Faculty Bibliography

To maximize organ utilization, we assessed the feasibility of retrieving the heart and two single lungs or the heart and a separate bilateral lung block for transplantation into multiple recipients. In eight dogs the excision of the heart-lung block or of the left lung was followed by six hours of lung preservation. Four of these lungs and all eight hearts were transplanted successfully. In addition, satisfactory retrieval of the three separate organs or of the heart and a separate bilateral lung block was done in six human cadavers. An appropriate division of the left atrial wall provided suitable cuffs for individual transplantation of the three organs or for the heart and bilateral lung block. This study demonstrates the feasibility of multiple organ donation from a single donor followed by separate organ transplantation

Routine use of axillobifemoral (ABF) bypass has been advocated because this operation is thought to achieve better patency than the axillounifemoral (AUF) procedure. In 5 years we performed 34 AUF and 22 ABF bypass operations for limb salvage in high-risk patients using 6 mm polytetrafluoroethylene grafts. Five-year cumulative life table patency rates for AUF bypasses were 71% with reoperation (secondary patency) and 44% without reoperation (primary patency). These values were not significantly different (p greater than 0.5) from those for ABF bypasses (77% and 50%, respectively). Five-year limb salvage results (AUF 73%; ABF 89%) were also not significantly different (p greater than 0.1). Correlation of arterial outflow characteristics with graft patency revealed that 78% of the patients who never had graft occlusion had occluded superficial femoral arteries (SFA) demonstrated at the first operation, while 79% of the patients who experienced graft closure had comparable SFA occlusions. Our aggressive approach to graft thrombosis included angiographic study of the inflow arterial system. This revealed that 16% of the failed grafts were associated with hemodynamically significant stenosis of the donor subclavian artery. Our results indicate that AUF bypass is the procedure of choice for unilateral limb ischemia in high-risk patients who require an axillary source and that patency of the SFA does not affect outcome. These results also emphasize the need to obtain angiographic evaluation of the inflow system

KIE: To help overcome the shortage of organs for transplantation, the authors propose a legislative change that would institute a policy of routine salvaging of organs from brain dead patients unless the family objected or the individual had previously registered an objection. They defend this approach as a good middle course between the current ineffective policy based on 'encouraged voluntarism' and a 'presumed consent' policy that would attempt to achieve effectiveness by transgressing established ethical and legal principles