Critical pathway for deceased donors: An analysis in three regions of Colombia / Ruta crítica de donantes fallecidos: un análisis de tres regiones en Colombia

Introduction. The critical pathway for deceased donation offers a methodical framework for guiding the donation process. It not only serves to assess performance but also to identify areas of potential improvement. Therefore, the identification and selection of potential organ donors (POD) is a key process. This study aims to describe the critical pathway for deceased donation in a cohort of POD in three regions (CRT1, CRT2, and CRT5) of Colombia. Methods. We retrospectively reviewed data of POD assessed from January 2022 to December 2022. General characteristics of POD, diagnosis, contraindication causes, and organ procurement were described. Analysis was conducted using the Chi-squared test for categorical variables and the Mann-Whitney test for quantitative variables. Results. Within the cohort of 1451 assessed POD, 441 (30.3%) were diagnosed with brain death. Among potential donors after brain death, 198 (44.9%) were eligible donors (medically suitable). Of these, 157 donors (79.3%) became actual donors (undergoing operative incision for organ recovery), with 147 (93,6 %) having at least one organ recovered (actual donors with organ recovery). Ultimately, 411 utilized organs were utilized. Additionally, there were observed differences in the characteristics of donors from different regions. Conclusion. This study reports the critical pathway for deceased donation in a cohort of POD in three regions of Colombia. This provides useful information and helps to gain insight and understanding into the process of organ donation and organ procurement in order to take actions that could improve the donation rates.

Introducción. La ruta crítica de donantes fallecidos permite un enfoque sistemático para la donación de riñón, y, proporciona una herramienta para evaluar el rendimiento de áreas de mejora potencial. La selección de posibles donantes de órganos (PDO) es un proceso clave. El objetivo de este estudio fue describir la ruta crítica para la donación de fallecidos en una cohorte de PDO en tres regiones de Colombia. Métodos. Estudio retrospectivo de PDO evaluados durante 2022. Se describieron las características generales de los PDO, el diagnóstico y las causas de contraindicación. El análisis se llevó a cabo utilizando la prueba de Chi-cuadrado para las variables categóricas y la prueba de Mann-Whitney para las variables cuantitativas. Resultados. Entre los 1451 POD evaluados, 441 (30,3 %) fueron diagnosticados con muerte cerebral. De los posibles donantes después de la muerte cerebral, 198 (44,9 %) fueron donantes elegibles (adecuados desde el punto de vista médico). Entre ellos, 157 donantes (79,3 %) fueron donantes reales (en quienes se realizó una incisión operatoria con la intención de recuperar órganos) y 147 (93,6 %) tuvieron al menos un órgano recuperado (donantes reales con recuperación de órganos). Finalmente, se identificaron 411 órganos utilizados. Conclusión. Este estudio reporta la ruta crítica para la donación de fallecidos en una cohorte de POD en tres regiones de Colombia. Esto proporciona información útil, ayuda a obtener conocimientos y comprender el proceso de donación y obtención de órganos, para tomar medidas que puedan mejorar las tasas de donación.

The question of death criteria in human organ donation / 器官移植

Donation after death is the most important ethical principle to carry out organ donation after citizens’ death. The newly-revised <i>Regulations on Human Organ Donation and Transplantation</i> does not define death, and avoids the key question of “whether to recognize brain death”. Certain legal risks or damages to the rights and interests of donors may exist in organ donation. Death is an inevitable part of human life. It is necessary to establish specific criteria, which is also the only approach, to define death in any era. Death criteria are established based on the view of death, and restricted by the development level of productive forces and other social factors. The determination of death criteria hugely varies between China and the West. To standardize organ donation and transplantation and promote high-quality development of organ donation, medical staff must adhere to the principle of pure motivation, take informed consents as the premise, respect the donors' and their close relatives' rights to choose their own death criteria, strictly follow the death judgment procedures and operating norms, and ensure the scientificity, accuracy and fairness of death determination.

Preliminary experience of robotic-assisted kidney transplantation in a single center / 器官移植

<b>Objective</b> To evaluate the safety, effectiveness and feasibility of robotic-assisted kidney transplantation (RAKT). <b>Methods</b> Clinical data of 16 patients who underwent kidney transplantation were collected. Among them, 8 recipients received RAKT (RAKT group) and 8 cases underwent open kidney transplantation (OKT) with the contralateral kidney from the same donor (OKT group). Perioperative status and the recovery of renal allograft function were compared between two groups. <b>Results</b> All patients successfully completed the surgery. In the RAKT group, no patient was converted to open surgery. The operation time in the RAKT group was longer than that in the OKT group (<i>P</i>=0.015). No significant differences were observed in the serum creatinine levels before surgery and upon discharge between two groups (both <i>P</i>>0.05). In the OKT group, one recipient developed delayed graft function (DGF), and the remaining recipients did not experience perioperative complications. No significant difference was noted in the short-term recovery of renal allograft function between two groups (<i>P</i>>0.05). <b>Conclusions</b> Postoperative recovery of the recipients in the RAKT group is equivalent to that of their counterparts in the OKT group. RAKT is a safe and effective procedure for the team expertise in kidney transplantation.

Ethical research of incentive policies for organ donation after citizen’s death / 器官移植

In recent years, with the rapid development of organ donation after citizen’s death and transplantation, central and local governments in China have successively released incentive policies. To protect the legitimate rights and interests of organ donors after citizen’s death and their families, current status of incentive policies for organ donation after citizen’s death was illustrated and analyzed from the perspective of ethics. Combining with the principles of justice, respect for autonomy, nonmaleficence and beneficence, the problems existing in the implementation of incentive policies for organ donation after citizen’s death were identified in China, such as lack of continuous psychological intervention in spiritual incentives, the misinterpretation of humanitarian assistance in practice and the impact of indirect economic incentives on individual donation autonomy, <i>etc</i>. Relevant countermeasures and suggestions were proposed at the government, society and individual levels, aiming to provide reference for improving the incentive policies for organ donation after citizen’s death and accelerate the development of organ donation in China.

Opportunities and challenges of marginal donor liver / 器官移植

With persistent breakthrough and maturity of surgical procedures and postoperative immunosuppressive therapy, the survival rate of liver transplant recipients and grafts has been significantly increased. The shortage of donor liver has become the main obstacle for clinical development of liver transplantation. How to expand the source of donor liver has become an urgent issue. Groundbreaking progresses have been made in the use of common marginal donor livers in clinical liver transplantation, such as elderly donor liver, steatosis donor liver, viral hepatitis donor liver and liver from donation after cardiac death. Nevertheless, multiple restrictions still exist regarding the use of marginal donor liver. Consequently, the definition of marginal donor liver and research progress in the application of common marginal donor livers were reviewed, and the opportunities and challenges of mariginal donoor liver were illustrated, aiming to provide reference for expanding the donor pool for clinical liver transplantation and bringing benefits to more patients with end-stage liver disease.

Clinical characteristics and current status of organ donations and Organ Procurement Organizations in foreign countries / 中华器官移植杂志

Organ transplantation has been an important means of rescuing the lives of end-stage patients with organ failure. However, an acute shortage of donor organs has become a common dilemma for organ transplantation all over the world so as to seriously restrict the development of organ transplantation. Many foreign countries have established a relatively mature organ donation system to foster favorable conditions for alleviating a shortage of donor organs. This review summarized the global measures and current domestic efforts of facilitating organ donation to provide theoretical rationales for further optimizing organ donations and transplantation system in China.

Research on the necessity and program design of the development of an ethical review information system for organ donation and transplantation / 中国医学伦理学

Currently， the ethical review model for organ donation and transplantation in domestic hospitals is generally characterized by suddenness， unpredictability， tight time， difficulty in convening meetings and training committee members， as well as generally low quality and efficiency of ethical review， which cannot meet clinical needs and cause the waste of some scarce resources. The team of the Clinical Application Center of Human Organ Transplantation and the Ethics Committee of the First People’s Hospital of Kunming combine more than 10 years of review practice experience， as well as continuously explore and optimize the ethical review process and operating procedures for organ donation and transplantation. The special application has been approved and jointly developed with Soochow University and the Medical Ethics Committee of Fujian Province to build a full-process information software system management platform for organ ethical review of donation and transplantation， giving the full play the advantages of the review information system in improving work efficiency and review quality， facilitating full-process information management， and conducting online training and learning for committee members， with a view to providing a specialized practical model for addressing the difficulties and challenges related to ethical review of human organ donation and transplantation.

Interpretation and reflection on the Regulations on Donation and Transplantation of Human Organs / 中国医学伦理学

The Regulations on Donation and Transplantation of Human Organs were issued on December 14， 2023. It was interpreted in terms of improving the human organ donation system and clarifying the responsibilities of the Red Cross Society； adding a new system for the acquisition and distribution of human organs， emphasizing the independence of the organ acquisition department， and implementing the priority right of organ distribution； strengthening the management of human organ transplantation， strictly limiting the scope of recipients of living organ transplantation； and regulating the operation of the ethics committee for human organ transplantation and stepping up the crackdown on violations of the regulations. This paper then considered how to implement and improve incentives for human organ donation， including the implementation of the priority rights of organ donors and their close relatives， the improvement of the organ donation compensation system， and the establishment of a humanitarian assistance system； the implementation of a system for the acquisition and distribution of organ donation organization； the acceleration of the construction of the personnel team of the organ acquisition organization； the increase of efforts to advocate and mobilise； and the enhancement of the construction of the ethics committee for human organ transplantation. The Regulations on Donation and Transplantation of Human Organs help to give fuller play to the enthusiasm and creativity in the field of organ transplantation， and all departments should revise the systems and administrative rules relating to human organ donation and transplantation in time， so as to facilitate the work of donation and transplantation of human organ.

Explicit consent or presumed consent： a confucian ethics review of the system for organ donation consent / 中国医学伦理学

At present， the system for organ donation consent in the world can be divided into two types based on the degree of initiative of consent， including explicit consent and presumed consent. The presumed consent system is more conducive to improving the organ donation rate than the explicit consent system， but the cultural adaptability of presumed consent in China is noteworthy. By examining the explicit consent system according to the ethical thoughts of Mencius， Xunzi， and the Confucian concept of body ethics， it can be found that the system of presumed consent is more consistent with the Confucian ethical concept of an ideal society than the explicit consent system. However， when implementing the policy of presumed consent， it is still necessary to pay attention to the influence of Confucian ethics， ensure gradual and incremental progress， and ensure the informed consent of donors.

Ethic analysis of the role of incentive system in the organ donation after citizen’s death / 器官移植

Organ transplantation has demonstrated its significant values by its excellent effectiveness in health reconstruction and life survival, where organ donation is a major component in promoting the development of organ transplantation in China. In recent years, an important progress has been made in organ transplantation in China with an annually increased organ donation rate. In spite of this, there is a serious fact confronted by us that the donated organ quantity is insufficient, which may be solved by further improvement of medical science and public health policy. According to the international experience, an incentive system may improve the organ donation rate effectively although the hidden ethic property of the incentive system itself may have an essentially conflict with the altruism contained in the organ donation. Therefore, in this article, the property of the incentive system, the interaction between organ donation and incentive system and the ethic justification of the system was reviewed, aiming to provide a reference for the further development of the organ donation and transplantation business in China.

Progress in quality management and control of donor organ procurement in foreign countries / 器官移植

Since the 20th century, organ transplantation has become a breakthrough technology to effectively save the lives of patients with end-stage organ failure, which has significantly enhanced the quality of life of patients. Organ donation is an important source of organ transplantation. Improving the quality of donor organ procurement is the key to promote the translation of donor organs and improve the prognosis of organ transplantation recipients. The United States, Spain and other countries have put forward a series of policies and standards in the quality management and control of donor organ procurement and achieved positive results. In this article, related concepts of medical quality management and control, advanced strategies and models of international donor organ procurement quality management, and quality control measures of Organ Procurement Organization, donors and donor organs were reviewed, aiming to provide reference for establishing a quality management and control system of donor organs with "Chinese characteristics" and advancing high-speed and high-quality development of donor organ procurement.

Organ Donation in the New Era under the Influence of Traditional Culture / 中国医学伦理学

The "Chinese model" of organ donation and transplantation in China has gradually been praised by the world. However, the shortage of organ is still the biggest difficulty at present, so it is urgent to improve the organ donation rate among the public and the number of individual organ donations. Through combing and analyzing some important values in Chinese traditional culture, this paper tried to help today’s organ donation find an appropriate value guidance, in order to promote the development of organ donation and transplantation in China.

Qualitative Study on the Cognition Status of Organ Donors’ Family Members to Advance Care Planning / 中国医学伦理学

Discussing the cognition, attitude and influencing factors of the family members of organ donors towards advance care planning (ACP) to provide a basis for the further promotion of ACP in the field of organ donation. Using qualitative research methods, 8 family members of organ donors were selected purposefully for semi-structured interviews, and the 7-step of Colaizzi was used to analyze and summarize the themes of the interview data. The results showed that the cognition status of the family members of organ donors of ACP could be summarized into 3 themes: problems faced by ACP implementation, positive recognition of the implementation of ACP, factors affecting the promotion of ACP. Organ donors’ family members are unfamiliar with the concept of ACP and have unclear cognition, but think that the implementation of ACP is of positive significance. It is suggested to further strengthen the publicity of ACP, medical autonomy, death education, so as to promote the development of ACP and improve the willing to donate organ.

Ethical Thoughts on the Quality Evaluation of the Kidneys from Expanded Criteria Donors / 中国医学伦理学

In the case of extremely shortage of donor kidney sources, the number of Expanded Criteria Donors (ECD) with relatively poor kidney quality and transplantation effect is increasing. In order to alleviate the contradiction between supply and demand by using transplantable kidneys as much as possible and avoid the failure or poor effect of transplantation caused by poor quality kidneys, the quality assessment and evaluation criteria of ECD kidney have become a research hotspot in the field of kidney transplantation. This paper analyzed the possible ethical defects in the research process, and put forward some suggestions for the transplantation team to strictly follow the ethical principles of "no harm", "beneficial" and "informed consent", and the organ transplantation ethics committee to pay attention to the ethical review of the quality evaluation process of ECD donor kidney.

Discussion on Difficulties of Ethical Review of DCD Organ Donation and Transplant based on Cases / 中国医学伦理学

The ethics committee of organ transplantation technology and clinical application in a hospital has encountered some difficulties and typical cases in its review work and practice for many years. Sometimes, it is difficult to make a decision in these dilemmas. Based on the previous experience of the hospital in the ethical review of organ donation and transplantation, combined with two typical cases, this paper discussed and analyzed two review points of whether the voluntary unpaid donation and the principle of informed consent were met, and whether the risk-benefit ratio was reasonable, and put forward relevant ethical and legal countermeasure for further research by institutional ethics committees and other parties, in order to provide reference for discussing the practical problems and ethical confusion of ethical review of organ donation and transplantation.

Experience and Reflection on the Ethical Review of Organ Donation and Transplantation after Citizens’ Death in Medical Institution / 中国医学伦理学

In order to explore the ethical review experience of organ donation and transplantation after the death of citizens, and provide reference value for medical institutions to carry out corresponding ethical review. By using descriptive research, purpose sampling method and the principle of data saturation, 10 members and secretaries of ethics committee on clinical application of organ transplantation technology were finally selected as respondents for semi-structured interviews. The Colaizzi 7-step analysis method was adopted to analyze, summarize and refine the theme. The results showed that the ethical review experience of organ donation and transplantation after the death of citizens included four themes: the responsibilities of ethics committee, the key points of ethics review, the form of ethics review conference and its advantages and disadvantages, and the construction of the ethics committee of organ transplantation. Therefore, there are defects in the ethical review of organ donation and transplantation in medical institutions at present. These can be remedied by enriching elements of the ethical review following the four principles of medical ethics, refining the laws related to organ donation after citizens’ death, constructing a reasonable and efficient pattern of ethical review conference, and establishing a robust and appropriate operation mode of organ transplantation ethics committee.

Capacity Building of Ethical Review of Organ Transplantation Ethics Committee in China / 中国医学伦理学

The construction of clinical application and ethics committee of human organ transplantation technology is constantly improving in China. The review of clinical application and ethics committee of human organ transplantation technology should follow the principle of prudence, with high requirements for timeliness and cumbersome preparation, and living organ transplantation needs to weigh the risk benefit ratio of both donors and recipients. According to the problems often existing in China’s clinical application and ethics committee of human organ transplantation technology, such as lack of supervision and guidance, lack of unified standard operating procedures, insufficient attention to the rights and interests of organ donors after citizens’death, the difficulties to judge and implement of brain death, lack of psychological assessment requirements and procedures, inadequate informed consent, etc. It can be solved from the following aspects: ensuring the independence of ethical review, strengthening the risk benefit ratio assessment of both donors and recipients of living organ transplantation, standardizing the review content, strictly implementing informed consent and medical psychological assessment to reduce the risks of both sides, enriching review methods to ensure timeliness, and strengthening the ethical review and supervision of organ donation.

Effects of three rehydration methods on prevention of on-site and delayed blood donation-related vasovagal responses: a cluster-randomized trial / 中国输血杂志

【Objective】 To compare the effects of 3 rehydration methods before blood donation on the prevention of on-site and delayed blood donation-related vasovagal response (VVR) . 【Methods】 From January to June 2021, 6 250 whole blood donors in 6 fixed blood donation sites signed informed consent and were divided into 198 clusters according to donor sites and dates, then they were randomly assigned to receive either oral rehydration salts (ORS), sugar water, or water group, and each drank 500 mL of ORS, sugar water or water within 20 minutes before blood donation. The researchers recorded the actual intervention accepted on site, and recorded the immediate VVR and related information. At rest after blood donation, donors submitted an electronic questionnaire containing socio-demographic information. At 48 hours after blood donation, the researchers called back every donor to record delayed VVR and related information. Logistic regression based on intention to treat (ITT) was used to analyze the difference of the incidence of VVR among the three groups, and the average treatment effect on treated (ATT) was calculated. PASS 2021was used to estimate the sample size and R (4.2.0) for statistical analysis. 【Results】 The cumulative incidence of blood donation-related VVR was 2.67% (2.29%-3.11%) among street whole blood donors under the 3 rehydration methods, in which, the incidence of immediate and delayed VVR was 1.02% (0.79%-1.31%) and 1.65% (1.36%-2.01%) respectively. ITT analysis found that ORS were more effective than water in reducing the incidence of delayed VVR【OR=0.59,95% CI[0.37,0.94]】.There was no significant difference in the incidence of immediate VVR between any two groups (P > 0.05), and there was no significant difference in the incidence of delayed VVR in the sugar water group compared with the water group (P > 0.05). There was a difference of -0.013 (【95% CI[-0.022, -0.004]】or -0.008【95% CI[-0.017, -0.000]】in the incidence of delayed VVR in the ORS group compared with water group or sugar water group, the difference was significant (P<0.05). The cumulative VVR of the three groups showed similar results to the delayed VVR. 【Conclusion】 Drinking ORS before blood donation is the most effective rehydration method to prevent delayed VVR. The next step is to establish the predictive model of delayed VVR to screen the susceptible population and provide them with ORS before blood donation, while other population can choose any liquid they like, thus achieving personalized blood donation-related VVR prevention and control.

Confidential unit exclusion in Guangzhou from 2009 to 2022 / 中国输血杂志

【Objective】 To investigate the condition of confidential unit exclusion(CUE) in Guangzhou, so as to ensure blood safety. 【Methods】 The number of CUE donors, demographic characteristics of CUE donors, reasons for CUE, and response time of CUE after blood donation in Guangzhou from 2009 to 2022 were statistically analyzed. 【Results】 From 2009 to 2022, the response ratios of CUE was 0.006 2% (260/4 170 984) and the ratios had statistically significant difference between different years(P0.05), but statistically significant differences were found in age, number of blood donations, education background, and marital status (P<0.05). Blood donors aged 18~30 (0.007 3%, P<0.05) and first-time blood donors (0.010 8%, P<0.05) were the main groups of CUE. High risk sexual behavior (28.46%, 74/260) was the primary reason for CUE. The CUE response peak was within 72 hours after blood donation, and the response ratios within 24-72 hours after blood donation was the highest (68.46%, 178/260). 【Conclusion】 CUE is a crucial measure to ensure blood safety. Detailed pre-donation health consultations are suggested for blood donors aged 18-30 and first-time blood donors so as to better excluding high-risk blood donors. Strengthening the publicity of CUE response and process, registering and classifying the reasons for CUE are also important.

Model of "One Core, Multiple Elements" emergency blood donation volunteer team: a case study of Nanjing city / 中国输血杂志

【Objective】 To explore the model of "One Core, Multiple Elements" emergency blood donation volunteer team (referred to as the Model) . 【Methods】 The Nanjing City Voluntary Blood Donation Joint Meeting serves as the core, with diverse entities including party committees, government departments, district governments, social organizations, enterprises, blood donors, etc. Following the principles of "emergency response in emergencies, wartime readiness, combining regular and wartime efforts," and adhering to the framework of the Model, the emergency blood donation volunteer team system in Nanjing was constructed. 【Results】 1) After the construction of the Model (2018—2022), the total number of emergency blood donation volunteers in Nanjing City increased by 191% compared to the pre-construction period (2013—2017), with an average annual blood donation of 20 929, showing significant differences (P<0.05). 2) After the construction of the Model, the number of emergency blood donation during the winter and summer increased by 206% and 185%, respectively, compared to the pre-construction period, demonstrating significant differences (P< 0.05) .3) Prior to the construction of the Model, Nanjing lacked a relatively stable emergency volunteer team. After the construction, Nanjing established a total of 5 relatively stable volunteer teams, with the district-level government and township personnel accounting for the highest proportion (52.96%), followed by medical personnel (23.95%), enterprise team (11.10%), State-owned Assets Supervision and Administration Commission team (7%), and Nanjing municipal government team (4.98%). 4) Following the Model, during the COVID-19 pandemic, Nanjing successfully initiated two Level Ⅱ blood emergency responses, with emergency blood donations reaching 23 041. 【Conclusion】 The Model can effectively ensure the blood supply in Nanjing region during emergencies.