【Objective】The purpose of this study was to clarify the difficulties involved in caring for families of organ donors following cardiac arrest and to investigate countermeasures against the difficulties associated with this situation from the view-points of attending nurses. 【Design】Cross-sectional survey 【Methods】Seventy-five nurses participated in this study. The questionnaire targeting organ coordinators was revised for nurses with help from the Japan Organ Transplant Network. It contains 44 items, an χ2 test was carried out after each item was cross-totalized. 【Results】The difficulties most frequently expressed by nurses were the “Inability to realize that the donor can't recover (47.9%)”; “emotional strain on the family that had to make the final decision, even if it was intended by the donor (47.9%)”; and“ uncertainties about the donor's intention regarding organ donation (39.7%)”. When difficulties in providing support by nurses were compared by classifying the institutes to which they belonged (by such replies as “It is an institute in which organ donation is carried out after brain death,” “No,” and “I don't know”), a significant difference was observed regarding difficulty in providing support toward “uncertainties of the donor's intention regarding organ donation (p=0.004)” and “the emotional strain on the family having to make the final decision, even if it was intended by the donor (p=0.032)”. Nurses who are not in-hospital transplantation coordinators, who have no experience regarding participation in organ transplantation simulations, or who did not know “or observe,” the in-hospital manual experienced more difficulties in supporting families. 【Conclusion】Conditions in which nurses experienced difficulties in caring for the emotions of donor families were clarified. The following means of support seemed effective regarding the preparatory system to reduce difficulties in providing support by nurses toward families: (1) Dissemination of in-hospital manuals to nurses; (2) participation in simulations, and (3) support of the in-hospital transplantation coordinators.
We performed living-donor kidney transplantation in a patient who had undergone various surgical procedures for bladder exstrophy in infancy. The patient was a 28-year-old man who had undergone augmentation cystoplasty using gastrointestinal segments, bladder neck closure, end-to-side anastomosis of the right upper-to-left ureter, and right ureterocutaneostomy. After confirming that the patient was continent with good bladder compliance without reflux, we performed living-donor kidney transplantation. Since perivesical adhesions were expected, we extended the retroperitoneal space using an infrarenal approach, which was deemed to facilitate adhesiolysis. After placing a double J catheter in the ureter, we performed a ureteroureteral end-to-side anastomosis. In patients with a history of surgery for congenital urinary tract anomalies, it is important to fully consider surgical procedures before surgery and prevent urinary tract infection by the appropriate management of urination after surgery.
Renal artery dissection is one of the most serious complications following renal transplantation, which can lead to perfusion failure and result in graft dysfunction and loss. We present a case of renal artery intimal dissection which occurred during the early post-renal transplantation period. A-45-year-old female on hemodialysis underwent livingrelated renal transplantation. The serum creatinine levels gradually decreased to 2.0 mg/dL until 8days after the surgery, then turned to increase at day 9. At that point, a perfusion failure was considered due to a renal artery stenosis. However, an intimal flap was clearly detected in the graft artery lumen by use of an intravascular ultrasound (IVUS)，and the renal artery dissection was diagnosed. A percutaneous transluminal angioplasty (PTA) was successfully performed to the artery dissection at day 13. The patient's serum creatinine levels immediately started to decrease and it reached around 1.1 mg/dL within 2 months, then stable to the present. The IVUS is useful to detect intimal flaps and the PTA can help achieve recovery of graft renal function due to artery intimal dissection following renal transplantation.
Because of severe organ donor shortage, the heart transplant candidates are still require to wait for a couple of years before a heart transplantation (HTx) in Japan, even with left ventricular assist device support. However, the indication of a Japanese adult heart transplant program was scheduled to revise its age requirement to below 65, from the previous requirement of “below 60,” and it is estimated that the number of patients who registered as candidates of HTx will further increase hereafter. Therefore aggressive utilization of potential cardiac allografts is encouraged to increase graft availability from a limited number of Japanese donors. In this report, we present the case of an HTx recipient of aged over 60 who received marginal cardiac allograft from a donor also over 60. Despite the allograft from a mostadvanced-age donor, the clinical course of the patient was almost favorable with no adverse events related to graft function. This case that was a high-risk HTx from a donor of advanced age to a recipient of advanced age will be a model case for future HTx recipients in Japan and will show us a potential capacity of marginal cardiac allograft from a donor of advanced age as a useful organ resource.
Pure red cell aplasia (PRCA) as a result of parvovirus B19 (PVB19) infection after transplantation is a rare complication, and there are very few cases describing liver transplant recipients. This report presents the case of an 8-year-old boy who developed severe anemia after living donor liver transplantation for primary sclerosing cholangitis. For the diagnosis and therapy, a real-time PCR assay was a useful noninvasive test. He required intravenous immunoglobulin therapy and successfully recovered.