Persistent psychiatric symptoms after eating psilocybin mushrooms.

50 mg and heparin 10 000 U are given 30 minutes before the expected time of removal. Mannitol acts synergistically with both these drugs and may be included in the regimen in future.'8 Phenoxybenzamine is supplied by the transplant surgeon since the drug is now available only under special licence. A single dose of 100 mg is given intravenously five minutes before removal. A long-acting muscle relaxant such as pancuronium 4 mg may be given at the same time to prevent contractions of the abdominal muscles at laparotomy. Postmortem examination should be carried out on every donor to exclude occult neoplasm, which might affect the health of the recipient. Conclusion The techniques and laws relating to organ removal from a heart-beating donor are well known; public attitude is sympathetic , and relatives seldom refuse to give consent for donation; and statistics show that there is a surplus of potential donors. Nevertheless, the supply of viable cadaveric kidneys falls far short of the need. The fault lies with the medical profession and must be due to lack of knowledge and skills or to inappropriate attitudes of hospital medical staff. Table III lists the requirements for participation in a transplantation programme. TABLE III-Skills, knowledge, and attitudes required for participation in transplantation programme Skills: IPPV Monitoring circulation Appropriate fluid treatment Knowledge: Organisational protocol for donation Legal aspects of donation Awareness of shortage of donor kidneys Attitudes: Obligations versus rights Attitudes towards organ donation/brain death/transplantation programme The relevant knowledge and techniques have been described. Appropriate attitudes can be learned only from the example of others. We have shown that a district general hospital can make appreciable contributions to a transplantation programme. The procedure has been facilitated by the use of flow charts. These prevent errors and simplify and hasten the procedure. In our hands the time taken from the diagnosis of brain death to the removal of kidneys ranges from threc to six hours. One estimate suggests that a small district general hospital should be able to supply six donors a year.' We calculate that if other hospitals of comparable size were to follow our example there would be a surplus of donor kidneys. This would allow surgeons to choose only those kidneys removed under optimal conditions for transplantation. The initial high failure rate would be expected to improve. A far greater number of patients undergoing long-term dialysis could be offered transplantation and hence …