Anaesthesia and Intensive Care for Organ Transplantation (2000)

J. R. Klinck and M. J. Lindop, edsChapman & Hall Medical, 1998. 396 pp. £85.00. This book, edited by John Klinck and Mike Lindop from Addenbrookes Hospital but with many contributors from North America, is effectively in two sections. The chapters at either end are concerned with general issues, those in the middle relate to particular organs. It follows the modern trend for British books to be published in American English. The first three chapters, on immunobiology, immunosuppression and organ preservation, cover the scientific understanding and advances which have made transplantation possible. Immunosuppression is a fast moving field and some of the trials awaited when it was written are now complete, but the main messages are unaffected. The fourth chapter covers organisational, legal and ethical issues associated with organ retrieval and transplantation. It compares the practice in different countries, including ‘opt out’ and ‘opt in’ arrangements but, surprisingly, it makes no mention of ‘elective ventilation’. The fifth chapter, on management of the organ donor, is clear and straightforward. Readers in the UK should be aware, however, that the Intensive Care Society and Department of Health state that the time of death should be recorded as the time of the first set of brain stem death tests, not the second as indicated here. The majority of chapters are concerned with transplantation of specific organs and the editors intend that these should be regarded as free-standing monographs. This has strengths and weaknesses. The standard, and the level of detail, is variable. All include some background on the disease processes, patient selection and the surgical procedure. Most of the authors describe the anaesthetic technique of their own institution and the reader might be best advised to regard these as one way of doing it rather than the way of doing it. Inevitably, perhaps, many statements are not supported by evidence. Several of the authors give their own views on management of the organ donor, some of which contradict the chapter devoted to the subject. I would have preferred a rather more robust editing. The chapters on liver transplantation are particularly good. That on the kidney, which might be expected to be the most widely read, would be better with less anecdote, a more focused approach and more justification for specific therapies advocated. Anaesthesia and intensive care are treated separately for the heart, heart–lung, lung and liver. They might have been better combined, since there is often a degree of repetition and it is unlikely one will be read without the other. There are specific chapters devoted to paediatric heart, lung, liver and bone marrow transplantation. Pancreatic and intestinal transplant are also covered. The final chapters again return to general issues that should be of widespread interest: infection, long-term outcome, anaesthesia for patients with a transplanted organ and, finally, the future of organ transplantation. Who is this book for? Organ transplantation is no longer experimental but it is confined to a relatively small number of centres. Anaesthetists outwith these centres are increasingly called upon to care for patients with transplants, however, as they present with other conditions. This book provides a good overview for them and for trainees. It is well indexed and illustrated but the most recent reference is from 1997 and those already familiar with the field will probably find little that is new.