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The Dallas Donation after Circulatory Death Transplantation Summit:expanding donation after circulatory death procedures through process improvement,broader utilization,and innovation

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 824-836,I0009页

作者： Michele Finotti Anji Wall Anthony D’Alessandro Gary Schwartz Chris Sonnenday David Goldberg Ashish Shah Peter Friend Jeff P.Orlowski greg mckenna Steve Newton Brad Adams William C.Chapman Amit Mathur Marwan Abouljoud Tim Pruett Amelia Hessheimer James F.Trotter Sumeet K.Asrani Giuliano Testa Simmons Transplant Institute Baylor University Medical CenterDallasTXUSA Hepatobiliary and General Surgery Unit Regional Hospital TrevisoDISCOGUniversity of PaduaPaduaItaly Division of Transplantation Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonWIUSA Department of Thoracic Surgery and Lung Transplantation Baylor University Medical CenterCenter for Advanced Heart and Lung DiseaseDallasTXUSA Department of Surgery University of MichiganAnn ArborMIUSA Division of Digestive Health and Liver Diseases Department of MedicineUniversity of Miami Miller School of MedicineMiamiFLUSA Department of Cardio-Thoracic Surgery Vanderbilt University Medical CenterNashvilleTNUSA Nuffield Department of Surgical Sciences University of OxfordOxfordUK LifeShare Transplant Donor Services of Oklahoma Oklahoma CityOKUSA Administration Baylor University Medical CenterDallasTXUSA Southwest Transplant Alliance DallasTXUSA Department of Surgery/Transplantation Washington UniversitySt.LouisMOUSA Division of Transplant Surgery Department of SurgeryMayo Clinic ArizonaAlix School of MedicinePhoenixAZUSA Divisions of Transplant and Hepatobiliary Surgery Henry Ford HospitalDetroitMIUSA Department of Surgery University of MinnesotaMinneapolisMNUSA General and Digestive Surgery Hospital Universitario La PazIdiPAZMadridSpain

Despite a significant increase in utilization over the past decade,the number of donation after circulatory death(DCD)organs that are procured and transplanted in the United States(US)remains well below its *** is still room for expansion,as utilizing DCD organs to the fullest extent is currently the most viable solution to the persistent mismatch between supply and demand in *** convened a multidisciplinary transplantation summit to examine various aspects of DCD,with faculty members from around the world with clinical and academic interest in DCD donation and transplantation,including abdominal and cardiothoracic surgeons,organ procurement organization directors,hepatologists,and *** conference focused on identifying barriers to DCD organ utilization and strategies to overcome these *** divide the barriers to DCD utilization into three mains categories:(Ⅰ)policy and process variation;(II)logistical and transportation challenges;and(Ⅲ)higher risk perceptions related to DCD *** each barrier,we proposed a variety of solutions,providing an overview of the status of DCD donation in the US and suggestions on how to increase the use of *** is a specific focus on ex situ machine perfusion,normothermic regional perfusion,and other opportunities to expand DCD utilization without negatively impacting recipient outcomes.

关键词： Donation after circulatory death donation(DCD donation) marginal graft donor pool machine perfusion(MP)

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Reimagining large river management using the Resist-Accept-Direct(RAD)framework in the Upper Mississippi River

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Ecological Processes 2023年第1期12卷 645-664页

作者： Nicole K.Ward Abigail J.Lynch Erik A.Beever Joshua Booker Kristen L.Bouska Holly Embke Jeffrey N.Houser John F.Kocik Joshua Kocik David J.Lawrence Mary Grace Lemon Doug Limpinsel Madeline R.Magee Bryan M.Maitland Owen mckenna Andrew Meier John M.Morton Jeffrey D.Muehlbauer Robert Newman Devon C.Oliver Heidi M.Rantala greg G.Sass Aaron Shultz Laura M.Thompson Jennifer L.Wilkening Minnesota Department of Natural Resources Lake CityMN 55041USA U.S.Geological Survey National Climate Adaptation Science CenterRestonVA 22041USA U.S.Geological Survey Northern Rocky Mountain Science CenterBozemanMT 59715USA Department of Ecology Montana State UniversityBozemanMT 59715USA U.S.Fish and Wildlife Service National Wildlife Refuge SystemOak HarborOH 43449USA U.S.Geological Survey Upper Midwest Environmental Sciences CenterLa CrosseWI 54603USA U.S.Geological Survey Midwest Climate Adaptation Science CenterSt.PaulMN 55108USA NOAA NEFSC OronoME 04473USA University of Nebraska-Lincoln LincolnNE 68503USA National Park Service Climate Change Response ProgramFort CollinsCO 80525USA U.S.Fish and Wild-life Service National Wildlife Refuge SystemBloomingtonMN 55437USA Habitat Conservation Division NOAAAlaska RegionAnchorageAK 99513USA Wisconsin Department of Natural Resources MadisonWI 53703USA Aquatic Sciences Center Center for LimnologyUW-MadisonMadisonWI 53706USA U.S.Geological Survey Northern Prairie Wildlife Research Center and Midwest Climate Adaptation Science CenterJamestownND 58401USA U.S.Army Corps of Engineers La CrescentMN 55947USA Alaska Wildlife Alliance AnchorageAK 99520USA U.S.Geological Survey Alaska Cooperative Fish and Wildlife Research UnitUniversity of Alaska FairbanksFairbanksAK 99775USA University of North Dakota Grand ForksND 58202USA Minnesota Department of Natural Resources DuluthMN 55804USA Wisconsin Department of Natural Resources Boulder JunctionWI 54512USA Great Lakes Indian Fish and Wildlife Commission(GLIFWC) OdanahWI 54861USA U.S.Geological Survey National Climate Adaptation Science Centerand School of Natural ResourcesUniversity of TennesseeKnoxvilleTN 37996USA U.S.Fish and Wildlife Service National Wildlife Refuge SystemFort CollinsCO 80526USA

Background Large-river decision-makers are charged with maintaining diverse ecosystem services through unprec-edented social-ecological transformations as climate change and other global stressors *** interconnected,dendritic habitats of rivers,which often demarcate jurisdictional boundaries,generate complex management ***,we explore how the Resist–Accept–Direct(RAD)framework may enhance large-river management by promoting coordinated and deliberate responses to social-ecological trajectories of *** RAD frame-work identifies the full decision space of potential management approaches,wherein managers may resist change to maintain historical conditions,accept change toward different conditions,or direct change to a specified future with novel *** the Upper Mississippi River System,managers are facing social-ecological transformations from more frequent and extreme high-water *** illustrate how RAD-informed basin-,reach-,and site-scale decisions could:(1)provide cross-spatial scale framing;(2)open the entire decision space of potential management approaches;and(3)enhance coordinated inter-jurisdictional management in response to the trajectory of the Upper Mississippi River *** The RAD framework helps identify plausible long-term trajectories in different reaches(or subbasins)of the river and how the associated social-ecological transformations could be managed by altering site-scale *** reach-scale objectives may reprioritize how,where,and when site conditions could be altered to contribute to the basin goal,given the basin’s plausible trajectories of change(e.g.,by coordinating action across sites to alter habitat connectivity,diversity,and redundancy in the river mosaic).Conclusions When faced with long-term systemic transformations(e.g.,>50 years),the RAD framework helps explicitly consider whether or when the basin vision or goals may no longer be achievable,and direct options may open y

关键词： Ecosystem Management Transformation Social-ecological system Anthropocene Climate change Basin planning Cross-scale interactions

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