Within the field of transplantation, the accurate reporting of the anatomy and condition of retrieved organs is imperative. The multistepped system currently in use in the UK can lead to misreporting and/or misinterpretation of the original findings. We have recently performed a pilot study to assess the feasibility and usefulness of a reporting system that incorporates digital photographs of retrieved kidneys.
Over a 4-month period, photographs of all cadaveric kidneys sent to a single UK renal transplant unit were taken using a range of digital cameras. Two standard views were taken of each organ prior to any bench work being performed: one of the entire organ and a close-up of the arterial patch.
In 2004, 20 renal transplant surgeons were asked to assess a collection of these images for eight organs at the British Transplantation Society annual congress. Based solely upon the original information provided by the retrieving surgeon, all assessing surgeons would have accepted all the organs. However, subsequent viewing of the images changed a significant number of management decisions: 66% would still accept the organ, 5% would turn it down, 6.3% wanted further inspection, 17% wanted to contact the retrieving surgeon, and 5% would accept the organ for an adult but not a pediatric recipient.
The photographs did not significantly alter the sensitivity of assessing vascular anatomy (ξ2, P=0.547 and 0.187 for arterial and venous anatomy respectively), diagnosing anomalies (P=0.522) or damage (P=0.333) between retrieving and assessing surgeon.
To assess the feasibility of running such a system a postal questionnaire was sent all UK Consultants involved in renal transplantation. A 74% response rate was achieved (n=69). Of the responders, 90% had 24-hour access to a computer, all of which had internet access. In addition, all had an e-mail account and felt that they would be able to open a picture attachment to an e-mail.
Taken together, these results suggest that digital photographs may be a useful adjunct to the reporting system. The inclusion of images may lead to better use of retrieved organs by ensuring that they are given to the most appropriate donor. In addition, visual assessment and subsequent rejection by one center could be performed more rapidly, allowing the organ to be offered to another center quickly. This would limit the cold ischemic time and potentially improve graft function in the final recipient.
Setting up such a system will be feasible as most transplanting surgeons already have the necessary access to and ability to use computers. The images were mainly taken using “home” cameras belonging to the surgical team and were deemed either satisfactory or excellent by the assessing surgeons. This suggests that the practicalities and cost of using digital photographs need not be prohibitive.
Based upon these findings, work is now under way in collaboration with UK Transplant to implement a reporting system that includes digital photographs of the organs.
Anusha G. Edwards
Andrew R. Weale
Justin D. Morgan
Chris J. Rudge
UK Transplant; Bristol, United Kingdom