Date of Award

1-1-2018

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

David C. Mulligan

Second Advisor

John P. Geibel

Abstract

ADDRESSING THE NATIONAL ORGAN DEFICIT: BIOMECHANICAL, TECHNICAL, AND LOGISTICAL INTERVENTIONS. Jennie K. Choe, Christopher Ibarra, Manuel I. Rodriguez-Davalos, and David C. Mulligan. Section of Transplantation Surgery and Immunology, Department of Surgery, Yale University, School of Medicine, New Haven, CT.

The United States is experiencing an unprecedented deficit of transplantable organs, as increasing numbers of patients are added to transplantation waiting lists while the number of donors has remained stagnant. This investigation seeks to utilize translational science, outcomes analysis, and policy recommendations to increase the quantity and quality of organs that become available for transplantation.

Three angles of investigation were chosen to address the problem of the growing organ deficit. 1) Biomechanical interventions: literature on commercially available normothermic machine perfusion devices for livers was examined with the objective of designing an experimental version that is affordable and easy for laboratories to build themselves. 2) Technical interventions: outcomes were analyzed for all patients who underwent living donor liver transplantation for primary sclerosing cholangitis at Yale-New Haven Hospital over a ten-year period. 3) Logistical interventions: literature on the efficiency and equitability of organ allocation systems in the United States, the UK, and Europe was examined and integrated with viewpoints from the expert surgical transplantation team at Yale-New Haven Hospital.

A blueprint was designed for a simple device that achieves the basic objectives of normothermic perfusion in small animal models. Outcomes analysis of all patients who underwent liver transplantation for PSC found patient and graft survival to be equally favorable in LDLT and deceased donor liver transplantation, supporting more widespread use of LDLT for end-stage liver disease. Experts at Yale agreed with published findings that identified ways in which DonorNet and other allocation systems have slowed the acceptance process for the most suboptimal organs, and put forward recommendations for improvement.

The national organ shortage is a massive and multifactorial problem, but innovation and collaboration can make inroads into it where previously none were thought possible.

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