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Studies upon Spinal Cord Injuries

II. The Nature and Treatment of Pain

Loyal Davis and John Martin

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Joseph Walker, Ritchie Gillespie, John Davis and William Dawson

✓ When anterior cervical discectomy is performed for either “hard” or “soft” cervical disc herniation using either the Cloward approach or simple discectomy, it is often difficult to confirm intraoperatively the adequacy of the lateral, superior, and inferior margins of the dissection. Placement of a nonionic contrast material, iohexol, into the disc space before obtaining anteroposterior and lateral x-ray spine films can indicate the adequacy of the margins of dissection of the soft disc or bone ridge to prevent a poor operative result.

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Eben Alexander Jr., John E. Adams and Courtland H. Davis Jr.

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Loyal Davis, John Martin and Stanton L. Goldstein

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J. Adair Prall, John D. Davis and N. Ross Jenkins

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Loyal Davis, John Martin, Stanton L. Goldstein and Moses Ashkenazy

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Loyal Davis, John Martin, Frank Padberg and Robert K. Anderson

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John Dickerson, Alex B. Valadka, Tina LeVert, Kimberly Davis, Mary Kurian and Claudia S. Robertson

Object. The number of patients waiting for organ transplantation continues to grow, while organs are donated by very few of the thousands of potential donors who die every year. The authors' neurosurgical intensive care unit (NICU) has worked closely with coordinators from the local organ procurement organization (OPO) for many years. In this study, the authors analyze donation rates in the NICU and discuss factors that may be important in maximizing these rates.

Methods. All referrals from the NICU to the OPO from 1996 to 1999 were analyzed. Of the 180 referrals, 98 patients were found to be medically suitable as potential donors. Another 15 patients died of hemodynamic collapse shortly after admission to the NICU. If one assumes that all 15 patients would have been suitable donors, the unsuccessful resuscitation rate becomes 15 (13.3%) of 113. Of the 98 eligible donors, consent was obtained and organs or tissue were recovered in 72, yielding a successful organ procurement rate of 73.5%.

Conclusions. Close working relationships among physicians, nurses, and OPO coordinators can result in higher donation rates than have been reported previously. Aggressive resuscitation and stabilization of all patients, early identification of potential organ donors, prompt declaration of brain death, and attempts by the OPO coordinator to build rapport with families are all important factors that may increase donation rates. Because most organ donors have sustained catastrophic intracranial events, neurosurgeons are uniquely positioned to influence organ donation policies at their hospitals and thus to salvage some benefit from tragic cases of overwhelming brain injury.