Procurement Team Research Articles

342.3: Nurse anaesthetists: The organ donor’s advocate throughout the organ donation process in the perioperative setting.

Introduction: In a situation where a possibility to organ donation (OD) occurs, the bed-side professionals (physicians, nurses) are expected to act to realize the OD due to their professional ethics. Perioperative nurses play a vital role in the OD process which includes acting as the donor’s advocate, as well as upholding values to provide the best quality nursing for the donor during the organ procurement. Perioperative nurses work collaboratively within surgical teams by providing intraoperative assistance to procurement teams at the time these procedures are required. The research covering perioperative nurses work situation while participating in OD is limited. The aim of this study was to describe Swedish Nurse Anesthetists’ (NA) experiences and conceptions of participating in the OD process with brain-dead (BD) donors. Methods: A qualitative study was chosen; analysis of the semi-structured interviews was carried out with Phenomenography. Informants: 21 NA (4 male, 17 female); all had experience of OD from BD donors. In addition, 12 NA had experience of organ transplantation. Age 34-64 y (years); work experiences as NA 1,5-41 y; experience of OD 1 - >30 donors. Results: OD was performed with a professional approach but was associated with some challenges e.g. when there was a child donor. To trust and understand BD and to be aware of that the patient is dead was conceived as crucial. All NA had no doubt in the BD concept and the declaration of death, but some described that it was challenging to relate to death when the body was warm, and the heart was beating: “The patient was seen as dead while the body was alive.” Knowledge and experience were essential factors to obtain a sense of safeness in these situations. The results illuminated the importance of routines, including the departments attitudes toward OD. The NA took pride in saving lives and acting as the donor’s advocate. A dignified approach during organ procurement reduced the sense of stress. Conclusions: The benefit of OD was conceived as undebatable. The professional ethics were seen in the NA core values of dignity and respect towards the donor, and to fulfill the donor’s wish to donate. The NA professional pride was illuminated in the conception of that it was positive to be able to contribute to the donors “gift of life”. Experience and knowledge supported the NA and provided safeness in their professional role. Focusing on the positive (the recipients), was conceived as the winning approach.

Pemberdayaan Napi Perempuan Lapas Way Hui Melalui Kerajinan Rajutan Dan Perhitungan Penentuan Harga Jual Produk

Female prisoners in these prisons become prisoners because they are entangled in various types of criminal law with various crimes committed by women such as due to many factors, leading to reasons for fulfilling the needs of those concerned. For this reason, there is a need for guidance for female prisoners as a form of self-empowerment to improve human resources in the form of life skills. Coaching skills provided by the Proposal Community Procurement team, namely training in the form of handicraft knitting. Knitted handicrafts that have been produced by inmates at the A Way Hui class II prisons include prayer hats, cellphone wallets, restleting wallets, and various kinds of brooches. Knitted products have a fairly high exclusivity value. These female prisoners are expected to succeed in making / producing creative and innovative knitted works seen from various aspects, namely aspects of material selection aspects, in addition the female prisoners are also given training to determine the cost of production and cost of goods sold from their knits.

PEMBERDAYAAN NAPI PEREMPUAN LAPAS WAY HUI MELALUI KERAJINAN RAJUTAN DAN PERHITUNGAN PENENTUAN HARGA JUAL PRODUK

Female prisoners in these prisons become prisoners because they are entangled in various types of criminal law with various crimes committed by women such as due to many factors, leading to reasons for fulfilling the needs of those concerned. For this reason, there is a need for guidance for female prisoners as a form of self-empowerment to improve human resources in the form of life skills. Coaching skills provided by the Proposal Community Procurement team, namely training in the form of handicraft knitting. Knitted handicrafts that have been produced by inmates at the A Way Hui class II prisons include prayer hats, cellphone wallets, restleting wallets, and various kinds of brooches. Knitted products have a fairly high exclusivity value. These female prisoners are expected to succeed in making / producing creative and innovative knitted works seen from various aspects, namely aspects of material selection aspects, in addition the female prisoners are also given training to determine the cost of production and cost of goods sold from their knits.

Compensation for Land Procurement for the Construction of the Northern Ring Road of Solok City by the Regional Government of Solok

This study aims to analyze compensation for land procurement for the construction of the northern ring road of Solok City by the Regional Government of Solok. The main approach method used is a research that emphasizes legal aspects by studying primary and secondary legal materials. It will later become a guideline for understanding and analyzing research problems. In addition, an empirical juridical approach is used as a support for the main approach. The results showed that the implementation of land procurement for the northern ring road of Solok City directly between Regional Government Agencies of Solok and landowners or their attorneys was carried out with the release of rights to land, buildings and objects associated with it under the principle of deliberation. It is in accordance with Article 10 of the Law of the Republic of Indonesia No. 2 of 2012 jo. Presidential Regulation of the Republic of Indonesia No. 71 of 2012. Regarding the determination of compensation carried out by means of deliberations between Government Agencies through the Land Procurement Team and landowners and their attorneys, based on the appraisal team’s assessment results, the basis for the assessment is fair replacement value and/or proper and fair replacement. It is in accordance with Article 10 of the Law of the Republic of Indonesia No. 2 of 2012 concerning Land Procurement for Development in the Public Interest and Presidential Regulation of the Republic of Indonesia No. 71 of 2012 concerning the Implementation of Land Procurement for Development in the Public Interest.

Improving Speed and Security When Sharing Protected Health Information of Deceased Organ Donors.

Because extensive data from medical records are gathered by organ procurement teams, the process of data transfer between sites created a data security risk. This includes the use of fax machines, courier services, and employees' vehicles. Even health records transmitted over public Wi-Fi become at risk for a data breach. The Plan-Do-Study-Act method for performance improvement was used to address this time-consuming and labor-intensive process. A secured virtual private network from within the donor hospital site setting was developed to improve the transfer of images and data. The goal was to improve the process and increase data security. Once the new network was in place, the process steps decreased and eliminated data vulnerability. Average process time decreased by approximately 1 hour. Organs procured increased from pre (expected 3, observed 2) to post (expected 3, observed 5) implementation of the new process.

Unintended consequences of changes to lung allocation policy.

Organ allocation for transplantation aims to balance the principles of justice and medical utility to optimally utilize a scarce resource. To address practical considerations, the United States is divided into 58 donor service areas (DSA), each constituting the first unit of allocation. In November 2017, in response to a lawsuit in New York, an emergency action change to lung allocation policy replaced the DSA level of allocation for donor lungs with a 250 nautical mile circle around the donor hospital. Similar policy changes are being implemented for other organs including heart and liver. Findings from a recent US Department of Health and Human Services report, supplemented with data from our institution, suggest that the emergency policy has not resulted in a change in the type of patients undergoing lung transplantation (LT) or early postoperative outcomes. However, there has been a significant decline in local LT, where donor and recipient are in the same DSA. With procurement teams having to travel greater distances, organ ischemic time has increased and median organ cost has more than doubled. We propose potential solutions for consideration at this critical juncture in the field of transplantation. Policymakers should choose equitable and sustainable access for this lifesaving discipline.

Contested Organ Harvesting from the Newly Deceased: First Person Assent, Presumed Consent, and Familial Authority.

Organ procurement policy from the recently deceased recasts families into gatekeepers of a scarce medical resource. To the frustration of organ procurement teams, families do not always authorize organ donation. As a result, efforts to increase the number of organs available for transplantation often seek to limit the authority of families to refuse organ retrieval. For example, in some locales if a deceased family member has satisfied the legal conditions for first-person prior assent, a much looser and easier standard to satisfy than informed consent, organ retrieval may proceed despite the family's objections. Some countries have replaced voluntary consent to organ donation with forms of organ conscription. Often referred to under the misnomer "presumed consent," such policies legalize the harvesting of organs at death, unless individuals exercise official options to opt out. As this article explores, however, there are good grounds for affirming the authority of the family to consent to or to deny organ donation on behalf of recently deceased family members, as well as to reject first-person assent and "presumed consent" policies of organ procurement. Insofar as individuals have failed clearly and competently to provide informed consent to organ donation, moral authorization for the use of the person and his body ought to be grounded on the foundational authority of the family, rather than the state's supposed interests in obtaining organs for transplantation.

Solid pancreas transplant: Pushing forward.

Pancreas transplant has evolved significantly in recent years. It has now become a viable treatment option on type 1 diabetic patients with poorly controlled diabetes on conventional treatment, insulin intolerance, hypoglycaemia unawareness, brittle diabetes and/ or end-stage kidney disease. The purpose of this review is to provide an overview of pancreas transplant historical origins and current barriers to broader utilization of pancreata for transplant, with a focus on areas for future improvement to better pancreas transplant care. Donor pancreata remain underutilized; pancreatic allograft discard rates remain close to 30% in the United States. Donations after cardiac death (DCD) pancreata are seldom procured. Study groups from Europe and the United Kingdom showed that procurement professionalization and standardization of technique, as well as development of independent regional procurement teams might increase organ procurement efficiency, decrease discards and increase pancreatic allograft utilization. Pancreas transplant programs should consider exploring pancreas procurement opportunities on DCD and obese donors. Selected type 2 diabetics should be considered for pancreas transplant. Longer follow-up studies need to be performed in order to ascertain the long-term cardiovascular and quality of life benefits following pancreas transplant; the outcomes of which might eventually spearhead advocacy towards broader application of pancreas transplant among diabetics.

Surgical quality in organ procurement during day and night: an analysis of quality forms

ObjectivesTo analyse a potential association between surgical quality and time of day.DesignA retrospective analysis of complete sets of quality forms filled out by the procuring and accepting surgeon on organs...

Dutch Law Approves Opt-out System.

Dutch Law Approves Opt-out System.

Follow-Up on Donor Family

Introduction After producing a procurement procedure for organs or tissues in Buenos Aires City, Argentina, a letter of thanks is sent to the donor families and the age and sex of the recipients are reported. Given the need to support them, a follow-up program is created for the donor family based on the premise of accompanying each family's own grief. Material and Methods A qualitative evaluation was carried out in two stages to 163 families. The first stage (42 families) was carried out through the PPAOT mental health team, with only one interview. In the second stage by the mental health team of EAIT and Velez Sarfield Hospital (121 families), mostly from pediatric donors, with repeated interviews for an average three-month period. Interviews with relatives of pediatric donors were initially carried out with both parents and siblings and then individually. In the case of an adult donor, it was done with two relatives and then an individual. Results Families mostly expressed feeling content, cared for, respected, listened to warmly and affectionately. Here it is visualized that the family finds a continent where they can express the feelings of emptiness, loss and loneliness. The main observations in the cases with police intervention were to be able to separate the experiences of the police procedure with the feelings in relation to the decision to donate and the transfer of hostility towards the procurement teams was worked on. It was also possible to process the experiences of the family at the time of transfer of donated organs and tissues. The lack of knowledge of the work of the procurement teams appears repeatedly, highlighting the surprise for the transparency, care, responsibility and affection of their task. Discussion In most cases, a normal evolution of grief is observed, with chronological shortening of the first stages of mourning, where the solidarity shown at the time of donation extends to a detachment of personal material objects from the donor and in participation of the family in activities of promotion of the donation and accompaniment of other families in mourning situations. Conclusions The donation allows the beginning of the duel and its elaboration with more experiential elements from the repair achieved through the exercise of a solidary act. The activities in the promotion of the donation of the donor families facilitate the conformation of networks of patients and their articulation with transplant patients.

Successfully in Situ Right-Left Split Liver Transplantation

Introduction In-situ or ex-vivo left lateral segmentectomy and right trisegmentectomy split-liver transplantation had become and standard practice in Argentina. Over the last 10 years more than 150 split procedures has been performed, but until recently none in-situ right-left split was performed. We aim to report the first case done at a single institution. Material and Method Report of an in-situ right-left split liver procurement performed more than 1 thousand kilometers far from the transplant center. Follow by the engraftment into an adult recipient (54 years) with a non respectable metastatic NET and a pediatric recipient (14 years), with cystic fibrosis and severe portal hypertension (24 mmHg). Results After grafts allocations, our liver procurement team flew to the donor hospital, with the necessary devices to perform the in-situ liver parenchymal transection. Donor was hemodynamically stable without inotropic drugs. After midline incision, hiliar dissection was performed, to identify the right hepatic artery, right portal vein and bile duct; Intraoperative cholangiography showed normal billiary anatomy. A bulldog clamp was placed in the right portal and hepatic artery to delineate the transaction line. The cava and middle hepatic veins were left to left graft (LG). Billiary tree and common hepatic artery were left in the right graft (RG). HTK solution was used for preservation. Operative time for the procurement was 3.5 hours. Right graft weight 980 grs. and left graft 450 grs. The RG was used in an adult recipient and the LG in a pediatric recipient, CIT were: 475 min and 430 min respectevily. GRWR for the RG and LG were 1.53 and 1.67 respectively. The LG required re-exploration for intra-abdominal hemorrhage, and postop. ascitis was present and medically treated; in spite of a reduction in the portal pressure to 17 mmHg). Recipients were discharge on postop. day: 7 and 14 respectively. Conclusions Right and left split-liver transplantation should be considered as a source to expand the cadaveric donor liver pool. A trained committed surgical team is needed to successfully perform these procedures. The adequate donor and recipient selection will increase motivation to routinely use it for adolescents or adult recipients.

Quality Improvement in Facial Transplantation: Standard Approach for Novel Procedures

With 40 procedures reported to date, facial transplantation (FT) is a viable reconstructive option for patients with severe facial defects.1 A major challenge of FT is developing patient-specific reconstructive strategies, as facial defects can vary widely in potential candidates. This variability and the limited number of procedures performed to date have made the standardization of approaches to FT particularly difficult. The improvement of any process, including FT, relies heavily on standardization if long-term sustainability is to be achieved, and patient safety must remain a top priority in the early stages of surgical innovation. Through teamwork optimization, surgical simulation, methodical use of surgical technology, and the application of efficient perioperative algorithms (Table 1), the senior author (E.D.R) has performed 2 FTs under institutional review board approval. The first was performed in March 2012 and consisted of a total face, double jaw, and tongue transplant in a patient who sustained ballistic midface injury.2 The second was performed in August 2015 and consisted of a total face, eyelids, ears, scalp, and skeletal subunit transplant in a patient who sustained high surface area burns.3 Both distinct facial defects were addressed successfully by FT; surgeries and recovery occurred without incident. The patients present excellent aesthetic, functional, and quality of life outcomes.2,3Table 1.: Standardized Processes in Clinical Facial Transplants Performed by Our Surgical TeamSTANDARD APPROACH TO FACIAL ALLOGRAFT PROCUREMENT, TRANSPLANT, AND SURGICAL TEAM Seventeen mock cadaveric FTs were performed in preparation for both procedures.2,3 Furthermore, 2 research allograft procurements were performed in brain dead donors.2,3 These rehearsals allowed real-time high-fidelity simulation, objective outcomes evaluation, and ensured surgical refinement through repetition. In each simulation, donor and recipient surgical teams work together to reinforce team dynamics and optimize performance before clinical FT. METHODICAL USE OF SURGICAL TECHNOLOGY Computerized surgical planning was incorporated into every simulation opportunity and subsequently integrated into both clinical FTs.2,3 Three-dimensional (3D) models generated from craniofacial computed tomography scans (Fig. 1) are used to identify optimal sites of osteotomy. In addition, personalized cutting guides are designed and 3D-printed for improved intraoperative accuracy.2,3 During surgery, facial allograft perfusion assessment using indocyanine green fluorescent angiography was performed, before transection of allograft source vessels, and upon completion of the procedure to ensure adequate blood flow.2,3Fig. 1.: Methodical use of surgical technology and optimization of team dynamics. A, Computerized surgical planning and design of bone cutting guides for precise guidance of osteotomies. B, Team-based surgical planning and simulation. (Printed with permission from and copyrights retained by Eduardo D. Rodriguez, M.D., D.D.S.).WORKFLOW STANDARDIZATION Standardization of logistical processes that are critical to FT was implemented, including an algorithm for asynchronous face and multiorgan allograft procurement from brain dead donors4 and an algorithm for the safe transfer of multiorgan donors to the FT team’s home institution in collaboration with the local organ procurement organization.4 These algorithms focus on ensuring the integrity of lifesaving solid organ allografts, enhancing surgical team safety, and improving communication between donor and recipient teams. Finally, perioperative nursing workflows have been developed in our most recent series of FT simulations.5 Through constant and objective self-evaluation, we continue to identify opportunities for process improvement. Our experience serves as proof of concept that exhaustive planning, process standardization, and quality improvement are possible for novel surgical procedures with limited worldwide experience.

Crossrail project: procuring infrastructure for London’s Elizabeth line

This paper sets out the origins and approach to procurement on Crossrail, the development of the ‘six pillars’ of procurement and how these were deployed to deliver over £11 billion of capital spend over a 5 year period. Initial reservations about retrofitting the approach into the existing governance processes were overcome by demonstrating clear gains through forward planning, managing risk early in the process and promoting efficiencies in production. The approach allowed a 30% reduction in the procurement team size while delivering the same outputs. In addition, all critical key dates were met, there were no successful challenges and the scope was procured within budget estimates.

Crossing Anatomic Barriers—Transplantation of a Kidney with 5 Arteries, Duplication of the Pyelocalyceal System, and Double Ureter

During the time of organ harvest, it is crucial for the kidney procurement team to consider significant vascular anatomical variations. Multiple renal arteries are not uncommon, and unintentional injury can result in an irreversibly damaged kidney graft that needs to be discarded. We present a kidney graft with 5 renal arteries and a single vein that was successfully procured and implanted with good graft function at discharge and at 4-yr follow-up. According to the literature, additional renal arteries can be found in about 33% of kidneys. This is the first study on a kidney with 5 arteries in the published literature, especially in the context of transplantation.

Deceased Donor Diver Transplantation Using a Lacerated Graft With Isolated Hyperbilirubinemia

The main limitation of liver transplantation is the shortage of organ donors. The scarcity of donor has led to the increased use of marginal grafts. An injured liver, especially lacerated, is generally considered as the marginal graft having high risk and poor outcome because it is susceptible to malfunctioning, bleeding, bile leakage and infection after liver transplantation. However, some authors have reported successful liver transplantation using injured graft under the meticulous care and careful selection of recipient. We report a case of successful liver transplantation using a right liver graft after in situ left hepatectomy with a lacerated graft with hyperbilirubinemia. Recipient was 52 years old male patient with alcoholic liver cirrhosis. He admitted due to esophageal variceal bleeding with a MELD score of 27 and Child Pugh score of 11. The donor was a 23 years old male who had multiple injuries from fall down. Emergency laparotomy was performed for intraabdominal bleeding. But his condition was deteriorated to brain death and liver function test revealed high bilirubin level (6.04mg/dL) and elevated AST/ALT levels (213/224U/L). The graft liver has 5cm vertical linear laceration in the inferior surface of the liver and it was sutured by Nylon 1‐0 in the previous laparotomy. Procurement team decided to perform in situ left hemihepatectomy to discard an injured left liver because bile duct ligation or injury during previous emergency operation was suspected due to hyperbilirubinemia. After liver transplantation using a right graft, liver function was rapidly normalized and he discharged without any major complication.

The Posterior Tibial Artery Flap as a Sentinel Flap in Face Transplant

Facial vascularized composite tissue procurement has unique logistical challenges and requires immense coordination with the solid organ procurement teams.[1] One aspect of the procedure is the procurement of a sentinel flap. Sentinel flaps are utilized in some centers for remote-site rejection monitoring in facial vascularized composite tissue allotransplantation, thus minimizing biopsies of the facial graft. Routine biopsies are performed on the sentinel flap and the facial allograft is biopsied only when the histopathology of the graft demonstrates a Grade I rejection or higher.[2] Harvesting the sentinel flap is an added challenge, especially since it is ideal to harvest prior to aorta cross-clamp to minimize ischemia time and prevent thrombus. Reported flaps used as sentinel flaps are the radial forearm flap, which have generally been inset into the groin of the recipient.[3] However, the radial forearm flap harvest places the procuring surgeon in the midst of the solid organ procurement teams, thus potentially complicating solid organ harvesting. We present our experience with the use of the posterior tibial artery flap as a sentinel flap in facial vascularized composite tissue allotransplantation. This flap is an ideal donor sentinel flap due to its location far from both the face transplant and solid organ procurement teams, its reliable vascular pedicle, and its ease of harvest.[4] We demonstrate the first utilization of this flap and believe that the use of this flap could maximize the ability for solid organ transplant teams to simultaneously perform solid organ harvesting while the sentinel flap is being raised, thus enabling a more streamlined process and better coordination in composite tissue allotransplantation.

The procurement dilemma: short-term savings or long-term shareholder value?

Purpose Research has shown the potential contribution of properly managed suppliers to the competitive position of firms. Major strategy schools of thought such as the industry view and the resource-based view have evolved in their perspective about supplier’s contributions, replacing a transactional perspective of supplier management with a more comprehensive view of their role in corporate strategy. This study aims to understand if procurement professionals have evolved in the same direction. Design/methodology/approach During a corporate wide assessment for a large consumer product corporation, the author had the opportunity to incorporate a four-statement question aimed at identifying the perception of value creation by different levels of procurement staff. The answers were compared with responses of a reference group that comprised business school students who had never been exposed to professional procurement as a function or skill. Findings The results show that buyers, even at senior levels, more clearly identify value as the result of price negotiation, a functional perspective, than as the construction of sustainable competitive advantages, the shareholder perspective. They do not discriminate sufficiently between short-term transactional value transfer and long-term shareholder value capture. Research limitations/implications The study was conducted on a sample of 500 people from four continents but limited to a single corporate environment. This study focused on innovation as a source of value and competitive advantages. Originality/value The paper shows to corporate deciders the impact of overly cost-focused procurement departments. This study reinforces their need to better balance the objectives assigned to their procurement team. This study outlines the steps necessary to align the cultural competitiveness of procurement to the objectives of the firm, with an extended enterprise scope.

Impact of Introducing Full-time In-house Coordinators on Referral and Organ Donation Rates in Rio de Janeiro Public Hospitals: A Health Care Innovation Practice

Establishing an organization to promote organ donation and a good organ procurement team assure quality and improve performance on organ donation rates. Brazil's organ procurement structure is based on 2 models disseminated worldwide: the "Spanish model," based on in-house coordinators, and the "American organ procurement organization (OPO) model," with extra-hospital coordinators. In 2006, Brazil's Federal Government had formally introduced the in-house coordination model for every hospital equipped with a mechanical ventilator bed. In January 2012, the Rio de Janeiro State OPO, Programa Estadual de Transplantes, introduced an innovation in the organization of the in-house coordination model in 4 selected public hospitals with high organ donation potential. It consisted in launching full-time in-house coordination teams, with≥1 physician and 2 nurses per hospital fully dedicated to organ procurement. The objectives were to observe the impact of this innovation in referral and organ donor conversion rates and to analyze the importance of middle managers in health care innovation implementation. Comparing the year before implementation (2011) and the year of 2014 showed that this innovation led to an overall increase in referrals-from 131 to 305 per year (+132%) and conversion rates-from 20% to 42% per year-resulting in an increase in number of donors from 26 to 128 per year (+390%). Despite wide variations among hospitals in the outcomes, our results seem very encouraging and express a positive impact of this model, suggesting that dissemination to other hospitals may increase the number of donors and transplants in our region.

Predicting Donor Death: Early Changes in Oxygen Saturation After Withdrawal of Support Predict Successful Donation During Donation After Circulatory Death.

We have previously shown that approximately 27% of patients do not progress to death in time to donate organs after attempted donation after circulatory death (DCD). As such, nearly 1000 transplants per year are not possible. One way to convert unsuccessful donations to successful donations is to increase procurement team "stand-down" times; however, increased stand-down times may predispose transplantable organs to increased ischemic damage. Hemodynamics for successful and unsuccessful donations, occurring between 2011 and 2014, were characterized to determine if some unsuccessful DCDs could have donated successfully, had procurement teams waited longer. Analysis of 169 DCDs demonstrated statistically significant differences in hemodynamic profiles after withdrawal of support (WOS) between successful and unsuccessful donations. Early decreases in oxygen saturation were predictive of successful organ donation. We observed that for unsuccessful DCDs, patients who died in more than 2 hours but less than 12 hours were agonal within 10 minutes of WOS, suggesting that increasing stand-down times would result in prohibitive warm ischemia time. Early changes in oxygen saturation after withdrawal of support predict donor death. Alternative approaches that convert unsuccessful DCDs to successful DCDs but that do not result in low-quality organs should be explored.