NIKOLE A. NEIDLINGER, M.D.

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This study examined how often and why invasive heart artery screening (coronary angiography) is performed in younger potential heart donors across the United States. Among younger, low-risk donors who received the screening, only 1-3% had significant blockages, yet screening rates varied widely by region with no clear clinical rationale. Standardized protocols are needed to avoid unnecessary procedures and inconsistent use of what is a discretionary test.

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Researchers compared outcomes of dual kidney transplantation (using two kidneys from a single marginal donor) versus standard single kidney transplants across nearly 3,200 recipients over two decades. Dual kidney transplant recipients had significantly lower rates of rejection and graft failure within five years, without any increase in surgical complications or hospital stay. Using both kidneys together is a safe and effective way to utilize organs that might otherwise be discarded, expanding the donor pool.

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Eight adult patients received simultaneous pancreas and kidney transplants using organs from young pediatric donors (average age five years, average weight 20 kg), with both organs placed together. All patients achieved immediate insulin independence, kidney function was good, and no grafts were lost to clotting. Transplanting en bloc pediatric pancreas and kidney grafts into adults is technically safe and produces excellent long-term metabolic and kidney outcomes.

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This analysis of over 14,000 donor heart offer refusals found that nearly a quarter were declined for reasons unrelated to the donor's condition, such as recipient illness or logistical issues. Several donor-related reasons for refusal (like mild heart abnormalities) were more common on weekends, even though the donors themselves were no different from weekday donors. This weekend effect points to subjective and resource-driven decision-making that results in preventable organ discard.

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Using a large national survey of heart transplant programs, researchers catalogued the reasons why potential donor hearts are turned down, finding that donor age, coronary disease, and weak heart function were most commonly cited. Age as a reason for refusal grew significantly over time even though older donors were not becoming more prevalent. Wide regional variation in refusal patterns, unexplained by actual donor characteristics, suggests that subjective bias is causing viable hearts to be discarded.

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This study evaluated the safety and efficiency of transporting brain-dead organ donors by air and ground ambulance to a centralized organ recovery facility over an 18-month period. Across 74 donor transports, the program yielded an average of 3.67 organs transplanted per donor, with only minor clinical events during transport and no cardiac arrests. Centralized recovery centers supported by dedicated critical care transport are a safe, cost-effective way to increase the number of organs recovered from each donor.

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This case report describes a patient who received a simultaneous heart and kidney transplant while a mechanical heart pump (Impella 5.5) remained in place to support circulation during the kidney portion of the surgery. The device was kept running through both transplants rather than removed after the heart was placed, allowing the kidney to be transplanted in the same operation with good immediate function. Leaving mechanical support in place during combined transplants may reduce kidney injury and the need for post-operative dialysis.

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Researchers analyzed whether transplanting pancreata from geographically distant donors led to worse outcomes compared to local donors, examining over 18 years of cases at a single large center. Pancreas survival, patient survival, and clotting complications were all comparable regardless of transport distance. Importing pancreata from farther away is safe and can help reduce patient wait times by expanding access to usable organs.

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The Donor Heart Study analyzed ECGs from over 4,000 potential cardiac donors and found that nearly two-thirds showed some abnormality, most often non-specific changes that resolved on a second reading. Only pathological Q waves were associated with a lower chance of the heart being used for transplant, and no ECG finding predicted worse recipient survival. Serial ECG testing can reassure clinicians that most early abnormalities are transient and should not by themselves disqualify a donor heart.

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This multi-center U.S. study compared liver transplant outcomes for donors recovered after circulatory death using normothermic regional perfusion (NRP) versus the standard rapid surgical recovery method. NRP recipients had shorter hospital stays, less early liver dysfunction, fewer bile duct complications, and zero cases of ischemic cholangiopathy, which is a serious complication that only occurred in the standard recovery group. NRP significantly improves liver transplant quality from circulatory-death donors and should be adopted more widely.

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This study examined how often donor age alone, without accompanying cardiac problems, drives heart transplant refusals. Among donors where age was frequently cited as the reason for refusal, most had no documented cardiac abnormality. The rate of discard jumps sharply at age 50 despite no evidence of a biological threshold at that age, indicating that arbitrary age cutoffs are causing viable hearts to be wasted.

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Researchers built and validated a machine-learning model to predict whether a given potential heart donor would be accepted for transplant, using data from nearly 74,000 donors nationwide. A random forest model achieved 83% accuracy and was deployed as an online tool. Age has become an increasingly strong predictor of discard over the past two decades, suggesting shifting but not necessarily evidence-based biases in donor selection.

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A survey of all 55 U.S. organ procurement organizations (OPOs) examined their experience with normothermic regional perfusion (NRP), a technique that restores circulation in a deceased donor to improve organ quality. Nearly all OPOs were performing NRP, but nearly half operated without a formal policy, and allocation challenges increased as programs gained more experience. Most OPOs called for national standardized guidelines to reduce inconsistency and maximize the number of organs successfully transplanted.

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A randomized trial compared standard tacrolimus versus extended-release tacrolimus (Envarsus) in kidney transplant recipients who had delayed graft function after transplant. The two formulations produced similar durations of delayed graft function and numbers of dialysis sessions, but patients on Envarsus required fewer dose adjustments because drug levels were more stable. Envarsus simplifies management during a clinically complex period without compromising recovery.

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The Donor Heart Study prospectively tracked echocardiograms in over 3,700 potential heart donors and found that 13% had reduced heart function at brain death. Among those with a follow-up scan, 58% recovered normal function within 24 hours. Reduced heart function at brain death, whether or not it recovers, did not predict worse outcomes in recipients, suggesting it should not automatically disqualify donor hearts.

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Researchers prospectively characterized 58 HIV-positive deceased donors in the U.S. from 2016 to 2020 under the HOPE Act. Most HIV-positive donors had a known diagnosis, 90% had been on antiretroviral therapy, and drug resistance mutations affecting older treatment classes were common but rarely threatened modern integrase inhibitor-based regimens. The number of HIV-positive donors is growing, and their characteristics support safe transplantation with appropriate recipient matching.

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This study investigated whether local transplant center competition and regional kidney availability affected how often donated kidneys were exported or discarded. Higher organ availability in a region was more strongly associated with discard than market competition was. Local organ shortage drives utilization more than competitive dynamics, suggesting that allocation policy changes may be more effective than market-based interventions.

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The first 13 U.S. liver transplants using normothermic regional perfusion from circulatory-death donors were reviewed across nine centers. At a median follow-up of over a year, 12 of 13 recipients were alive with good liver function, and no recipient developed ischemic cholangiopathy, the most feared complication of this donor type. These early results support the broader adoption of this technique to reduce liver waitlist deaths.

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Researchers from the Donor Heart Study described the practical and regulatory obstacles encountered when conducting a prospective research study involving deceased organ donors. Key challenges included obtaining ethical authorization, engaging multiple organ procurement organizations, managing donor logistics, and sustaining study momentum over five years. The paper offers concrete solutions and lessons to help future investigators design more efficient donor-based research studies.

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The Tabula Sapiens consortium built a comprehensive reference map of nearly 500,000 human cells sampled from 24 tissues and organs, many from the same donors. The atlas identified over 400 distinct cell types, characterized how gene expression varies across tissues, and revealed tissue-specific patterns of RNA splicing and immune cell distribution. This resource provides a detailed molecular foundation for understanding human biology and disease across the entire body.

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This study examined the impact of performing a liver biopsy before surgical recovery in donors who died after circulatory death, reviewing 20 years of data from a single organ procurement organization. Livers that underwent pre-procurement biopsy were transplanted at a higher rate (80%) than those recovered without biopsy (49%), and the biopsy excluded only 6.6% of donors from proceeding. Pre-procurement liver biopsy helps identify usable livers that might otherwise be declined and reduces wasted recovery efforts.

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Data from 29 U.S. organ procurement organizations were analyzed to measure how often surgical injuries during organ recovery permanently damage an organ. Injuries making an organ non-transplantable occurred in about 0.3% of recovered organs, with kidneys most often affected. Even at this low rate, the sheer volume of donors means hundreds of transplantable organs are lost to procurement injury each year, highlighting the need for ongoing surgical quality improvement.

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Prospectively collected data from across the U.S. described what happens to livers after a transplant surgeon declines them during the actual procurement operation. Only 49% of intraoperatively declined livers were ultimately transplanted, with livers declined after the organ was already cross-clamped being transplanted at much lower rates. The study identifies opportunities to reduce waste, including building in time before cross-clamp to allow reallocation and collecting systematic data on late declines.

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Six deceased donors with prior COVID-19 infection had 13 organs successfully recovered and transplanted through multiple U.S. organ procurement organizations, with no SARS-CoV-2 transmission to any recipient, procurement staff, or hospital personnel. At least two additional authorized donors did not proceed because no organs were allocated. Organ donation from donors who have recovered from COVID-19 appears safe and should not be automatically ruled out.

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A prospective study across 20 organ procurement organizations examined whether brain-dead donors who received therapeutic hypothermia after cardiac arrest before death had different donation outcomes than those who did not. Organs per donor and individual organ transplant rates were similar between groups, but kidney recipients from hypothermia-treated donors had 25% less delayed graft function. Therapeutic hypothermia in a donor before death is a protective factor that should favor accepting their kidneys for transplant.

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This consensus document from the American Society of Anesthesiologists and transplant organizations outlines evidence-based guidelines for anesthesia and critical care management during deceased donor organ procurement. The guidelines call for greater anesthesiologist and intensivist involvement in donor care and standardized data collection during procurement. Improved donor management by trained specialists has the potential to increase the number and quality of organs recovered from each donor.

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This multi-center study tracked what happened to kidneys exported across the country for highly sensitized transplant candidates, who are given allocation priority but are difficult to match. Of 520 kidneys exported for these patients, 77% reached the intended recipient, 19% went to a different patient, and 3.5% were discarded — with a positive compatibility test being the most common reason for redirection. Performing actual tissue crossmatching before shipping the kidney, rather than relying on a virtual estimate, dramatically increased the rate of delivery to the intended recipient.

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A California transplant network introduced a brief ritual before organ recovery in which the donor's family wrote a personalized tribute read aloud in the operating room, followed by a moment of silence. Hospital staff and families both responded positively, and donor hospitals that implemented the ritual showed improved donation rates. Honoring donors with a family-designed tribute improves both the experience for families and the willingness of hospital staff to support donation.

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Doctors at organ transplant organizations sometimes take a small tissue sample from a donor's liver before transplanting it to check if the organ is healthy enough to use. Researchers surveyed 49 transplant organizations across the U.S. and found that about 82% do this procedure, but they do it inconsistently—some almost never use it while others use it regularly—depending mainly on factors like the donor's age, weight, and alcohol history. The main reasons this matters: transplant centers need better information about whether these biopsies actually help predict which livers will work well after transplant, because right now organizations are doing them very differently, and most doctors aren't even sure the biopsies are easy or accurate enough to rely on.

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Researchers prospectively collected data from 36 U.S. organ procurement organizations over a year to measure the rate of surgical injuries that permanently ruin an organ during procurement. Out of nearly 20,000 organs analyzed, 59 (0.3%) were rendered non-transplantable, with kidneys accounting for 73% of those losses. Although rare, these losses add up to a meaningful number of transplantable organs destroyed each year, underscoring the importance of surgical quality programs.

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A randomized controlled trial tested whether inhaled albuterol, a drug that clears fluid from the lungs, could improve oxygen levels and increase lung donation rates in 506 brain-dead organ donors. Lung function and donation rates were identical between the albuterol and placebo groups, but albuterol caused dangerous heart rate elevations that required dose reductions or stopping the drug entirely. High-dose inhaled albuterol should not be used in organ donors.

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A California organ procurement organization introduced a brief pre-recovery ritual in which families wrote a personalized tribute to their loved one, which was read aloud in the operating room before organ recovery, followed by a 15-second moment of silence. Families and hospital staff universally embraced the ritual, and donation rates improved in hospitals where it was implemented. A simple act of recognition for donors can improve both the donation experience for families and the engagement of hospital staff.

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This single-center study followed over 2,100 kidney transplant recipients for a mean of six years to assess how donor and recipient hepatitis C (HCV) status affected outcomes. Transplanting an HCV-positive kidney into an HCV-positive recipient provided similar graft survival to an HCV-negative kidney, but reduced patient survival compared to uninfected pairs. HCV-positive recipients who received HCV-negative kidneys had higher rejection rates, suggesting that matching strategies and treatment need careful consideration.

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A 29-year single-center review of over 1,200 transplants from donors who died after cardiac arrest compared outcomes to over 5,000 transplants from brain-dead donors. Kidney, pancreas, and lung outcomes were comparable between the two donor types at one, three, and ten years. Liver transplants from circulatory-death donors had significantly more bile duct complications and retransplantation, but kidneys, pancreata, and lungs from this donor type are a valuable and underutilized resource.

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A retrospective analysis of 674 pancreas transplant recipients examined how often diabetes develops after the transplant itself, and what factors predict it. Post-transplant diabetes occurred in 14% of recipients by three years and 25% by ten years, with older donor age, recipient obesity, post-transplant weight gain, and rejection being the strongest predictors. These findings help clinicians identify patients who need closer metabolic monitoring after pancreas transplantation.

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This review compared two types of antibody induction therapy used at the time of kidney transplantation: antithymocyte globulin (ATG) and interleukin-2 receptor antagonists (IL2-RA). The evidence showed that IL2-RA provides equal protection against rejection at lower cost and with fewer side effects. The authors concluded there is insufficient evidence to justify routine use of ATG over the safer, cheaper alternative for standard-risk kidney transplant recipients.

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Pretransplant blood samples from 237 consecutive deceased-donor kidney recipients were tested for donor-specific antibodies using a sensitive bead-based test. Higher antibody levels, particularly for class II, were progressively associated with antibody-mediated rejection, worse kidney function, and lower graft survival. Measuring pretransplant donor-specific antibody levels provides important prognostic information and the risk increases in a dose-dependent manner with higher antibody levels.

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This review summarized evidence on using pancreas donors who fall outside traditional criteria, including very young or old donors, obese donors, and donors who died after cardiac arrest. Current data showed that pediatric donors and selected donors up to age 50 produce results comparable to ideal donors, while obese donors are better suited for islet rather than whole-organ transplant. Expanding donor criteria with appropriate selection can safely grow the pancreas donor pool without compromising outcomes.

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This laboratory study showed that an inflammatory enzyme (secretory phospholipase A2) can break down red blood cells that have abnormal membrane structure, releasing a lipid signal (lysophosphatidic acid) that damages blood vessel walls. In rats, this lipid directly increased blood vessel leakiness in a dose-dependent way, and blocking its receptor prevented the damage. This mechanism may help explain how systemic inflammation leads to vascular injury and fluid leakage in critically ill patients.

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In a prospective study of 54 trauma ICU patients, higher levels of secretory phospholipase A2 in the blood correlated with injury severity, worse lung oxygen exchange, and abnormal chest X-rays at 72 hours. Patients with elevated enzyme levels required more ventilator support. Secretory phospholipase A2 is an early, measurable marker of post-injury lung inflammation that may help predict which trauma patients will develop respiratory complications.

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This retrospective study at an urban trauma center examined whether routine CT head scans are justified in trauma patients who have a seizure, given that many are simply medication non-compliant. A normal neurological exam had a 90% negative predictive value for brain injury, but the Glasgow Coma Scale score alone was a poor discriminator overall, and 11% of patients whose seizure preceded the injury had unsuspected brain abnormalities on CT. Routine head CT is warranted in trauma patients with seizure activity regardless of neurological exam findings.

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A 27-year-old developed multiple strokes four days after surgery to repair a stab wound to the heart. Imaging revealed a blood clot inside the repaired left ventricle as the source of the emboli. This case highlights that blood clots forming inside the heart after penetrating cardiac injury can cause strokes, a complication not previously reported with this type of trauma.

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A patient presented with a cecal volvulus, a twisting of the large intestine, which was found at surgery to be caused by an adhesive band connected to a Meckel's diverticulum, a congenital intestinal pouch. The Meckel's diverticulum was resected and the patient recovered fully. This case documents an extremely rare cause of cecal volvulus and reinforces the importance of exploring the entire bowel when operating for intestinal obstruction.