Transplantation | Year: 2012
Every country needs to increase the number of deceased organ donors and the potential impact of a change to opting-out legislation remains unproven, despite the apparent association between opting out and higher donor rates. However, the Spanish model-so successful in Spain and many other countries-is not based on a requirement for opting out, and, in the UK, deceased organ donation has increased by 25% in 3 years through implementation of a series of recommendations that have transformed the infrastructure of donation. A major review of opting out concluded that it is not appropriate for the UK at this time. © 2012 by Lippincott Williams & Wilkins.
Carbone M.,Addenbrookes Hospital |
Mutimer D.,Queen Elizabeth Hospital |
Transplantation | Year: 2013
Hepatitis C virus (HCV) infection is common in solid organ allograft recipients and is a significant cause of morbidity and mortality after transplantation, so effective management will improve outcomes. In this review, we discuss the extent of the problem associated with HCV infection in donors and kidney, heart, and lung transplant candidates and recipients and recommend follow-up and treatment. Patients with end-stage kidney disease without cirrhosis and selected patients with early-stage cirrhosis can be considered for kidney transplant alone. In HCV-infected kidney allograft recipients, the progression of fibrosis should be evaluated serially by Fibroscan or serologic measures of fibrosis. Transplantation of kidneys from HCV-positive donors should be restricted to HCV-positive recipients as it is associated with a reduced time waiting for a graft and does not affect posttransplant outcomes. Hepatitis C virus antiviral therapy should be considered for all HCV-RNAYpositive kidney transplant candidates, irrespective of the baseline liver histopathology. Protease inhibitors have yet to be fully evaluated in patients with renal dysfunction and in the transplant population. As these agents may cause anemia in patients with normal renal function, tolerability may be a problem in patients with end-stage kidney disease. The impact of HCV infection on survival in heart and lung transplantation is unclear. Because of the shortage of organs, few HCV-infected patients are accepted for transplantation. Universal use of nucleic acid amplification testing (NAT) for the screening of potential organ donors should be reserved to high-risk donors. Assays that quantify HCV core antigen may become more cost-effective than NAT for the screening of potential organ donors. © 2013 Lippincott Williams & Wilkins.
Carbone M.,Addenbrookes Hospital |
Carbone M.,DoNation |
Neuberger J.M.,Queen Elizabeth Hospital |
Journal of Hepatology | Year: 2014
Summary Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis (AIH) represent the three major autoimmune liver diseases (AILD). PBC, PSC, and AIH are all complex disorders in that they result from the effects of multiple genes in combination with as yet unidentified environmental factors. Recent genome-wide association studies have identified numerous risk loci for PBC and PSC that host genes involved in innate or acquired immune responses. These loci may provide a clue as to the immune-based pathogenesis of AILD. Moreover, many significant risk loci for PBC and PSC are also risk loci for other autoimmune disorders, such type I diabetes, multiple sclerosis and rheumatoid arthritis, suggesting a shared genetic basis and possibly similar molecular pathways for diverse autoimmune conditions. There is no curative treatment for all three disorders, and a significant number of patients eventually progress to end-stage liver disease requiring liver transplantation (LT). LT in this context has a favourable overall outcome with current patient and graft survival exceeding 80% at 5 years. Indications are as for other chronic liver disease although recent data suggest that while lethargy improves after transplantation, the effect is modest and variable so lethargy alone is not an indication. In contrast, pruritus rapidly responds. Cholangiocarcinoma, except under rigorous selection criteria, excludes LT because of the high risk of recurrence. All three conditions may recur after transplantation and are associated with a greater risk of both acute cellular and chronic ductopenic rejection. It is possible that a crosstalk between alloimmune and autoimmune response perpetuate each other. An immunological response toward self- or allo-antigens is well recognised after LT in patients transplanted for non-autoimmune indications and sometimes termed "de novo autoimmune hepatitis". Whether this is part of the spectrum of rejection or an autoimmune process is not clear. In this manuscript, we review novel findings about disease processes and mechanisms that lead to autoimmunity in the liver and their possible involvement in the immune response vs. The graft after LT. © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Neuberger J.,DoNation |
Neuberger J.,Queen Elizabeth Hospital
Transplant International | Year: 2012
Because the demand for solid organ transplantation exceeds the availability of donated grafts, there needs to be rationing for this life-saving procedures. Criteria for selection of patients to a national transplant list and allocation of donated organs should be transparent yet there is no consistent approach to the development of such guidelines. It is suggested that selection and allocation policies should comply with minimum standards including defining of aims of the allocation process and desired outcome (whether maximizing benefit or utility or ensuring equity of access), inclusion and exclusion criteria, criteria for futility and suspension and removal from the transplant list, appeals processes, arrangements for monitoring and auditing outcomes and processes for dealing with noncompliance. Furthermore, guidelines must be consistent with legislation even though this may compete with public preference. Guidelines must be supported by all stakeholders (including health-care professionals, donor families and potential transplant candidates). However, there must also be flexibility to allow for exceptions and to support innovation and development. © 2011 The Authors.
Langenbeck's Archives of Surgery | Year: 2015
Aim This review aims to outline the delivery of liver transplant services in the UK. Background Liver transplantation in the UK is based on seven designated transplant units serving a population of just over 60 million people. Nearly 900 liver transplants were done in 2013/2014. Process Potential deceased donors are identified and referred to centrally employed specialist nurses for obtaining family consent and for donor characterisation. Organs are retrieved by a National Organ Retrieval Service, based on seven abdominal and six cardiothoracic retrieval teams providing a 24/7 service which has shown to be capable of retrieving organs from up to ten donors a day. Donated organs are allocated first nationally to those who qualify for superurgent listing. The next priority is for splitting livers, and if there is no suitable recipient or the liver is not suitable for splitting, then livers are offered first to the local centre; each centre has a designated donor zone, adjusted annually to ensure equity between the number of patients listed and the number of donors. The allocation scheme is being reviewed, and national schemes based on need, utility and benefit are being assessed. Governance Outcomes are monitored by National Health Service Blood and Transplant (NHSBT), and if there is a possibility of adverse deviation, then further inquiries are made. Outcomes, both from listing and from transplantation, are published by the centre on the NHSBT website (www.odt. nhs.uk). NHSBT works closely with stakeholders primarily through the advisory groups with clinicians, patients, lay members and professional societies and aims to provide openness and transparency. Conclusions The system for organ donation and delivery of liver transplant in the UK has developed and is now providing an effective and efficient service, but there remains room for improvement. © Springer-Verlag Berlin Heidelberg 2015.
Neuberger J.,Queen Elizabeth Hospital |
Journal of Autoimmunity | Year: 2016
Liver transplantation, although now a routine procedure, with defined indications and usually excellent outcomes, still has challenges. Donor shortage remains a key issue. Transplanted organs are not free of risk and may transmit cancer, infection, metabolic or autoimmune disease. Approaches to the donor shortage include use of organs from donors after circulatory death, from living donors and from those previously infected with Hepatitis B and C and even HIV for selected recipients. Normothermic regional and/or machine perfusion, whether static or pulsatile, normo- or hypothermic, are being explored and will be likely to have a major place in improving donation rates and outcomes. The main indications for liver replacement are alcoholic liver disease, HCV, non-alcoholic liver disease and liver cancer. Recent studies have shown that selected patients with severe alcoholic hepatitis may also benefit from liver transplant. The advent of new and highly effective treatments for HCV, whether given before or after transplant will have a major impact on outcomes. The role of transplantation for those with liver cell cancer continues to evolve as other interventions become more effective. Immunosuppression is usually required life-long and adherence remains a challenge, especially in adolescents. Immunosuppression with calcineurin inhibitors (primarily tacrolimus), antimetabolites (azathioprine or mycophenolate) and corticosteroids remains standard. Outcomes after transplantation are good but not normal in quality or quantity. Premature death may be due to increased risk of cardiovascular disease, de novo cancer, recurrent disease or late technical problems. © 2015 Elsevier Ltd.
Murphy P.G.,DoNation |
Smith M.,University College London
British Journal of Anaesthesia | Year: 2012
Implementation of the recommendations from the Organ Donation Taskforce has introduced for the first time into the UK a nationwide framework for deceased donation. This framework is based, in principle, upon a conviction that donation should be viewed as part of end-of-life care and that the actions often necessary to facilitate it become justified when donation is recognized to be consistent with the wishes and interests of a dying patient. The implementation of the Taskforce recommendations across the complex landscape of acute hospital care in the UK represents a challenging programme of change management that has three more or less distinct phases. This programme has involved first creating and communicating the Taskforces vision for donation in the UK, secondly introducing the structural elements of this new framework into hospital practice, and finally creating the environment in which these new elements can deliver the overall programme goals. Implementation has focused heavily upon areas of practice where significant opportunities to increase donor numbers exist. It is recognized that the greatest challenge is to overcome the societal and clinical behaviours and beliefs that currently create barriers to donation. Although national audit data may point to some of these areas of practice, international comparisons suggest that differences in approach to the care of patients with catastrophic brain injury may have a profound influence on the size of the potential donor pool. © 2012 The Author.
DoNation | Date: 2013-02-28
A food donation tracking system is provided for tracking food donations along a food donation route that includes a food recipient location and a plurality of food rescue locations. The system includes a display device at each of the food rescue locations, each display device being operable to generate a dynamic unique code specific to the food rescue location where the display device is located. A driver scans the dynamic unique code with a handheld unit. Tracking information is recorded and transmitted from the handheld unit to a central server. The tracking information includes location information identifying the food rescue location of the food donation pickup based on the dynamic unique code scanned at the food rescue location and time information corresponding to when the unique code was scanned at the food rescue location.
DoNation | Date: 2011-11-03
Shopping systems and methods that automate the merchandise selection process are implemented for producing picking/shipping documents that allow the merchandise to be picked at a warehouse and sent to recipients. The initiator of the process is a purchaser that specifies the recipients demographics and other parameters as they relate to the merchandise. The purchaser may also specify various constraints that both limit the amount of merchandise selected and filter the merchandise to better match the recipients requirements as a group.
News Article | November 28, 2016
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