Procurement Techniques Research Articles

Procurement and Preservation of Neonatal Porcine Cardiac Tissue.

The porcine and human heart are remarkably similar in cardiac physiology and biochemistry. Translational research involving the porcine biomedical model is becoming increasingly applicable for the study of human cardiac function in health and disease. Presently, few protocols exist for collecting experimentally viable cardiac tissue from large animal models, particularly during neonatal maturation. To address this deficiency, we have developed a technique to procure and preserve ventricular tissue from neonatal piglets at day 3 (n=4) and day 30 (n=6) post-partum. Piglets were subjected to a strict sedation, anesthesia, and analgesia regimen. During surgery, cardiopulmonary indices of electrocardiogram, heart rate, systolic and diastolic blood pressure, respiration rate, peripheral O2 saturation, and end-tidal CO2 were monitored continuously to ensure normal cardiac function. Prior to cardiectomy, each heart was perfused with an intravenous administration of heparin (10 ml/kg) and ice-cold Custodiol HTK cardioplegia solution (10 ml/kg). After cardiac explantation, myocardial samples (dimensions: 1 x 1 x 1 cm) were dissected from the left and right ventricles and snap-frozen in liquid nitrogen. Analysis via SDS-PAGE and densitometry demonstrated that myofibrillar proteins are stable and undegraded. Western Blots showed full expression of protein. These results suggest that the detailed cardiac tissue procurement technique preserves the experimental viability of the cardiac tissue and prevents the degradation of myofibrillar proteins.

Surgical techniques for cardiac procurement, preparation and perfusion using the Organ Care System

We provide an audio-visual step-by-step guide to the preparation of a donor heart for the application of normothermic, ex situ cardiac perfusion on the TransMedics Organ Care System using a heart donated after brain death. The use of the Organ Care System increases heart transplantation activity by enabling the utilization of hearts donated after circulatory death, the use of extended criteria grafts and the extension of out-of-body time, which can help overcome geographic or surgical barriers. Ex situ cardiac perfusion is a new technique and is therefore not yet routinely performed in many centres. However, it can be assumed that this technique will become more established and widespread in the future. Our video tutorial, which summarizes all important steps, can therefore be of benefit to surgical teams for planning, training or as a refresher.

The current landscape of in situ and ex situ machine perfusion utilization for liver grafts from cardiac donation after circulatory death donors in the US

Donation after circulatory death (DCD) is driving the increase in deceased organ donors in the United States. Normothermic regional perfusion (NRP) and ex situ machine perfusion (es-MP) have been instrumental in improving liver transplant outcomes and graft utilization. This study examines the current landscape of liver utilization from cardiac DCD donors in the United States. Using the United Network for Organ Sharing Standard Transplant Analysis and Research file, all adult (≥18 years old) DCD donors in the United States from which the heart was used for transplantation from October 1, 2020, to September 30, 2023, were compared by procurement technique (NRP versus super rapid recovery [SRR]) and storage strategy (es-MP versus static cold storage). One hundred eighty-eight livers were transplanted from 309 thoracoabdominal NRP donors (61% utilization) versus 305 (56%) liver transplants from 544 SRR donors. es-MP was used in 20% (n = 38) of NRP cases versus 32% (98) of SRR cases. Of the liver grafts, 281 (59%) were exposed to NRP, es-MP, or both. While there is widespread utilization of machine perfusion, more research is needed to determine optimal graft management strategies, particularly concerning the use of multiple technologies in complementary ways. More complete data collection is necessary at a national level to address these important research questions.

E-FireGuard: Empowering firefighters through innovative E-commerce solutions

For firefighters to remain safe and successful in ever-more-complex and tough firefighting situations, they must have access to state-of-the-art equipment. Nevertheless, obtaining the newest firefighting technology is frequently hampered by conventional procurement techniques. This article introduces “E-FireGuard,” a cutting edge E-commerce platform created to solve these issues and provide firemen with simple access to top- notch gear. Firefighters may easily browse, buy, and evaluate a variety of firefighting goods online with E-FireGuard. Procurement procedures may be expedited because to the platform's user-friendly design, extensive product selection, and safe payment alternatives. Moreover, E-FireGuard facilitates the adoption of cutting-edge technology and best practices by acting as a center for cooperation, information exchange, and innovation among firefighters.

Procurement practices and operational performance: a study of linear and curvilinear relationships in a developing economy

PurposeWhile operational performance is important for a company's competitiveness and profitability, this study claims that procurement may be required to drive operational performance. This study aims to focus on how procurement practices is related to operational performance among selected manufacturing firms.Design/methodology/approachThe model was tested on a sample of 329 manufacturing firms in clothing and textiles, chemicals and plastics, food and beverages processing, wood processing, metal processing and pharmaceutical manufacturing industries in a developing economy.FindingsThe results indicate that firms with higher and optimal level of procurement practices achieve higher levels of operational performance. Regardless of the H1 rationale, this study suggests that increasing procurement techniques has a limit in terms of improving operational performance. This study establishes that extreme level of procurement practices is associated with decreasing operational performance.Practical implicationsThis study calls attention to how managers can guide organizations in refining their procurement strategies and practices; there is the need to strive to strike a balance between diversification and efficiency in procurement.Social implicationsManufacturing firms are often integral parts of local communities. The decisions they make regarding procurement practices can impact the economic health of these communities. Striking a balance between diversification and efficiency can contribute to sustainable business practices that benefit both the company and the local community.Originality/valueAs the main contribution, this study brings the additional perspective that extreme level of procurement practices is associated with decreasing operational performance.

Perfusion Techniques in Kidney Allograft Preservation to Reduce Ischemic Reperfusion Injury: A Systematic Review and Meta-Analysis.

The limited supply and rising demand for kidney transplantation has led to the use of allografts more susceptible to ischemic reperfusion injury (IRI) and oxidative stress to expand the donor pool. Organ preservation and procurement techniques, such as machine perfusion (MP) and normothermic regional perfusion (NRP), have been developed to preserve allograft function, though their long-term outcomes have been more challenging to investigate. We performed a systematic review and meta-analysis to examine the benefits of MP and NRP compared to traditional preservation techniques. PubMed (MEDLINE), Embase, Cochrane, and Scopus databases were queried, and of 13,794 articles identified, 54 manuscripts were included (n = 41 MP; n = 13 NRP). MP decreased the rates of 12-month graft failure (OR 0.67; 95%CI 0.55, 0.80) and other perioperative outcomes such as delayed graft function (OR 0.65; 95%CI 0.54, 0.79), primary nonfunction (OR 0.63; 95%CI 0.44, 0.90), and hospital length of stay (15.5 days vs. 18.4 days) compared to static cold storage. NRP reduced the rates of acute rejection (OR 0.48; 95%CI 0.35, 0.67) compared to in situ perfusion. Overall, MP and NRP are effective techniques to mitigate IRI and play an important role in safely expanding the donor pool to satisfy the increasing demands of kidney transplantation.

Skin Grafts in Plastic Surgery: A Comprehensive Review of Procedures, Techniques, and Clinical Considerations

Objective: This study aims to analyze the progress and challenges related to the use of skin grafts in plastic surgery, with the purpose of providing a comprehensive understanding of the associated techniques and clinical considerations. Theoretical Framework: A review of the fundamentals of plastic surgery is presented, emphasizing the importance of skin grafts in wound and deformity reconstruction, as well as exploring the impact of tissue engineering on the evolution of these techniques. Method: This study is based on a systematic review of the scientific literature, following recognized guidelines. Relevant articles addressing different types of skin grafts, their clinical applications, and associated procurement techniques were selected. Results and Discussion: The results of the review highlight the variety of skin grafts available and their respective indications. The discussion addresses the challenges in selecting the appropriate type of graft and the ethical issues related to its procurement and use. Implications of the Research: This study offers important insights for plastic surgeons and researchers on best practices in skin graft utilization, emphasizing the need for ethical considerations and specific care in graft selection and procurement. Originality/Value: It contributes to the literature by providing a comprehensive analysis of skin graft techniques in plastic surgery, including recent advancements and emerging issues. Its relevance lies in the practical guidance it offers to professionals in the field.

Abdominal normothermic regional perfusion in the United States: current state and future directions.

Normothermic regional perfusion (NRP) is a novel procurement technique for donation after circulatory death (DCD) in the United States. It was pioneered by cardiothoracic surgery programs and is now being applied to abdominal-only organ donors by abdominal transplant programs. Liver and kidney transplantation from thoracoabdominal NRP (TA-NRP) donors in the United States was found to have lower rates of delayed kidney graft function and similar graft and patient survival versus recipients of cardiac super rapid recovery (SRR) DCD donors. The excellent outcomes with NRP have prompted the expansion of NRP technology to abdominal transplant programs. Excellent early outcomes with liver and kidney transplantation have prompted the growth of NC-NRP procurement for abdominal-only DCD donors across the US, and now requires standardization of technical and nontechnical aspects of this procedure.

Normothermic regional perfusion procurement for abdominal organ donors: techniques and troubleshooting.

Normothermic regional perfusion (NRP) is a novel procurement technique for donation after circulatory death (DCD) in the United States. It was pioneered by cardiothoracic surgery programs and is now being applied to abdominal-only organ donors by abdominal transplant programs. Multiple technical approaches can be used for abdominal-only NRP DCD donors and this review describes these techniques. NRP has been associated with higher utilization of organs, particularly liver and heart grafts, from DCD donors and with better recipient outcomes. There are lower rates of delayed graft function in kidney transplant recipients and lower rates of ischemic cholangiopathy in liver transplant recipients. These benefits are driving increased interest from abdominal transplant programs in using NRP for DCD procurements. This paper describes the technical aspects of NRP DCD that allow for maximization of its use based on different donor and policy characteristics.

Association of procurement technique with organ yield and cost following donation after circulatory death

Donation after circulatory death (DCD) could account for the largest expansion of the donor allograft pool in the contemporary era. However, the organ yield and associated costs of normothermic regional perfusion (NRP) compared to super-rapid recovery (SRR) with ex-situ normothermic machine perfusion, remain unreported. The Organ Procurement and Transplantation Network (December 2019 to June 2023) was analyzed to determine the number of organs recovered per donor. A cost analysis was performed based on our institution’s experience since 2022. Of 43 502 donors, 30 646 (70%) were donors after brain death (DBD), 12 536 (29%) DCD-SRR and 320 (0.7%) DCD-NRP. The mean number of organs recovered was 3.70 for DBD, 3.71 for DCD-NRP (P < .001), and 2.45 for DCD-SRR (P < .001). Following risk adjustment, DCD-NRP (adjusted odds ratio 1.34, confidence interval 1.04-1.75) and DCD-SRR (adjusted odds ratio 2.11, confidence interval 2.01-2.21; reference: DBD) remained associated with greater odds of allograft nonuse. Including incomplete and completed procurement runs, the total average cost of DCD-NRP was $9463.22 per donor. By conservative estimates, we found that approximately 31 donor allografts could be procured using DCD-NRP for the cost equivalent of 1 allograft procured via DCD-SRR with ex-situ normothermic machine perfusion. In conclusion, DCD-SRR procurements were associated with the lowest organ yield compared to other procurement methods. To facilitate broader adoption of DCD procurement, a comprehensive understanding of the trade-offs inherent in each technique is imperative.

Single center utilization and post-transplant outcomes of thoracoabdominal normothermic regional perfusion deceased cardiac donor organs.

Thoracoabdominal normothermic regional perfusion (TA-NRP) following cardiac death is an emerging multivisceral organ procurement technique. Recent national studies on outcomes of presumptive TA-NRP-procured organs are limited by potential misclassification since TA-NRP is not differentiated from donation after cardiac death (DCD) in registry data. We studied 22 donors whose designees consented to TA-NRP and organ procurement performed at our institution between January 20, 2020 and July 3, 2022. We identified these donors in SRTR to describe organ utilization and recipient outcomes and compared them to recipients of traditional DCD (tDCD) and donation after brain death (DBD) organs during the same timeframe. All 22 donors progressed to cardiac arrest and underwent TA-NRP followed by heart, lung, kidney, and/or liver procurement. Median donor age was 41 years, 55% had anoxic brain injury, 45% were hypertensive, 0% were diabetic, and median kidney donor profile index was 40%. TA-NRP utilization was high across all organ types (88%-100%), with a higher percentage of kidneys procured via TA-NRP compared to tDCD (88%vs. 72%, p=.02). Recipient and graft survival ranged from 89% to 100% and were comparable to tDCD and DBD recipients (p ≥ .2). Delayed graft function was lower for kidneys procured from TA-NRP compared to tDCD donors (27%vs. 44%, p=.045). Procurement from TA-NRP donors yielded high organ utilization, with outcomes comparable to tDCD and DBD recipients across organ types. Further large-scale study of TA-NRP donors, facilitated by its capture in the national registry, will be critical to fully understand its impact as an organ procurement technique.

Identifying Critical Success Factors of Public Private Partnership Projects in Türkiye

Public private partnerships (PPPs) have become increasingly common as a result of states' shifting roles in infrastructure services from service providers and operators to policymakers and regulators. PPPs have been established as a prominent technique of public service procurement in both developed and developing countries. PPPs give the parties the opportunity to split the costs and risks of providing a public service or building a public infrastructure. Successful project management is crucial, especially in light of PPP projects' size and complexity. This study investigates the critical success factors (CSFs) of PPP investments in developing countries. In this regard, 23 CSFs were selected based on a thorough literature review, and a questionnaire survey was run to examine the impact of those factors on PPP performance. The information is gathered from 82 different companies in Türkiye that represent both the public and private sectors. The statistical analysis results show that favorable legal framework, detailed and clear project identification, and extensive cost-benefit assessment are the most significant drivers of success. Additionally, factor analysis is used on the data to investigate and identify underlying correlations between the factors, as well as to categorize them into fewer, more focused, and more thorough factors. The results of factor analysis suggest five dimensions; namely project finance, project management, operational factors, procurement, and organizational factors. The study's findings are anticipated to benefit both the public sector in its focus on legal concerns to permit better operation and the contractors in its examination of their capacity to manage big projects more effectively.

Post-transplant survival after normothermic regional perfusion versus direct procurement and perfusion in donation after circulatory determination of death in heart transplantation

BackgroundSince 2019, the annual transplantation rate of hearts donated following circulatory death (DCD) has increased significantly in the United States. The two major heart procurement techniques following circulatory death are direct procurement and perfusion (DPP) and normothermic regional perfusion (NRP). Post-transplant survival for heart recipients has not been compared between these two techniques. MethodsThis observational study uses data on adult heart transplants from donors after circulatory death from January 1, 2019, to December 31, 2021, in the Scientific Registry of Transplant Recipients. We identified comparable transplant cases across procurement types using propensity-score matching and measured the association between procurement technique and 1-year post-transplant survival using Kaplan-Meier and mixed-effect Cox proportional hazards models with random intercepts for each center. ResultsAmong 318 DCD heart transplants, 216 (68%) were procured via DPP, and 102 (32%) via NRP. Among 22 transplant centers that accepted circulatory-death donors, 3 used NRP exclusively, and 5 used both procurement techniques. After propensity-score matching on recipient and donor factors, there was no significant difference in one-year post-transplant survival (93.1% for NRP vs 91.1% for DPP, p = 0.79) between procurement techniques. ConclusionsNRP and DPP procurements are associated with similar one-year post-transplant survival. If NRP is ethically permissible and improves outcomes for abdominal organs, it should be the preferred procurement technique for DCD hearts. Data availability statementThe data that support the findings of this study are available from the Scientific Registry of Transplant Recipients (SRTR). Restrictions apply to the availability of these data, which were used under license for this study.

Recycling transplanted organs: An exceptional case and literature review.

Recycling transplant kidneys, in other words using an allograft which has previously been transplanted in one recipient for transplant in a second recipient, can be a source of opportunity for expanding the pool of available grafts in the United States and beyond. We describe a case of renal transplantation from a donor who had undergone a kidney transplant 3 years prior and had good graft function at the time of procurement. The recipient underwent transplantation uneventfully and to date has demonstrated excellent graft function. We also include a literature review of reported cases of recycled/retransplanted kidneys. -Recycling transplanted kidneys is a largely untapped resource which could help decrease the transplant waitlist. -Utilizing such kidneys does need special considerations in terms of procurement technique, backtable, crossmatch, recipient selection and follow-up.

Procurement Planning Technique: A Strategy for Sustaining Production Capacity of Bread-Baking Firms in Port Harcourt, Rivers State, Nigeria

The small and medium-scale industry is considered to be an informal section in the Port Harcourt Rivers State, Nigeria. However, the volume of business activity carried out in the sector was perceived to be capable of opening and increasing the per capita income of the city Port Harcourt if their mode of operation is mainstreamed to size procurement of materials geared towards increasing productivity amongst bread baking firms. Thus, the general aim was to evaluate how procurement technique enhances production capacity among firms in the bread-baking industry in Port Harcourt. The study was necessitated as a result of the inability of firms to strategically increase production capacity, given the apparent local means for material procurement in practice. A correlation design was adopted for the study, with the aid of a structured questionnaire on a total population of 96 firms. Questionnaires were administered to 96 production supervisors; hence, it was a judgmental census study. Findings upheld that all dimensions measured were of strong positive correlation at the least measure of 0.6 (p) ≥ 0.00. Among the conclusions reached was that making decisions was more strategically viable for firms to adopt in the industry. Thus, an empirically proven approach to procurement selection technique would be more reliable for sustaining the production capacity of the firms studied.

Slovenia ∙ Dynamic Purchasing Systems Proved as Suitable Purchasing Technique for Joint Public Procurement in Two ELENA-funded Projects in Slovenia

Slovenia ∙ Dynamic Purchasing Systems Proved as Suitable Purchasing Technique for Joint Public Procurement in Two ELENA-funded Projects in Slovenia

Preserved 2-y Liver Transplant Outcomes Following Simultaneous Thoracoabdominal DCD Organ Procurement Despite Effects on Liver Utilization Rate.

Current techniques for donation after circulatory determination of death (DCD) heart procurement, through either direct procurement and machine perfusion or thoracoabdominal normothermic regional perfusion (NRP), have demonstrated excellent heart transplant outcomes. However, the impact of thoracoabdominal DCD (TA-DCD) heart procurement on liver allograft outcomes and utilization is poorly understood. One hundred sixty simultaneous heart and liver DCD donors were identified using the United Network for Organ Sharing/Organ Procurement and Transplantation Network database between December 2019 and July 2021. Liver outcomes from TA-DCD donors were stratified by heart procurement technique and evaluated for organ utilization, graft survival, and patient survival. Results were compared with abdominal-only DCD (A-DCD; n = 1332) and donation after brain death (DBD; n = 12 891) liver transplants during the study interval. Kaplan-Meier methods with log-rank testing were used to evaluate patient and graft survival. One hundred thirty-three of 160 livers procured from TA-DCD donors proceeded to transplant. TA-DCD donors were younger (mean 28.26 y; P < 0.0001) with lower body mass index (mean 26.61; P < 0.0001) than A-DCD and DBD donors. TA-DCD livers had equivalent patient survival ( P = 0.893) and superior graft survival (P = 0.009) compared with A-DCD. TA-DCD livers had higher rates of organ discard for long warm ischemia time (37.0%) than A-DCD (20.5%) and DBD (0.5%; P < 0.0001), with direct procurement and machine perfusion procurements leading to a higher discard rate (18.5%) than NRP procurements (7.4%). Liver transplants after TA-DCD donation demonstrated equivalent patient outcomes and excellent graft outcomes. NRP procurements resulted in the lowest rate of organ discard after DCD donation and may represent an optimal strategy to maximize organ utilization.

Dilemmas concerning heart procurement in controlled donation after circulatory death.

With an expanding population at risk for heart failure and the resulting increase in patients admitted to the waiting list for heart transplantation, the demand of viable organs exceeds the supply of suitable donor hearts. Use of hearts after circulatory death has reduced this deficit. Two primary techniques for heart procurement in circulatory death donors have been described: direct procurement and perfusion and thoraco-abdominal normothermic regional perfusion. While the former has been accepted as an option for heart procurement in circulatory death donors, the latter technique has raised some ethical questions in relation to the dead donor rule. In this paper we discuss the current dilemmas regarding these heart procurement protocols in circulatory death donors.

Biocompatible Solid‐State Ion‐Sensitive Organic Electrochemical Transistor for Physiological Multi‐Ions Sensing

AbstractWearable bioelectronic sensors have gained tremendous prominence and applicability in healthcare technologies as they offer an alternative to traditional clinical testing and health monitoring. However, many challenges must be overcome for off‐site and point‐of‐care commercial applications, including sensitivity, selectivity, multiple analyte detection, sample procurement technique, invasiveness, biocompatibility, and accurate real‐time sensing. Specifically, a wearable sweat‐based diagnostic biosensing platform offers a noninvasive way for rapid and real‐time monitoring of various physiological biomarkers. This work develops a flexible solid‐state organic electrochemical transistor with an extended sensing node for multi‐ions sensing in the physiological range with high selectivity, fast response, and superior sensitivity. The solid‐contact architecture is implemented for easy sample handling, processability, device miniaturization, and flexibility. For the first time, multiplexed ions (sodium (Na+), potassium (K+), and calcium (Ca2+)) sensing with the integration of ion‐selective membranes and biocompatible semiconducting channel in an extended gate‐solid‐state organic electrochemical transistor (ExG‐SSOECT) is presented. The integrated ExG‐SSOECT device platform exhibits improved performance among the available wearable sensors and offers great potential to be a suitable biochemical sensor in wearable bioelectronics.

Revitalizing pancreas transplantation: creation of a hands-on training course for pancreas allograft procurement, backbench preparation, and transplantation.

Despite a steady increase in the number of organs available for transplant in the United States, over the last two decades there has been a precipitous decrease in the annual number of pancreas transplants performed. One overlooked consequence of this decline in pancreas transplant volume has been a decrease in experience in proper pancreas procurement and transplantation techniques for transplant surgeons as well as fewer trained abdominal transplant fellows entering the workforce certified for pancreas procurement and transplantation, with those achieving certification having less-developed judgment, skills, and experience. To augment current fellowship training and provide a concentrated experience in pancreas procurement and transplantation, the ASTS developed a hands-on surgical skills workshop focused on proper techniques for pancreas allograft procurement and backbench preparation.