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.

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.

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.

Exploration on ethical pathways for organ donation:a new perspective of comprehensive incentive model: / 中国医学伦理学

Conducting an in-depth analysis and research in the field of global organ donation by reviewing and integrating the recently published work Incentives and Obstacles in Organ Donation:A Multicultural Study among Beijing,Chicago,Tehran,and Hong Kong.This book provided an in-depth analysis of challenges and opportunities in the ethical,cultural,social,and legal of organ donation around the world.Through meticulous analysis and comparison of incentive models in different cultural contexts,the aim was to provide a more comprehensive understanding framework.By examining cases from Beijing,Chicago,Tehran,and Hong Kong,it explored incentive models for organ donation in various regions,such as honor incentives,compensatory incentives,and family incentives,revealing their effectiveness and limitations.This book particularly emphasized the uniqueness and challenges faced by the incentive models for organ donation in various cultural and social contexts,and advocated the adoption of comprehensive incentive strategies and customized policies based on different cultural backgrounds.Additionally,it also proposed recommendations for future research and policy formulation.This work not only provided profound insights into the field of medical ethics,but also provided important theoretical support for the improvement of organ donation policies worldwide.

Analysis of clinical maintenance effect of 76 organ donors / 中国现代医生

@#Objective By analyzing the means of donor maintenance from the perspective of intensive care medicine,the difference of clinical indicators before and after donor treatment is obtained,summarizing the treatment experience and effect of clinical maintenance of donor donors,and providing more clinical evidence for the maintenance and treatment of organ donation donors.Methods A retrospective analysis was performed on 76 organ donors collected from the Department of Intensive Care Medicine,Army Medical Center,Chinese People's Liberation Army from January 2014 to December 2021,collected donor maintenance treatment,including mechanical ventilation,continuous renal replacement therapy(CRRT)treatment,enteral nutrition and parenteral nutrition,enteral and parenteral nutrition,plasma exchange,at the same time,the paired t test was used to compare the organ function before and after treatment.Results The lung,liver and kidney of 76 donors were evaluated before and after treatment to determine the number of eligible donors.The difference between the number of eligible donors of kidney and liver before and after treatment was statistically significant(P<0.05).There was no significant difference in lung evaluation(P>0.05).Conclusion Timely and effective organ support therapy for organ transplantation donors is beneficial to the recovery of organ function and improve the utilization rate of organ.

Clinical outcome of kidney transplantation from DBD donors complicated with acute kidney injury / 器官移植

Objective To evaluate the clinical outcome of kidney transplantation from donation after brain death (DBD) donors complicated with acute kidney injury (AKI). Methods Clinical data of 216 DBD donors were retrospectively analyzed, and they were divided into the AKI group (n=69) and control group (n=147) according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Donors in the AKI group were further divided into the KDIGO stage 1 and stage 2-3 subgroups. One hundred and thirty-five recipients were assigned into the AKI group and 288 recipients in the control group. Postoperative recovery of renal function and clinical outcomes of the recipients were recorded. The risk factors of delayed graft function (DGF) were identified. Results The highest serum creatinine (Scr) level, Scr level before procurement, the highest blood sodium level and blood sodium level before procurement in the AKI group were higher than those in the control group. The application duration of vasopressors in the AKI group was longer than that in the control group. In the AKI group, the amount of fluid resuscitation within 48 h was higher, the HCO3− level at admission was lower, and the incidence of diabetes insipidus and hypotension was higher than those in the control group. The highest Scr level and the Scr level before procurement in KDIGO stage 2-3 donors were significantly higher than those in KDIGO stage 1 counterparts (all P<0.05). Compared with the control group, the incidence of DGF and acute rejection was higher, the proportion of continuous renal replacement therapy was higher, the Scr level within postoperative 90 d was higher, and the urine amount within postoperative 3 d was less than those of recipients in the AKI group. Compared with KDIGO stage 1 recipients, KDIGO stage 2-3 recipients had higher Scr levels at postoperative 3, 4, 5 and 15 d, and less urine amount at postoperative 2 d (all P<0.05). Univariate analysis showed that donor age, the highest Scr level, the highest blood sodium level and the amount of fluid resuscitation within 48 h were the risk factors for DGF in recipients after kidney transplantation. Multivariate analysis showed that donor age was the independent risk factor for DGF in recipients after kidney transplantation (all P<0.05). Conclusions For the application of DBD donors complicated with AKI, active organ maintenance should be performed to alleviate AKI. It exerts no effect upon graft function and survival rate at postoperative 6 months, which may achieve equivalent efficacy as non-AKI donors and may be used as a source of extended criteria donor kidneys.

Conhecimento, desejo e atitude de estudantes de Medicina e Enfermagem sobre a doação de órgãos / Knowledge, attitudes and willingness to donate organs among Medical and Nursing students

Resumo Introdução: A necessidade crescente de doadores de órgãos e de profissionais capacitados impulsiona novos estudos que esclareçam o entendimento e comportamento da sociedade perante a doação de órgãos. Estudantes de saúde vêm sendo alvo de estudos por seu influente papel social e, além disso, quando formados, farão parte de etapas fundamentais da doação. Contudo, evidencia-se conhecimento insuficiente dos estudantes apesar de possuírem atitude positiva. Objetivo: Este estudo teve como objetivo avaliar o grau de conhecimento, desejo e atitude perante as doações de órgãos entre os acadêmicos de Medicina e Enfermagem na cidade de Recife, em Pernambuco. Método: Trata-se de um estudo transversal realizado a partir da análise de questionários respondidos por estudantes de Enfermagem e Medicina nos últimos períodos acadêmicos. Além de dados demográficos, os estudantes foram questionados quanto ao entendimento sobre aspectos da validação de possível doador, diretrizes do protocolo de morte encefálica, motivações e opções pessoais em relação à doação de órgãos. Resultado: De fevereiro a dezembro de 2022, 218 questionários foram coletados, dos quais 208 entraram para a amostra. Dentre os estudantes, 57,2% eram do sexo masculino, a média de idade foi de 24 ± 2,7 anos. Dos graduandos, 85,1% cursavam Medicina, e 14,9%, Enfermagem. Apenas 49% dos estudantes sabiam da não necessidade de neurologista para o diagnóstico de morte encefálica. Ademais, 63% não sabiam quem é o responsável por abordar a família do potencial doador. Grande parte dos acadêmicos já considerou a possibilidade de ser doador de órgãos, representando 92,3% do total de estudantes avaliados. Dos alunos, 67% afirmaram já ter conversado com as próprias famílias sobre a doação de órgãos e que elas conheciam essa decisão. Em caso de familiar apresentar diagnóstico de morte encefálica, 83,2% dos alunos consentiram a doação. Em relação aos possíveis benefícios materiais ou emocionais para a família do doador, 86,1% julgam que a doação de órgãos pode trazer algum benefício. Conclusão: Apesar da atitude positiva, o estudo evidenciou conhecimento insuficiente dos alunos, reforçando a necessidade de ampliação do currículo das universidades e criação de cadeiras direcionadas à aquisição de conhecimento e habilidades quanto à condução de casos de morte encefálica e atuação perante os potenciais doadores.

Abstract Background: The increasing demand for organ donors and proficient experts is prompting fresh research endeavors aimed at clarifying societal perceptions and actions related to organ donation. Students from the healthcare area have been a focal point in these studies. Despite their favorable attitudes, a notable gap in knowledge among students has been underscored. Objective: To assess the level of knowledge, willingness, and attitudes toward organ donation among medical and nursing students in the city of Recife, Brazil. Methods: A cross-sectional investigation was undertaken, involving the examination of questionnaires that were answered by medical and nursing students during their last academic years. Results: Between February and December 2022, a total of 218 questionnaires were gathered, of which 208 were included in the final sample. Among the participants, 57.2% identified as male, with an average age of 24 ± 2.7 years. In terms of academic background, 85.1% were enrolled in medical school, while 14.9% were attending nursing school. A notable observation was that only 49% of the students were aware that the diagnosis of brain death does not necessarily require the involvement of a neurologist. Furthermore, a significant proportion of students (63%) were unfamiliar with the entity responsible for initiating discussions with the potential donor's family. Interestingly, 92.3% of the students had contemplated the prospect of becoming organ donors themselves. If a family member were diagnosed with brain death, a significant majority of students, specifically 83.2%, expressed their willingness to grant consent for organ donation. Conclusions: Despite the positive attitudes, this study revealed insufficient knowledge among students, thereby underscoring the need for universities to expand their curricula and establish courses aimed at acquiring knowledge and skills related to brain death cases and actions related to potential donors.

Perception of college-going girls towards corneal donation in North India: A latent class analysis study

Purpose: To assess the perception of college?going girls toward corneal donation in Northern India. Methods: An online survey with a pre?structured, pre?validated questionnaire was conducted on 1721 college?going girls in Northern India. The knowledge and attitude scores were regressed, and latent class analysis was carried out. Results: The average of scores for all participants was computed individually for the knowledge questions and the attitude questions, and based on this score, total participants were divided into two groups: Better corneal donation behaviors (BCDB) and poor corneal donation behaviors. The binomial logistic regression model of knowledge domain for predicting BCDB, age of the participant, their awareness about corneal donation, and willingness to discuss eye donation among family members were found significant. Similarly, for the attitude domain, awareness about corneal donation, knowledge about hours within which ideal eye donation needs to be undertaken, and knowledge about eye donation during coronavirus disease 2019 (COVID?19) pandemic were found to be significant. Latent class analysis identified one subset of participants having poorer knowledge and attitude scores and that they were more from a rural background, were having more than first order as birth order, were belonging to SC/ST classes, had illiterate or secondary education of father and mother, and were living in rented houses. Conclusion: The findings of the study significantly contribute to devising a mechanism to improve knowledge and influencing the attitude about eye donation among the youth, especially young women, who can act as counselors and motivators for the masses as well as their own families, in the generations to come.