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Organ Donation

  1. Living donation transplantations
    1. Offers the advantage of optimal preparation for the recipient and donor.
    2. Minimize the organ preservation time.
    3. Laparoscopic and laparoscopy-assisted techniques has proven to be a major improvement to living
    4. donation.
    5. If one of the kidney is better than the other, better one if left for donor.
    6. Left kidney if preferred due to its long renal vein.
    7. Flank incision is used most often and donor receives 25 gms of mannitol in 1 hour infusion at the beginning
    8. of the surgery to improve perfusion. 
  2. Cadaver donation
    1. Allocation of cadaver donor grafts is based on a waiting list, with special priorities given to HLA zero mismatch pairings, pediatric recipients, and patients with a high PRA titer.
    2. Most cadaver kidney grafts come from brain-dead, heart-beating cadavers.
    3. Criteria for cadaver donor are: Ages 18 months to 55 years; no HT/DM or Malignancy (other than primary brain tumours and treated skin cancer); no generalized viral or bacterial infection; normal BUN and creatinine values and negative assay for syphilis, hepatitis, HIV and HTLV-I.
    4. Goals of resuscitation for brain dead donor are systolic BP > 90 mm/Hg and urinary output > 0.5 ml/kg/Hr. Q
    5. Absolute contraindications to cadaver donation include some active infection, including HIV, and extracranial malignancy.
    6. Relative contraindications include poor renal function in the donor, positive hepatitis serologies, advanced donor age (especially if paired with hypertension or diabetes).
    7. This procurement essentially involves perfusion of the involved organs with ice-cold (4°C) organ preservation solution.
    8. These solutions typically contain high levels of potassium to depolarize cell membranes.
    9. These solutions also may contain impermeant sugars to prevent cell swelling, albumin or dextrans to maintain osmolality and to prevent swelling of the extravascular extracellular fluid compartment, and free radical scavengers and agents (eg, allopurinol) to reduce reperfusion injury.
    10. The most commonly used preservation solution is UW solution (formulated at the University of Wisconsin).
    11. To provide target cells for the crossmatch, lymphoid tissue (ie, lymph nodes, spleen) is obtained at the time of procurement.

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