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Abdominal Transplantation
Abdominal Transplantation
Preface A b d o m i n a l Tr a n s p l a n t a t i o n
Claus U. Niemann, MD Editor
Solid organ transplantation is now performed in hundreds of academic and private hospitals across the nation, with most of them being kidney and liver transplants. Patient outcome has dramatically improved over recent decades due to significant advances in immunosuppression and perioperative care of transplant patients. A well-defined, protocol-driven multidisciplinary team approach has been established in most transplant centers; thus transplant services are well ahead of most other surgical service lines. At a minimum, institutional protocols define preoperative, intraoperative, and postoperative management of these complex patients. Increasingly, these protocols are often built on evidence-based information rather than single institutional experience. Organ transplantation is exceedingly complex and involves many steps well beyond matching the right organ to the right patient. An enormous logistical infrastructure is required before an organ is even offered for transplantation. In fact, considering organs as distinct biological systems in deceased donors (which by federal law are no longer human subjects) is an increasingly recognized paradigm that has led to donor management goals and a national performance metrics that closely tracks organ function and organ recovery rate. Organ transplantation is very transparent with center-specific patient waitlists and transplant outcomes readily available online for the public. A regular comprehensive (some may argue too comprehensive) review of transplant centers, organ procurement organizations, and histocompatibility laboratories are performed by the United Network of Organ Sharing (UNOS), which is directly contracted by the Department of Health and Human Services to oversee the transplantation in the United States. In summary, transplantation in the United States has already many elements of care delivery models that are envisioned with accountable care organizations. A highly specialized group of multidisciplinary physicians provide care to a specific patient
Anesthesiology Clin 31 (2013) ix–x http://dx.doi.org/10.1016/j.anclin.2013.09.006 anesthesiology.theclinics.com 1932-2275/13/$ – see front matter Ó 2013 Elsevier Inc. All rights reserved.
x
Preface
population. The care and outcomes of these patients are constantly evaluated with a robust quality metrics that allows evaluation of overall patient care, cost, and quality. Claus U. Niemann, MD Department of Anesthesia and Perioperative Care Department of Surgery Division of Transplantation University of California San Francisco 521 Parnassus Avenue San Francisco, CA 94143-0648, USA E-mail address: [email protected]
Preface A b d o m i n a l Tr a n s p l a n t a t i o n
Claus U. Niemann, MD Editor
Solid organ transplantation is now performed in hundreds of academic and private hospitals across the nation, with most of them being kidney and liver transplants. Patient outcome has dramatically improved over recent decades due to significant advances in immunosuppression and perioperative care of transplant patients. A well-defined, protocol-driven multidisciplinary team approach has been established in most transplant centers; thus transplant services are well ahead of most other surgical service lines. At a minimum, institutional protocols define preoperative, intraoperative, and postoperative management of these complex patients. Increasingly, these protocols are often built on evidence-based information rather than single institutional experience. Organ transplantation is exceedingly complex and involves many steps well beyond matching the right organ to the right patient. An enormous logistical infrastructure is required before an organ is even offered for transplantation. In fact, considering organs as distinct biological systems in deceased donors (which by federal law are no longer human subjects) is an increasingly recognized paradigm that has led to donor management goals and a national performance metrics that closely tracks organ function and organ recovery rate. Organ transplantation is very transparent with center-specific patient waitlists and transplant outcomes readily available online for the public. A regular comprehensive (some may argue too comprehensive) review of transplant centers, organ procurement organizations, and histocompatibility laboratories are performed by the United Network of Organ Sharing (UNOS), which is directly contracted by the Department of Health and Human Services to oversee the transplantation in the United States. In summary, transplantation in the United States has already many elements of care delivery models that are envisioned with accountable care organizations. A highly specialized group of multidisciplinary physicians provide care to a specific patient
Anesthesiology Clin 31 (2013) ix–x http://dx.doi.org/10.1016/j.anclin.2013.09.006 anesthesiology.theclinics.com 1932-2275/13/$ – see front matter Ó 2013 Elsevier Inc. All rights reserved.
x
Preface
population. The care and outcomes of these patients are constantly evaluated with a robust quality metrics that allows evaluation of overall patient care, cost, and quality. Claus U. Niemann, MD Department of Anesthesia and Perioperative Care Department of Surgery Division of Transplantation University of California San Francisco 521 Parnassus Avenue San Francisco, CA 94143-0648, USA E-mail address: [email protected]