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Transplant Services: The Surgery Is the Least of It

  • Thomas DifloEmail author
  • Gregory Veillette
  • Vaughn Whittaker
Chapter

Abstract

Transplantation in the twenty-first century is a huge business. Kidneys, livers, hearts, pancreata, lungs, and small intestine, either alone or in combination, are transplanted every day. The complexity of the surgery and care of the patients is almost rivaled by the intricate regulatory system that governs transplantation in the United States. Success in transplantation is propelled by surgical and medical expertise but also by adhering to local, state, and federal rules and regulations. Unlike the days of old, starting a transplant program now requires gargantuan amounts of paperwork, organization, and money. In this chapter, we will review some of the history of transplantation, the development of regulatory requirements, and the day-to-day necessities for running successful transplant programs. This chapter will concentrate on the transplantation of kidneys and livers, although many of the requirements are similar for the transplantation of other organs.

Keywords

Uniform Anatomical Gift Act (UAGA) National Organ Transplant Act (NOTA) Organ Procurement and Transplantation Network (OPTN) United Network for Organ Sharing (UNOS) Centers for Medicare and Medicaid Services (CMS) Organ procurement organization (OPO) Donor service area (DSA) UNET Human leukocyte antigen (HLA) Model for End-Stage Liver Disease (MELD/PELD) Independent Donor Advocate Team (IDAT) 

References

  1. 1.
    Starzl TE. My thirty-five year view of organ transplantation. History of transplantation: thirty-five recollections. UCLA Tissue Typing Laboratory. 1991;145–79.Google Scholar
  2. 2.
    Borel JF, Feurer C, Magnee C, et al. Effects of the new antilymphocyte peptide Cyclosporin A in animals. Immunology. 1977;32:1017.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Calne R. Recollections from the laboratory to the clinic. History of transplantation: thirty-five recollections. UCLA Tissue Typing Laboratory. 1991;227–41.Google Scholar
  4. 4.
    US Department of Health & Human Services. Organdonor.gov. Retrieved from: https://organdonor.gov/about-dot/laws/history.html
  5. 5.
    A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to examine the definition of brain death. JAMA. 1968;205(6):337–40.Google Scholar
  6. 6.
    National Conference of State Legislatures (NCSL). Con-Certificate of Need State Laws. August 25, 2016. Retrieved from: http://www.ncsl.org/research/health/con-certificate-of-need-state-laws.aspx.
  7. 7.
    Axelrod D, Guidinger M, Metzger R, et al. Transplant center quality assessment using a continuously updatable, risk-adjusted technique (CUSUM). Am J Transplant. 2006;6(2):313–23.CrossRefGoogle Scholar
  8. 8.
    Habbous S, Arnold J, Begen MA, et al. Duration of living kidney transplant donor evaluations: findings from 2 multicenter cohort studies. Am J Kidney Dis. 2018; in print. Habbous S, Garg AX, Lam NN. Optimizing efficiency in the evaluation of living donor candidates: Best Practices and Implications. Current Transplant Rep. 2018;5(1):55–63.Google Scholar
  9. 9.
    Abecassis M, Burke R, Klintmalm G, et al. American society of transplant surgeons transplant center outcomes requirements—A threat to innovation. Am J Transplant. 2009;9(6):1279–86.CrossRefGoogle Scholar
  10. 10.
    Edwards EB, Roberts JP, McBride MA, et al. The effect of the volume of procedures at transplantation centers on mortality after liver transplantation. N Engl J Med. 1999;341(27):2049–53.CrossRefGoogle Scholar
  11. 11.
    Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364(22):2128–37.CrossRefGoogle Scholar
  12. 12.
    Hosenpud JD, Breen TJ, Edwards EB, et al. The effect of transplant center volume on cardiac transplant outcome: a report of the United Network for Organ Sharing Scientific Registry. JAMA. 1994;271(23):1844–9.CrossRefGoogle Scholar
  13. 13.
    Rana A, Pallister Z, Halazun K, et al. Pediatric liver transplant center volume and the likelihood of transplantation. Pediatrics. 2015;136(1):e99–e107.CrossRefGoogle Scholar
  14. 14.
    Reese PP, Yeh H, Thomasson AM, et al. Transplant center volume and outcomes after liver retransplantation. Am J Transplant. 2009;9(2):309–17.CrossRefGoogle Scholar
  15. 15.
    Tracy ET, Bennett KM, Danko ME, et al. Low volume is associated with worse patient outcomes for pediatric liver transplant centers. J Pediatr Surg. 2010;45(1):108–13.CrossRefGoogle Scholar
  16. 16.
    Shaw BW. Starting a liver transplant program. Semin Liver Dis. 1989;9(3):159–67.CrossRefGoogle Scholar
  17. 17.
    Wiesner R, Edwards E, Freeman R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology. 2003;124:91–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Thomas Diflo
    • 1
    Email author
  • Gregory Veillette
    • 2
  • Vaughn Whittaker
    • 3
  1. 1.Department of Surgery, Section of Intra-abdominal Organ TransplantationWestchester Medical Center, New York Medical CollegeValhallaUSA
  2. 2.New York Medical College, Westchester Medical CenterValhallaUSA
  3. 3.Department of SurgeryWestchester Medical Center and New York Medical College, School of MedicineValhallaUSA

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