with non-heart beating donors].

Shortage of kidney donors and the large number of patients with chronic renal failure leads to the search for new sources of transplantable organs. One of the ways is to use non-heart beating donors, NHBD. This type of donors accounted in medically advanced countries of western Europe and the USA for 20-40% of all kidney donors. In the Czech Republic this programme has not been developed so far. The department in Plzen has been concerned with the preparation of this programme since 1998, so far in clinical experiments within the framework of valid legal standards. In addition to medical problems is in the foreground, in particular of NHBD group 2 and 3, the ethical problem associated with the termination of cardiopulmonary resuscitation in conditions medically insolvable as regards induction of spontaneous cardiac activity, respiration or function of the CNS. The authors reflect on this serious problem and discuss views held by some departments abroad. In the conclusion they emphasize the unconditional necessity of primary efforts to save the patient's life by all available medical means. The doctor must never be led by the idea of irreversibility of the process with the objective or organ collection for transplantation.

Heart Arrest↗
PubMed2000

[A kidney harvesting technic from a non-heart beating donor].

The authors describe the technique of collection of kidneys from NHBD. They present their own protocol elaborated in Plzen for collection of kidneys from NHBD. For collection they use a special double-balloon catheter inserted into the aorta to ensure that the perfusion fluid will penetrate into visceral branches of the aorta. For the flow of the perfusion fluid a urinary catheter is used inserted via the femoral vein into the vena cava inferior. Immediately after the beginning of perfusion laparotomy is performed with immediate cooling of the kidney with ice. The authors give an account of their own experience and discuss further technical possibilities as regards collection of kidneys from NHBD.

Cadaver↗
PubMed2000

[Donors with non-beating hearts--a new possibility in expanding the kidney donor program].

In the Czech Republic in recent years a steady decline of renal transplantations was recorded due to shortage of organ donors. The authors present initial experience with the collection of organs from dead non heart beating donors (NHBD). In the course of less than two years this programme was introduced within the framework of a clinical experiment (grant IGA MofH CR ND/4781-3) at the Surgical Clinic, Faculty Hospital in Plzen. A total of 20 kidneys were collected from NHBD and another 12 kidneys were not collected, most frequently because of difficulties in communication and organization. The donors were grouped according to the Maastricht classification. The mean age of donors was 43.3 years, the mean period of warm ischaemia was 22 minutes and the serum creatinine level was 145 mumol/l. Of 20 collected kidneys a normal histological appearance was recorded in 14, the remainder had different degrees of damage due to inadequate rinsing. Based on hitherto assembled experience the authors emphasize perfect team collaboration in collection from NHBD and a precise technique of collection. The next stage of the clinical study will be the preparation proper for clinical transplantation of kidneys from NHBD.

Adult↗
PubMed1999

[Ethical problems in organ transplantation].

Organ transplantation is an accepted therapeutic method with good results, but it is connected with many not only medical but also ethical problems. One of the most important problems is the donor programme. In cadaverous donors the main ethical and legal question is the decision who can issue the consent with organ retrieval; in living donors it is the problem of motivation and financial compensation. Allocation of organs with low compatibility or from non-ideal donors, and the recipient's consent in these cases may involve difficult decisions.

Ethics, Medical↗