[Combined heart and kidney transplantation in terminal myocardial and renal insufficiency]. / Kombinierte Transplantation von Herz und Niere bei terminaler myokardialer und renaler Insuffizienz.

In a 38-year-old man combined heart and kidney transplantation was performed successfully in one operation. Both organs have functioned well postoperatively: the patient was discharged from hospital on the 19th postoperative day and has remained in functional class I (New York Heart Association) eight months later. Only two episodes of cardiac rejection have been observed during this period, responding to treatment, and there was no evidence of rejection of the kidney. Such combined heart-kidney transplantation from one donor seems to be a promising form of treatment for patients in end-stage myocardial and renal failure. The frequency of cardiac rejections my be lower after combined heart-kidney transplantation than after cardiac transplantation alone.

Aims and practical application of a multi organ procurement protocol.

According to the present situation of nonrenal organ transplantation there is an urgent need for heart, liver and pancreas grafts. To confront the steadily widening gap between cadaveric organ demand and supply the introduction of a multiorgan procurement protocol is mandatory. This protocol that is described in detail should regulate the collaboration between donor hospitals, the Eurotransplant Foundation, and transplant centers. On the basis of general, specific, and organspecific criteria potential donors can be evaluated, selected and accepted, then being followed by a well organized combined organ retrieval. The application of the proposed procurement protocol is expected to contribute significantly to the frequency and success rate of organ transplantation in Europe.