procurement

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procurement

 [pro-kūr´ment]
the obtaining of something.
organ procurement in the nursing interventions classification, a nursing intervention defined as guiding families through the donation process to ensure timely retrieval of vital organs and tissue for transplantation.

procurement

Medpeak-UK
A UK term of art for obtaining goods/services which ideally are cost effective and provide the best quality outcomes for service users. Effective procurement needs effective commissioning guidelines as well as a transparent and open process in which to apply to provide services and goods.

NIH-Speak
The acquisition by purchase, lease or barter of property or service for the direct benefit or use of the US National Cancer Institute (NCI) or other government agencies. The procurement instrument most often used is a contract, which details the rights, duties and obligations of each of the parties involved.

Transplantation
Before activating a "procurement team”, it must be established that the donor meets certain criteria (below). If the donor criteria are met, the team may charter a small private jet and fly to the donor's hospital. Once the donor's thoraco-abdominal cavity is opened, it is packed with a "slush" preparation—ice and lactated Ringer's solution—which reduces organ activity to a metabolic "ground zero”. The team then organises itself into 3 to 5 sections, each of which is poised to remove 1 organ block—e.g., the liver, pancreas, kidneys (which count as one block collectively), heart-lung block or heart and lungs as separate blocks.

Once the team is ready, the aorta is cannulated and clamped above the heart; at this critical step—known as "cross-clamping”—a countdown of viability begins, after which time each organ block has an allowed "cold ischaemia time" before it becomes suboptimal for transplantation—which is 4 to 6 hours for the heart-lung block, 20 hours for the liver and pancreas, and up to 72 hours for the kidneys. After cross-clamping, the vena cava is cut and the donor's blood is exsanguinated and a perfusate is gravity-fed into each organ via the aorta and arteries; the organs are then removed by each "section" and placed in containers filled with the "slush" preparation, maintained at near 0ºC, and then transported to their respective recipient teams.

Transplantation Harvesting
The obtaining of organs for transplantation; the best donor of multiple organs is a recently brain-dead patient with unimpaired circulation.

Procurement criteria, transplant organs 
Physical criteria
Young age, previous excellent health before the trauma that left the donor in a persistent vegetative state, absence of substance abuse history.
 
Legal criteria
Appropriate permission for organ donation from next-of-kin.
 
Lab criteria
Serologic tests (IgG, IgM ELISA) for HIV-1, HTLV-I, HAV, HBV, hepatitis C, Treponema, blood-group compatiblity, HLA matching.

procurement

Transplantation The obtention of organs for transplantation; the best donor of multiple organs destined for transplantation is a recently brain-dead Pt with unimpaired circulation. See Slush preparation, Transplantion, UNOS.
Procurement criteria  
Physical criteria–eg, young age, previous excellent health before the trauma that left the donor in a persistent vegetative state, absence of substance abuse history
Legal criteria–ie, appropriate permission for organ donation has been obtained from next-of-kin
Lab criteria A battery of serologic tests–IgG, IgM ELISA–for  HIV-1, HTLV-I, HAV, HBV, hepatitis C, RPR–Treponema 
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