Direct Procurement Research Articles

Value, significance and use of 'exotic' materials – in the light of the presence of obsidian on Neolithic sites in Poland

At Neolithic archaeological sites in Poland, obsidian stands out as the most common ‘exotic’ raw material. Thereare over several hundred Neolithic sites where artefacts made from this raw material have been recovered. Given the absence of natural obsidian outcrops in Poland, it is evident that these artefacts were imported to the sites through various means, such as direct procurement or exchanges.One of the most extensive collections was found at Opatów, representing the Samborzec-Opatów group of the Late Neolithic. This collection forms the core of our discussion, in which we aim to explore the economic systems involved in the acquisition of obsidian. Results obtained from our analyses (technological, morphological, and traceological) constitute the foundation for considering various hypotheses regarding the significance and value of ‘exotic’ materials for Neolithic communities.

The Rapidly Evolving Landscape of DCD Heart Transplantation.

To summarise current international clinical outcomes from donation after circulatory death heart transplantation (DCD-HT); discuss procurement strategies, their impact on outcomes and overall organ procurement; and identify novel approaches and future areas for research in DCD-HT. Globally, DCD-HT survival outcomes (regardless of procurement strategy) are comparable to heart transplantation from brain dead donors (BDD). Experience with normothermic machine perfusion sees improvement in rates of primary graft dysfunction. Techniques have evolved to reduce cold ischaemic exposure to directly procured DCD hearts, though controlled periods of cold ischaemia can likely be tolerated. There is interest in hypothermic machine perfusion (HMP) for directly procured DCD hearts, with promising early results. Survival outcomes are firmly established to be equivalent between BDD and DCD-HT. Procurement strategy (direct procurement vs. regional perfusion) remains a source of debate. Methods to improve allograft warm ischaemic tolerance are of interest and will be key to the uptake of HMP for directly procured DCD hearts.

Direct Procurement with Machine Perfusion and Normothermic Regional Perfusion in Donation after Circulatory Death Heart Transplantation

ObjectiveDonation after circulatory death (DCD) heart transplants have increased in US with DPP and TA-NRP techniques. There remains a paucity of data examining DPP and TA-NRP outcomes. The purpose of this study was to investigate the impact of DCD technique on post-transplant outcomes compared to DBD donors. MethodsAdult patients undergoing heart transplantation between December 1, 2019, and June 30, 2023 were identified in the UNOS registry. DPP and TA-NRP cohorts were detected using time of death to aortic cross-clamp of 30 minutes. Categorical variables were compared using chi-square or Fisher exact tests, while continuous variables were compared using Mann-Whitney U tests. Propensity score matching was performed using a 1:3 match. 1-year survival was analyzed using log-rank test and Cox proportional hazard regression model. ResultsDuring the study period, there were 7338 DBD and 419 DCD heart transplants. At 1-year, there was no difference in survival between unmatched (p=0.13) and matched (p=0.36) DBD and DCD recipients. There was an increase in acute rejection and rejection requiring treatment in DCD compared to DBD in the matched cohort. 134 TA-NRP and 242 DPP transplants occurred. 1-year survival and post-transplant outcomes were similar in DPP and TA-NRP. TA-NRP functional warm ischemia times increased significantly during the study period. ConclusionsIn a matched cohort, DCD heart recipients experience increased acute rejection, both treated and non-treated, compared to DBD. Despite differences in the techniques, and likely functional warm ischemic times, acute rejection, survival, and other secondary outcomes are similar between DPP and TA-NRP.

Mitochondrial Function After Normothermic Regional Perfusion or Direct Procurement Followed by Hypothermic Oxygenated Machine Perfusion in Heart Transplantation After Circulatory Death.

Strategies to minimize ischemic damage during heart transplantation (HTX) by donation after circulatory death (DCD) are warranted because the inevitable ischemic injury linked to DCD HTX deteriorates mitochondrial respiratory capacity and ultimately graft quality. This study aimed to examine the myocardial mitochondrial function during DCD HTX with hypothermic oxygenated machine perfusion (HOPE) and compare the effect of normothermic regional perfusion (NRP) with that of direct procurement and perfusion (DPP). A porcine DCD HTX model was used with hearts subjected to either DPP (n = 6) or NRP (n = 7) followed by HOPE and orthotopic HTX. Mitochondrial respiratory function was analyzed by high-resolution respirometry in left ventricle biopsies at baseline, after 180 min of HOPE, and after 60 min of reperfusion post-HTX. Mitochondrial oxidative phosphorylation (P = 0.0008), respiratory control ratio (P = 0.04), and coupling efficiency (P = 0.04) declined during DCD HTX. Fatty acid oxidation was preserved after 3 h of HOPE with a modest, statistically nonsignificant decline after reperfusion (P = 0.2). Oxidative phosphorylation was inversely correlated with troponin-T levels (r = -0.70, P = 0.0004). No statistically significant difference in mitochondrial respiratory capacity was observed between participants exposed to NRP and DPP. Mitochondrial respiratory capacity declined gradually throughout the course of DCD HTX and correlated with the degree of myocardial damage. Following HOPE, the extent of mitochondrial deterioration was comparable between NRP and DPP.

Donation After Circulatory Death Cardiac Recovery Technique: Single-Center Observational Outcomes

BackgroundRecovery of hearts from donation after circulatory death donors has been performed either with direct procurement and perfusion (DPP) using the TransMedics Organ Care System or with normothermic regional perfusion (NRP) with subsequent cold storage. It remains unclear which of these 2 strategies yields optimal posttransplant outcomes. MethodsAll heart transplant recipients from donors after circulatory death donors at the Vanderbilt University Medical Center (Nashville, TN) were reviewed (February 2020 to January 2023). Recipients were stratified into an NRP or DPP cohort. All DPP recoveries were performed using the TransMedics Organ Care System. The key outcome was severe primary graft dysfunction at 24 hours, defined by the need for postoperative extracorporeal membrane oxygenation. ResultsA total of 118 hearts were transplanted (NRP, 87; DPP, 31). Donors recovered using NRP were younger (25 years [interquartile range {IQR}, 21-31 years] vs 31 years [IQR, 24-37 years]; P = .008) and had shorter distance traveled (292 miles [158-516 miles] vs 449 miles [IQR, 248-635 miles]; P = .02). Recipient preoperative risk factors were similar between the groups. There was no difference in the incidence of severe primary graft dysfunction at 24 hours (NRP, 5.8%; and DPP, 12.9%; P = .24). However, ejection fraction at 7 days after transplantation was higher in the NRP group (65% [IQR, 60%-65%] vs 60% [IQR, 60%-68%]; P = .005). There was no difference in inotrope scores at 24 hours (P = 1.00) or 72 hours (P = .87) or in 30-day (NRP, 95% vs DPP, 97%; P = .75) and 1-year (NRP, 94% vs DPP, 86%; P = .19) survival. ConclusionsNRP and DPP strategies for recovery of cardiac allografts yield comparable early allograft outcomes. Future studies are needed to confirm these findings in larger prospective cohorts.

A multinational firm’s global manufacturing location and outsourcing strategies

Due to rising labor costs in China and trade friction, many multinational firms (MNFs) consider moving manufacturing outside China to Southeast Asian Countries. Based on observations in real world, we build a three-tier supply chain model consisting of one component supplier, two contract manufacturers (CMs), an MNF, and a local original equipment manufacturer (OEM). The MNF monopolizes the market in country 1 (e.g., U.S.), but competes in country 2 (e.g., China) with the local OEM. The component supplier and one CM are located in country 2, and the other CM is located in country 3 (e.g., a country in Southeast Asia). We investigate the MNF’s global manufacturing location and procurement outsourcing strategies with considerations of tariffs and market environments. Currently, the MNF outsources its manufacturing to the CM in country 2, and decides whether to continue the cooperation with the current CM or develop a new CM in country 3. The MNF also considers whether to outsource its component procurement to the corresponding CM. Our study reveals that the MNF’s optimal strategy depends on the relative market sizes, the fixed cost of developing a new CM, as well as the manufacturing cost and tariff disadvantages in country 2. Interestingly, we find that the tariff disadvantage in country 2 does not always motivate the MNF to cooperate with the CM in country 3. Instead, an appropriate tariff may be beneficial to the MNF that manufactures in country 2. In addition, the MNF’s preferred procurement strategy is related to its manufacturing location. When cooperating with the CM in country 2, the MNF would switch from direct procurement to outsourced procurement as the market size of country 1 increases.

Micro-level incentives and the mechanism of import substitution in Russian public procurement

ABSTRACT Based on a large survey of manufacturing firms in 2018, this research shows that after the first wave of international sanctions imposed on Russia in 2014, along with direct preferences for domestic producers introduced by the government, Russian procurers developed specific mechanisms to stimulate import substitution and simultaneously to ensure an appropriate quality of supply. Contrary to initial expectations, our empirical analysis shows that the import of raw materials, components, or equipment itself did not limit access to public procurement for relevant suppliers. Procurers encouraged suppliers not to refuse to import (since firms without imports did not have any advantages in access to public procurement contracts), but rather to reorient their own purchases to markets where imports competed with Russian analogues and, if necessary, could be replaced by them. The import of modern equipment and technologies was extremely important for the upgrading of Russian manufacturing industry in the 2000s and 2010s. Therefore, the presence of imported inputs can be an indirect attribute of a higher quality of supply. However, international sanctions imposed in 2014 increased the risks of supply disruptions for Russian procurers. The results can be considered an example of the strategic adaptation of procurers at the micro level (outside of the direct procurement regulation) to new market conditions. These findings may be important for understanding how the Russian economy has responded to much larger and more severe international sanctions in 2022.

Early U.S. Heart Transplant ExperienceWith Normothermic RegionalPerfusion Following Donation After Circulatory Death.

Heart transplantation following donation after circulatory death (DCD HT) has short-term survival outcomes comparable to donation after brain death and has led to a significant increase in transplantation volume. The U.S. experience with the normothermic regional perfusion (NRP) DCD HT procurement method has not been evaluated. The aim of this study was to examine short-term outcomes associated with NRP vs direct procurement and perfusion (DPP) methods used during DCD HT in the United States. The UNOS (United Network for Organ Sharing) registry was queried for all adult (age≥18 years) heart recipients and corresponding donors of controlled DCD HT from January 2019-December 2023. Transplantations were stratified by NRP or DPP reperfusion methods. The primary outcome was overall survival. A total of 918 heart donors and recipients met inclusion criteria, including 622 (68%) DPP and 296 (32%) NRP transplantations. Unadjusted Kaplan-Meier survival analysis demonstrated improved short-term survival associated with NRP (log-rank P = 0.005). After adjustment, DCD HT with NRP was independently associated with improved survival (HR: 0.39 [95%CI: 0.22-0.70]; P = 0.002). A propensity-matched analysis similarly demonstrated a cumulative survival benefit to NRP (log-rank P = 0.006). In this largest national series of DCD HT procurement perfusion strategies, NRP is associated with improved short-term survival as compared with DPP. This study evaluates the U.S. early experience with DCD HT, and longer-term follow-up data are needed to further assess the impact of DPP and NRP methods on post-heart transplantation outcomes.

Heart Transplantation After Donation After Circulatory Death: Early United States Experience

BackgroundGiven the renewed interest in heart transplantation after donation after circulatory death (DCD), a contemporary analysis of trends and longer-term survival is warranted. MethodsAdult heart transplant recipients (December 2019-September 2023) were identified in the Organ Procurement and Transplantation Network. Recipients were stratified as donation after brain death (DBD) or DCD. DCD procurements were further classified as direct procurement and perfusion (DCD-DPP) or normothermic regional perfusion (DCD-NRP), based on the declaration of death to cross-clamp interval (≥40 minutes DCD-NRP). The main outcome was posttransplant survival at 1 and 3 years. ResultsOf 11,625 transplantations, 792 (7%) involved DCD allografts (249 DCD-NRP, 543 DCD-DPP). The proportion of transplants involving DCD allografts significantly increased from 2% (December 2019) to 11% (January-September 2023, P < .001). Upon adjusted analysis, 1-year posttransplant survival was similar for DBD vs DCD-DPP (hazard ratio [HR], 1.00; 95% CI, 0.66-1.66) or DCD-NRP (HR, 0.92; 95% CI, 0.49-1.72). This remained true at 3 years for DCD-DPP (HR, 1.07; 95% CI, 0.77-1.48) and DCD-NRP (HR, 1.04; 95% CI, 0.62-1.73). Incidence of postoperative stroke, dialysis, acute graft rejection, and primary graft dysfunction were similar across groups. Across various strata of recipient risk and center volume, survival was equivalent between the DBD and DCD cohorts. ConclusionsRates of DCD heart transplantation continue to rise. Across various recipient risk and center volume categories, DCD and DBD recipients show comparable posttransplant survival up to 3 years. These findings encourage broader use of such donors in attempts to expand the organ pool.

Metabolic Considerations in Direct Procurement and Perfusion Protocols with DCD Heart Transplantation.

Heart transplantation with donation after circulatory death (DCD) provides excellent patient outcomes and increases donor heart availability. However, unlike conventional grafts obtained through donation after brain death, DCD cardiac grafts are not only exposed to warm, unprotected ischemia, but also to a potentially damaging pre-ischemic phase after withdrawal of life-sustaining therapy (WLST). In this review, we aim to bring together knowledge about changes in cardiac energy metabolism and its regulation that occur in DCD donors during WLST, circulatory arrest, and following the onset of warm ischemia. Acute metabolic, hemodynamic, and biochemical changes in the DCD donor expose hearts to high circulating catecholamines, hypoxia, and warm ischemia, all of which can negatively impact the heart. Further metabolic changes and cellular damage occur with reperfusion. The altered energy substrate availability prior to organ procurement likely plays an important role in graft quality and post-ischemic cardiac recovery. These aspects should, therefore, be considered in clinical protocols, as well as in pre-clinical DCD models. Notably, interventions prior to graft procurement are limited for ethical reasons in DCD donors; thus, it is important to understand these mechanisms to optimize conditions during initial reperfusion in concert with graft evaluation and re-evaluation for the purpose of tailoring and adjusting therapies and ensuring optimal graft quality for transplantation.

(232) - Direct Procurement Followed by Hypothermic Oxygenated Perfusion in DCD Heart Transplantation

(232) - Direct Procurement Followed by Hypothermic Oxygenated Perfusion in DCD Heart Transplantation

(1060) - Direct Procurement and Perfusion Supplemented with the Senomorphic Agent Ruxolitinib Improves the Microvascular Coronary Flow in Hearts Donated After Circulatory Death in Dependence on Donor Sex and Age

(1060) - Direct Procurement and Perfusion Supplemented with the Senomorphic Agent Ruxolitinib Improves the Microvascular Coronary Flow in Hearts Donated After Circulatory Death in Dependence on Donor Sex and Age

(305) - Post-Transplant Survival in Heart Transplantation Using Normothermic Regional Perfusion (NRP) vs. Direct Procurement and Perfusion (DPP) in Donation After Circulatory Determination of Death

(305) - Post-Transplant Survival in Heart Transplantation Using Normothermic Regional Perfusion (NRP) vs. Direct Procurement and Perfusion (DPP) in Donation After Circulatory Determination of Death

(1215) - Impact of Initial Hematocrit Levels During Direct Procurement and Perfusion on the Likelihood of Primary Graft Dysfunction in Donation After Circulatory Death Heart Transplant Patients

(1215) - Impact of Initial Hematocrit Levels During Direct Procurement and Perfusion on the Likelihood of Primary Graft Dysfunction in Donation After Circulatory Death Heart Transplant Patients

(231) - Outcomes in Donation After Circulatory Death Cardiac Transplantation Following Direct Procurement and Perfusion Compared with Normothermic Regional Perfusion

(231) - Outcomes in Donation After Circulatory Death Cardiac Transplantation Following Direct Procurement and Perfusion Compared with Normothermic Regional Perfusion

(524) - Predictors of Severe Graft Dysfunction After DCD Heart Transplantation with Direct Procurement and Preservation

(524) - Predictors of Severe Graft Dysfunction After DCD Heart Transplantation with Direct Procurement and Preservation

Application of ABC VEN Method in Procurement Management and Its Impact on Internal Business Processes that Impact General Patient Customer Retention in 2022 (Case study at RS X)

ABSTRACT X Hospital wants to increase the efficiency of pharmaceutical services by replacing the consumption-based drug procurement method with the ABC VEN method to overcome challenges such as out-of-stock, direct purchases from other vendors, and the use of multiple vendors, with a potentially positive impact on customer retention and compliance with relevant regulations and research. This study aims to examine the application of the ABC VEN method to improve inventory procurement planning at X Hospital, compare its effectiveness with the consumption method on internal business processes, and measure its impact on customer retention. This study uses a non-experimental approach with quantitative descriptive and observational retrospective, analyzes drug procurement January-July 2022, and evaluates the ABC VEN method from December 2022 through informant interviews at X Hospital to analyze internal business processes and retention of customers using the Balanced Scorecard approach. The number of samples used was 175 samples. The analysis of validation and reliability tests showed that most of the indicators on the satisfaction aspect were in the high category, while overall patient satisfaction was in the sufficient category. The indicators on the assurance and tangible dimensions are included in the sufficient category, showing attention to the availability of drugs and seating facilities to increase customer retention. The application of the ABC VEN Method at X Hospital from August to December 2022 has a higher realization rate (87%) than the Consumption Method (66%), with a direct procurement efficiency of 57% or IDR 64,816,401. Despite payment constraints, related parties consider implementing the ABC VEN Method more effective and can improve internal business performance and customer retention. Keywords: X Hospital, ABC VEN Method, Pharmacy Services

(915) - UK Experience of Direct Procurement of Lungs with Ongoing Abdominal Normothermic Regional Perfusion from Controlled DCD Donors

(915) - UK Experience of Direct Procurement of Lungs with Ongoing Abdominal Normothermic Regional Perfusion from Controlled DCD Donors

Financial impact of donation after circulatory death heart transplantation: A single-center analysis.

Clinical success of donation after circulatory death (DCD) heart transplantation is leading to growing adoption of this technique. In comparison to procurement from a brain-dead donor, DCD requires additional resources. The economic impact of DCD heart transplantation from the hospital perspective is not well known. We compared the financial data of patients who received DCD allografts to those who received a DBD organ at our institution from January 1, 2021 to December 31, 2022. We also compared the cost of ex-situ machine perfusion to in-situ organ perfusion employed during DCD recovery. We performed 58 DBD and 22 DCD heart-alone transplantations during the study period. Out of 22 DCD grafts, 16 were recovered with thoracoabdominal normothermic regional perfusion (TA-NRP) and six with direct procurement followed by normothermic machine perfusion (DP-NMP). The contribution margin per case for DBD versus DCD was $234,362 and $235,440 (P=.72). The direct costs did not significantly differ between the two groups ($171,949 and 186,250; P=.49). In comparing the two methods of procuring hearts from DCD donors, the direct cost of TA-NRP was $155,955 in comparison to $223,399 for DP-NMP (P=.21). This difference translated into a clinically meaningful but not statistically significant greater contribution margin for TA-NRP ($242, 657vs. $175,768; P=.34). Our data showed that the adoption of DCD procurement did not have a negative financial impact on the contribution margin in our institution. Programs considering starting DCD heart transplantation, and those who are currently performing DCD procurement should evaluate their own financial situation.

Recommendation of Prospective Construction Service Providers in Government Procurement Using Decision Tree

The determination of prospective construction service providers using the direct procurement method is the authority of the Goods/ Services Procurement Officer. Administrative requirements are an important factor in selecting prospective construction service providers. The use of the decision tree method in this study is to find out, determine, and analyse the variables that influence the assessment of the feasibility of prospective construction service providers, and get an accuracy value in providing an assessment of the feasibility of prospective construction service providers. The data used in this study are 153 datasets consisting of 13 variables. The existing variables are divided into basic variables and additional variables. The basic variables consist of 5 variables, namely experts, work experience, quality of work, winning tenders and contract value. While the additional variables consist of 8 variables namely business entity status, business entity form, business entity NPWP, business entity domicile, business entity qualification, type of business licence, percentage of work and construction services business licence. By using the decision tree method, the accuracy on the basic variable is 84.84%. The addition of additional variables to the basic variables resulted in an accuracy of 90.91%. This shows that by adding additional variables the accuracy results are higher than using only the basic variables.