Site Visit

Purpose of the trip

Dr. Shams-Ud-Din as part of the TTS-ILTS Paired Transplant Centers Program travelled to UCSF. His trip's purpose was to interact with the UCSF Organ transplant team, to see their protocols of pre and post transplant Patient management, to see deceased donor organ transplantation, organ procurement and normothermic perfusion dynamics and implications.

Interaction with Organ transplant team

During his visit, Dr. Shams-Ud-Din was able to meet with:

  • Dr Nancy Ascher (Professor of Surgery) * Pictured above
  • Dr Sandy Feng (Professor of Surgery)
  • Dr Peter Stock (Professor of Surgery)
  • Dr Ryutaro Hirose (Professor of Surgery)¬†
  • Dr Bilal Hameed (Professor of Medicine and Ambulatory Director of Hepatology)
  • Dr Saeed Shareef (Assistant Professor of Surgery) *Pictured left
Deceased donor Organ transplantation and Organ Procurement

SRTR: (Scientific registry of transplant recipient)

  • It is responsible for providing statistical and analytic support to the organ procurement and transplantation network (OPTN) including the formulation and evaluation of organ allocation and other OPTN policies.
  • It monitors post-transplant outcomes (including 1-month, 90-day, 1-year, and 3-year graft and patient survival)
Normothermic Perfusion Dynamics and implication

A method of organ preservation, provides oxygen and nutrition during preservation and allows aerobic metabolism.

  • A very good addition in deceased donor liver transplant specially in circulatory death donors to assess the viability of liver, as well as very useful in fatty liver to assess the function as well as to prevent post-transplant reperfusion injury, or primary non function
Activities

We removed the liver from a pig and put it in normothermic perfusion machine which usually provides a normal environment and nutrition to the liver. It has an arterial pump and portal vein pump and you can adjust the pressure in each by a nozzle. It contains TPN solution, normal saline and bile salt solution which are set at different levels to support the liver. Liver functions are monitored usually every 2 hours by an ISTAT machine by monitoring the lactate level and ABGs. We kept the liver up to 24 hours.

Cases
  • Circulatory death donor organ procurement
  • Brain death donor organ procurement
  • Pancreatic bench work and transplant
  • Deceased donor bench work
  • Recipient implantation in deceased donor
Remarks
  • Highly appreciable¬† work of TTS-ILTS platform for establishing such a wonderful program to support emerging programs
  • TTS-ILTS platform not only helps the emerging center to learn techniques in the field of transplantation but also creates a social bonding among the two centers.
  • As UCSF is among the worlds famous organ transplant programs it really has great impact on learning and adopting their protocols in our center, which will make our program more effective in-patient management.