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The history of ethical principles in liver transplant organ allocation in the united states: how historical and proposed allocations system fare in balancing utility vs. urgency and justice vs. pragmatism
Curr Opin Organ Transplant. 2023 Sep 22. doi: 10.1097/MOT.0000000000001103. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: The United States (US) liver transplant community is processing changes to the allocation system and developing a new proposal that will result in even greater change. This review evaluates the ethical implications of these decisions, focusing on two sets of competing ethical principles (Urgency vs. Utility and Justice vs. Pragmatism).RECENT FINDINGS: About four years ago, the Organ Procurement and Transplantation Network (OPTN) implemented the Acuity Circle Model to replace the geographic boundaries...
Source: Current Opinion in Organ Transplantation - September 28, 2023 Category: Transplant Surgery Authors: Aaron Ahearn Source Type: research

What is needed to ensure long-term sustainability for the field of vascularized composite allotransplantation?
Curr Opin Organ Transplant. 2023 Sep 29. doi: 10.1097/MOT.0000000000001114. Online ahead of print.ABSTRACTThe field of vascularized composite allotransplantation (VCA) has demonstrated remarkable advances since its inception with some excellent long-term results in a variety of graft types. However, unlike solid organ transplantation, it has yet to become mainstream. We therefore discuss strategies on ensuring long-term sustainability by addressing continued clinical developments of VCA to improve the risk-to-benefit balance, importance of public support, improved policy and financial support, and need for a bridge to the ...
Source: Current Opinion in Organ Transplantation - September 28, 2023 Category: Transplant Surgery Authors: Yoshiko Toyoda L Scott Levin Source Type: research

A review of transplant infectious diseases and pediatric transplant infectious diseases curriculum
Curr Opin Organ Transplant. 2023 Sep 22. doi: 10.1097/MOT.0000000000001105. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: As the volume and complexity of solid organ and hematopoietic stem cell transplantation continue to see rapid growth, the training of a specialized transplant infectious diseases physician workforce is of increasing interest and importance. This review provides an overview of the evolution of transplant infectious diseases training programs, essential elements of training, as well as future needs.RECENT FINDINGS: Despite the first publication of a transplant infectious diseases curriculum in 2010, mo...
Source: Current Opinion in Organ Transplantation - September 26, 2023 Category: Transplant Surgery Authors: Megan K Morales Lara Danziger-Isakov Saman Nematollahi Source Type: research

Coagulation management during liver transplantation: monitoring and decision making for hemostatic interventions
Curr Opin Organ Transplant. 2023 Sep 19. doi: 10.1097/MOT.0000000000001101. Online ahead of print.ABSTRACTPURPOSE OF REVIEW: Rebalanced hemostasis describes the precarious balance of procoagulant and antithrombotic proteins in patients with severe liver failure. This review is aimed to discuss currently available coagulation monitoring tests and pertinent decision-making process for plasma coagulation factor replacements during liver transplantation (LT).RECENT FINDINGS: Contemporary viscoelastic coagulation monitoring systems have demonstrated advantages over conventional coagulation tests in assessing the patient's coagu...
Source: Current Opinion in Organ Transplantation - September 20, 2023 Category: Transplant Surgery Authors: Kofi B Vandyck Walter Rusin Samhati Mondal Kenichi A Tanaka Source Type: research

Pain management for liver transplant recipients
We present current evidence-based literature that reviews optimal pain management strategies for this challenging patient demographic.RECENT FINDINGS: Multiple studies have shown that thoracic epidurals provide superior pain control in open hepatic resections. Recent data suggests thoracic epidurals may be safely considered in select liver transplant recipients with normal preoperative coagulation status; however, this evidence is limited, and further studies are needed. When the risks of coagulopathy prohibit epidural placement, truncal blocks such as transversus abdominis plane blocks or quadratus lumborum blocks and abd...
Source: Current Opinion in Organ Transplantation - September 20, 2023 Category: Transplant Surgery Authors: Simrat Kaur Patrick Henthorn Adrian Hendrickse Source Type: research