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The global organ donation crisis continues to escalate despite advancements in medical procedures. Uncont-rolled donation after circulatory death provides an alternative method to increase the donor pool, especially for kidney transplants. This case study from Iran offers insights into the complex, yet essential, facets of organ procurement under uncontrolled donation after circulatory death protocols. A 38-year-old woman experienced a severe cerebrovascular accident and subsequent cardiac arrest. She was declared for uncontrolled donation after circulatory death, and her organs were preserved using cardiopulmonary bypass for 6 hours. Notably, her kidneys were successfully removed and transplanted into 2 recipients: a 43-year-old man with chronic kidney disease due to hypertension and a 48-year-old man with chronic kidney disease associated with diabetes mellitus. The first recipient experienced initial complications with kidney function that required a prolonged hospital stay, but he eventually exhibited improved renal function. The second recipient experienced fluctuating kidney function initially, which stabilized, demonstrating the practical viability of kidneys procured through uncontrolled donation after circulatory death. This pioneering case in Iran underscores the potential of uncontrolled donation after circulatory death to expand organ procurement and addresses critical medical, ethical, and legal challenges. We emphasize the need for refined protocols that reduce wait times and improve organ viability, thereby contributing to the broader organ donation network. Future research should focus on enhancement of normothermic regional perfusion techniques to improve outcomes for both donors and recipients.

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BACKGROUNDS/AIMS: The aim of this study was to find the safety and effectiveness of enhanced recovery after surgery (ERAS) in patients who undergo hepatopancreaticobiliary (HPB) surgeries and its association with the postoperative complications and survival rate of the patients. METHODS: This study was conducted on patients who underwent HPB surgeries in Imam Khomeini Hospital Complex, Iran from 2018 to 2020. Patients who underwent surgery after from 2019 to February 2020 considered as the ERAS group (n=47) in which ERAS was implemented postoperatively including removing nasogastric tube and initiating surgical diet at 6 hours post operation, and removing intraabdominal drains and Foley catheter at postoperative day one. Other patients (n=43) were considered as the control group in which conventional postoperative care was implemented. RESULTS: Ninety patients with the mean age of 47.3±13.3 yrs/old (range= 17-76) including 39 females were enrolled into the study. There were no significant differences between the demographic and preoperative comorbidities between the two groups. Pain severity of the patients in the ERAS group was significantly lower than the control group (visual analogue scales of 3.4±0.77 vs. 4.47±0.88, p<0.001). However, there were no significant differences between the other postoperative data between the two groups. One patient in each group died during hospitalization period due to myocardial infarction. CONCLUSIONS: ERAS may be safe and effective in patients who undergo HPB surgery and may be associated with less severe postoperative pain.

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ackground: During the pandemic of COVID-19, the overwhelm of infected patients created an exponential surge for ICU and ward beds. As a result, a major proportion of elective surgeries was postponed. However, various emergency and urgent procedures were allowed. Due to the mortality complications of hepatopancreatobiliary issues, we decided to afford urgent procedures under intensive protective arrangements. Method and results: In our ward (liver transplant), 4 ICU beds and 16 ward beds were allocated to non-COVID-19 patients. A total of 36 hepatopancreatobiliary procedures were managed for one month. All the surgeries were afforded under personal protective equipment and other intensive protective arrangements for personnel and patients. During 6 weeks following the surgery, all patients were followed up through telemedicine and no new case of COVID-19 was detected. Conclusion: In general, it appears that intensive protections could significantly reduce the number of COVID-19 incidence among patients with co-morbidities who undergo invasive procedures.

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