Cadaveric transplantation activities in our centers.

Baskent University is one of the most important transplantation centers in Turkey. This study assesses the contribution that Baskent University Hospital Network is currently making to the national solid organ pool. The National Coordinating Center (NCC) was founded in 2001, and data from the Baskent University transplantation center from January 2001 to through May 2005 were retrospectively analyzed. The number of brain-dead patients in this period was 36 and the number of family consent was 20. For all brain-death cases, the rate of consent for donation was 55.6%. Of the 64 total grafts collected in this study period, 85.9% were transplanted at this center and 14.1% were offered to the NCC. The rate of heart and liver grafts offered to the NCC was 9.4% and 4.7%, respectively. According to the results, 29.6% of all heart grafts, 4.5% of all liver grafts, and 4.5% of all kidney grafts in Turkey are performed from donors identified by Baskent University. The current rate of consent for cadaver organ donation is high compared with other centers. The majority of these grafts were used in our center, but we also made some contribution to the national donor organ pool. The transplantation activities in our network will hopefully lead to a larger organ pool and shorter waiting lists.

Our experience in cardiac transplantation in Baskent University.

Recently cardiac transplantation has an important place in treatment of end-stage cardiac failure. In Turkey between 2003 and 2005 at 10 centers 64 cardiac transplantations were performed including five at our facility. Herein we have presented our results. All patients were men of mean age 34.2 +/- 10.7 (17 to 44) years. Upon preoperative echocardiography their mean ejection fraction was 18% +/- 3.27% (17% to 23%). Pulmonary vascular resistance was 4.47 wood unit in one patient and in one case, there was Rh incompatibility between donor and recipient. We used HTK solution for protection of donor hearts. Mean ischemia time was 251.2 +/- 62.7 minutes (155 to 314). Mean aortic clamping time was 84 +/- 4.7 minutes (80 to 90). In all patients we performed a biatrial anastomosis technique. Hemofiltration was used to prevent hemodilution during operation. In the postoperative period four patients had acute renal dysfunction; one, a minor cerebrovascular accident; two, reoperated because of bleeding; one, cholestasis; one, temporary atrio-ventricular block; and one, mediastinitis. Mean follow-up time was 15.6 +/- 19.7 months (2 to 50). Neither early nor late mortality has occurred. All patients are in New York Heart Association class I. In all cases we used triple immunosuppressive therapy. In the follow-up period the mean number of cardiac biopsies per patient was 4.2 +/- 3.03 (2 to 8). Two cases had cardiac catheterization. As a complication of cardiac biopsy, pericardial tamponade developed in one patient; in another one we observed a right ventricular aneursym after cardiac biopsy. Cardiac transplantation was performed with low mortality and morbidity rates in end-stage cardiac failure patients with longer life expectancy and higher life quality. Unfortunately in our country, because of difficulties to find donor hearts, cardiac transplantations were small in number. For better results, we need a larger series.

Organ donation: a cross-sectional survey of the knowledge and personal views of Turkish health care professionals.

Health care professionals (HCPs) represent a key element in the cadaveric organ donation process. This cross-sectional survey assessed HCPs' knowledge, attitudes, and behavior related to cadaveric organ donation and transplantation. One thousand one hundred eighty-four HCPs were randomly selected from various units of five health care institutions located in three major Turkish cities. Each individual completed a questionnaire. The ages ranged between 18 and 63 years. By examining the tendency to organ procurement, 78.6% of the physicians and 69.5% of the nurses stated that establishing brain death during ventilator support is the optimum condition. The results indicated good overall knowledge of the criteria for brain death. Physicians displayed significantly better understanding of the criteria for brain death and optimal conditions for organ procurement. While physicians have significantly better knowledge about kidney transplantation, there was no difference for liver transplantation. Compared to nurses, doctors had significantly better knowledge of which organs can be used in the current transplantation process. Although 44.2% claimed they were willing to donate their organs, only 17.9% actually carried a legal donation card. The rate of willingness to donate was significantly higher among doctors than nurses. Physicians have significantly better knowledge about legal aspects of organ donation and transplantation. Overall, the survey revealed that lack of knowledge has a negative impact on people's attitudes toward organ donation even among health care professionals. Improvements must be made to develop a nationwide Donor Hospital Education Program that will provide training concerning transplantation and organ donation.

Health care professionals' knowledge of procedural issues in transplantation: the need for continuing education programs.

Organ transplantation is a multidisciplinary field that requires a good knowledge of the processes and excellent cooperation throughout the entire hospital. The aim of this study was to determine the level of knowledge of health care professionals (HCPs) at our transplantation center concerning general definitions and procedural issues related to transplantation. A questionnaire including nine items-five questions on general definitions and four on procedural issues-was distributed to 100 randomly selected HCPs. Four participants were excluded because they completed the questionnaire incorrectly; thus, there were 96 total respondents. The mean number (+/-SD) of correct answers overall was 5.78 +/- 1.36. Concerning general definitions, 11.5% of the respondents answered all of the questions correctly. However, the corresponding rate for the procedural questions was 3.1%. One percent of the respondents answered 1 or zero definition questions correctly, and 19.8% answered 1 or zero procedural questions correctly. The HCPs showed better knowledge of general issues related to transplantation than procedural issues. The results of this study suggest that the knowledge of HCPs in transplantation centers in Turkey is limited to the extent that their specialty is linked to transplantation. It is important that continuing medical education programs be instituted in organ procurement and transplantation centers in Turkey. These in-service training programs would enhance HCPs' understanding of and participation in procedures related to transplantation, and thus improve the total quality of the transplantation process.

Problems in postoperative renal transplant recipients who present to the emergency unit: experience at one center.

When a renal recipient in Turkey develops a postoperative problem, consultation by the transplant team in the emergency unit is often the first step toward a solution. The main aim of this study was to identify the types of postoperative problems that cause renal transplantation patients to visit the emergency room. Gathering this information was believed to be an important step toward developing new management strategies for these problems, in line with the quality management systems used throughout our hospital network. We collated the physical signs in the 78 patients when they presented to the emergency room. The most common one was fever (26.9%) followed by nausea/vomiting, diarrhea, abdominal pain, dyspnea, skin lesions, headache, musculoskeletal trauma, hematuria/dysuria, epistaxis, psychological disorders, angina pectoris, hypertension, epilepsy, and rectal bleeding. Among the 78 patients, 45 (57.7%) were hospitalized and 33 (42.3%) were discharged with medical advice or drug treatment. Among the 45 hospitalized patients, 97.8% were initiated on medical treatment. Knowing the surgical and medical emergency issues prevalent in recipients enables the development of new procedures and algorithms, leading to more effective management and follow-up of renal transplant recipients.