Left lobe living donor liver transplantation using the resection and partial liver segment 2-3 transplantation with delayed total hepatectomy (RAPID) procedure in cirrhotic patients: First case report in Korea.

In liver transplantation, the primary concern is to ensure an adequate future liver remnant (FLR) volume for the donor, while selecting a graft of sufficient size for the recipient. The living donor-resection and partial liver segment 2-3 transplantation with delayed total hepatectomy (LD-RAPID) procedure offers a potential solution to expand the donor pool for living donor liver transplantation (LDLT). We report the first case involving a cirrhotic patient with autoimmune hepatitis and hepatocellular carcinoma, who underwent left lobe LDLT using the LD-RAPID procedure. The living liver donor (LLD) underwent a laparoscopic left hepatectomy, including middle hepatic vein. The resection on the recipient side was an extended left hepatectomy, including the middle hepatic vein orifice and caudate lobe. At postoperative day 7, a computed tomography scan showed hypertrophy of the left graft from 320 g to 465 mL (i.e., a 45.3% increase in graft volume body weight ratio from 0.60% to 0.77%). After a 7-day interval, the diseased right lobe was removed in the second stage surgery. The LD-RAPID procedure using left lobe graft allows for the use of a small liver graft or small FLR volume in LLD in LDLT, which expands the donor pool to minimize the risk to LLD by enabling the donation of a smaller liver portion.

[Analysis of causes of death and etiological characteristics of skin tissue donors].

Objective: To investigate the causes of death and etiological characteristics of skin tissue donors, and to provide reference for allogeneic skin transplantation. Methods: From October 2008 to October 2018, 49 skin tissue donors accepted by the Burn Department of Wuhan Third Hospital met the inclusion criteria of this study, and a cross-sectional study was conducted. According to the cause of death, the donors were divided into accidental death group (19 cases) and non-accidental death group (30 cases). The sex and death age of 49 donors were recorded, and the death age between different sex donors and that of donors between accidental death group and non-accidental death group were compared. Diseases or circumstances that caused the death of donors, hepatitis B, hepatitis C, acquired immunodeficiency syndrome, syphilis virus carrying status, and peripheral blood microbial culture results of 49 donors were recorded, and the detection of blood-borne infectious risk factors of donors between accidental death group and non-accidental death group was compared. Abnormal skin tissue was also selected during allogenic skin graft preparing for pathological examination. Data were statistically analyzed with Mann-Whitney U test and continuity correction chi-square test. Results: (1) Out of the 49 donors in this group, 38 were male (77.55%) and 11 were female (22.45%). The death age was 42.00 (24.00, 55.00) years, and the death age of male donors was similar to that of female donors (Z=0.120, P>0.05). The death age of donors in accidental death group was lower than that in non-accidental death group, but the difference was not statistically significant (Z=-1.581, P>0.05). (2) Among the causes and circumstances of the 49 donors in this group, there were 19 cases (38.78%) of injury, poisoning, and some other consequences of external causes, 11 cases (22.45%) of circulatory system diseases, 9 cases (18.37%) of tumors, 3 cases (6.12%) of nervous system diseases, 2 cases (4.08%) of respiratory system diseases, and 2 cases (4.08%) of congenital malformation, deformation, and chromosome abnormality, 1 case (2.04%) of blood and hematopoietic organ diseases and some diseases related to immune mechanism, 1 case (2.04%) of digestive system disease, and 1 case (2.04%) of genitourinary system disease. (3) There were 9 donors (18.37%) with blood-borne infectious risk factors among the 49 donors in this group, including 8 cases (16.33%) of blood-borne infectious diseases, which were 5 cases (10.20%) of hepatitis B, 2 cases (4.08%) of syphilis, and 1 case (2.04%) of hepatitis C, respectively. Blood microorganism culture was positive in 1 case (2.04%), in which multi-drug resistant Pseudomonas aeruginosa was detected. Risk factors of blood-borne infection were detected in 2 donors in accidental death group, with detection ratio lower than that in non-accidental death group (7 cases), but the difference was not statistically significant (χ(2)=0.562, P>0.05). (4) A total of 8 donors' abnormal skin tissue were selected, including 4 cases of intradermal pigmented nevus, 1 case of scar, 1 case of pseudoepithelioma hyperplasia, 1 case of epidermal verrucous hyperplasia, and 1 case of large amount of pigment granules in dermis. Conclusions: Non-accidental death caused by diseases is the main cause of death of skin tissue donors, and the risk of donor-derived infection of non-accidentally dead donors is slightly higher than that of accidentally dead donors. Before the allogeneic skin is obtained and transplanted, the cause of death of the donor should be carefully investigated, and the health status should be evaluated, so as to avoid the occurrence of donor-derived infection.

Donación dirigida de sangre de Cordón Umbilical de Hermano Compatible en el Sistema de Salud Público de Chile / Directed sibling donor cord blood donation in the Chilean Public Health System

Resumen: Introducción: La sangre de cordón umbilical (SCU) como fuente para trasplante de células proge- nitoras hematopoyéticas (TPH) está bien establecida. Internacionalmente, menos del 10% de los TPH de SCU corresponde a donantes hermanos compatibles. Dentro de la red del Programa Infantil Nacional de Drogas Antineoplásicas (PINDA), existe desde enero 2004 un programa de donación dirigida de SCU para TPH. Pacientes y Método: Se diseñó un estudio observacional, retrospectivo, descriptivo, se revisaron el número y características de las unidades de SCU recolectadas en el PINDA y el número, características y evolución de los pacientes trasplantados con esas unidades entre enero de 2004 y octubre de 2018. Resultados: Sesenta unidades de SCU han sido recolectadas, de ellas 55 con registro completo. La mediana de volumen de las unidades almacenadas fue 74,8 ml (30,0-170,8), la mediana de células nucleadas totales 7,6 x 10e8 (2,0-21,1), mediana de células CD34+ 1,6 x 10e6 (0,2-11,6). Cuatro pacientes con leucemias de alto riesgo fueron trasplantados; mediana de segui miento es de 8 años. Todos desarrollaron complicaciones severas post TPH, uno de ellos falleció de recaída y los tres actualmente vivos presentan un Karnofsky/Lansky 100%. Conclusión: El programa ha permitido el trasplante de 4 pacientes que de otro modo no habrían tenido acceso a un donante. Este programa de donación dirigida puede ser considerado una primera etapa para el desarrollo de un banco público de sangre de cordón umbilical en Chile.

Abstract: Introduction: Cord blood (CB) as a source of Hematopoietic Stem Cells for Transplantation (HSCT) is well established. Worldwide, nonetheless, less than 10% of the CB HSCTs are performed with a match sibling donor. Since 2004, the Chilean National Childhood Cancer Program (PINDA) net work, has established a CB directed donation program for HSCT. Patients and Method: An obser vational, descriptive and retrospective study was designed to assess the number and characteristics of the CB units collected in the program as well as the number, clinical characteristics and follow-up of the patients who received an HSCT from those CB units between January 2004 and October 2018. Results: Sixty CB units have been collected; 55 of them with full records and stored. The median volume collected was 74.8 ml (30.0-170.8), the median number of total nucleated cells was 7.6 x 10e8 (2.0-21.1), and the median of CD34+ cells was 1.6 x 10e6 (0.2-11.6). Four high-risk leukemia patients received HSCT, all of them developed severe complications after transplantation and one patient died due to relapse. Those patients currently alive have a 100% Karnofsky/Lansky score. The median follow-up time was 8 years. Conclusion: The PINDA program has allowed 4 patients to be transplan ted who otherwise would not have had access to a donor. This directed donation program could be seen as a model for the development of a public cord blood bank in Chile.

Factores psicosociales influyentes en la actitud de estudiantes de medicina paraguayos hacia la donación de órganos / Influential psychosocial factors in the attitude of Paraguayan medical students towards organ donation

INTRODUCCIÓN: el trasplante de órganos es considerado el avance más significativo de la medicina moderna. Paraguay es uno de los países con las tasas más bajas de donación de órganos, alcanzando 7 donaciones por millón de personas. OBJETIVO: determinar los factores psicosociales que influyen en la actitud de estudiantes de Medicina paraguayos de una universidad pública hacia la donación de órganos. MATERIALES Y MÉTODOS: el estudio fue observacional analítico de corte transversal y muestreo no probabilístico por conveniencia entre abril a junio del 2017 en la Universidad Nacional de Asunción (Paraguay). RESULTADOS: los factores más frecuentes e influyentes fueron, un 37,6% (105) que manifestó informarse mediante Internet; consideran escasa la información sobre trasplantes en 61,6% (172); conscientes de la falta de órganos en 87,8% (245); aprobación de la donación pero sin estar registrados en las instituciones vinculadas por 86,37% (241). Asociación de estado civil, concepto de muerte encefálica y autopsia con la experiencia previa/favor/contra de la donación, alcanzaron valores significativos (p<0,05). CONCLUSIÓN: el estado civil, concepto de muerte encefálica y autopsia son factores influyentes y favorables en las actitudes sobre la donación en estudiantes de Medicina del Paraguay.

BACKGROUND: organ transplantation is considered the most significant advance in modern medicine. Paraguay is one of the countries with the lowest rates of organ donation, reaching 7 donators per million people. AIM: to determine the psychosocial factors that influence the attitude of Paraguayan medical students of a public university towards organ donation. METHODS: the study was cross-sectional analytical observational and non-probabilistic convenience sampling between April and June 2017 at the National University of Asunción (Paraguay). p<0.05 was considered as significant. RESULTS: 279 cases were analyzed; age rank between 18 and 30 years old (21.75 ± 2.12); female participation was greater 70.3% (196). The most frequent and influential factors were 37.6% (105) who reported being informed using the internet; 61.6% (172) consider information about organ transplant insufficient; they are aware of the lack of organ donators in 87.8% (245); they approve the organ donation, despite of being unregistered in the related institutions, about 86.37% (241). There is an association of marital status, concept of brain death and autopsy with previous experience / being in favor / being against donation (p<0.05). CONCLUSION: marital status, concept of brain death and autopsy are influential and favorable factors in attitudes about donation in medical students of Paraguay.

Trends in corneal transplantation from 2001 to 2016 in Brazil / Tendências no transplante de córnea de 2001 a 2016 no Brasil

ABSTRACT A retrospective and analytical study was conducted by using data from the National Transplantation System on 184,575 corneal transplantations performed between January 2001 and December 2016 in order to analyze thetrends in corneal transplantation from 2001 to 2016 in Brazil. The Cochran-Armitage test, analysis of variance, and Duncan's multiple comparisons were used to verify the existence of trends, compare the mean values between regions, and verify the mean differences, respectively. A significance level of 5% was used for all tests. The analysis showed that there was a 2.4-fold increase in the number of corneal transplantations (from 6,193 [35.2 per million people (pmp)] to 14,641 [71 pmp]; p<0.001), a 50.7% increase in the efficacy of meeting the population's demand for corneal transplantation (from 35.3% to 53.2%; p<0.001), an 11-fold increase in the number of corneal transplantation centers (from 32 to 356), and a 2.5-fold increase in the number of corneal transplantation teams (from 276 to 688) in Brazil during the period studied. The waiting list for corneal transplantation decreased by 45.4% (from 23,549 [123 pmp] to 12,865 [62.4 pmp]; p<0.001), and the corneal transplantation teams performed about 19 corneal transplantations per year. The best indices were observed in the southern, midwestern, and southeastern regions, and the worst indices were in the northern and northeastern regions. Brazil has been improving its capacity to perform corneal transplantation in the past 16 years, although this improvement varies across regions. However, the population's demand for corneal transplantation is yet to be satisfactorily met, primarily due to the low number of corneal donations.

RESUMO Estudo retrospectivo e analítico, baseado em dados do Sistema Nacional de Transplantes de 184.575 transplantes de córnea realizados no período de janeiro de 2001 a dezembro de 2016, com o objetivo de analisar as tendências do transplante de córnea no Brasil de 2001 a 2016. Os testes de Cochran-Armitage, análise de variância e comparações múltiplas de duncan foram realizados para verificar a existência de tendência, comparação de médias entre regiões e verificação da diferença média, respectivamente. Um nível de significância de 5% foi utilizado em todos os testes. No Brasil, houve um aumento: de 2,4 vezes no número de transplantes de córnea (de 6.193 [35,2 pmp] para 14.641 [71 pmp] - p<0,001); de 50,7% na eficácia de atender a demanda populacional de transplantes de córnea (de 35,3% para 53,2% - p<0,001); de 11 vezes no número de centros de transplantes de córnea (de 32 para 356); e de 2,5 vezes no número de equipes transplantadoras de córnea (de 276 para 688). A lista de espera para o transplantes de córnea diminuiu em 45,4% (de 23.549 [123 pmp] para 12.865 [62,4 pmp] - p<0,001). A produtividade das equipes de córnea ao longo dos anos foi de 19 transplantes de córnea ao ano. Os melhores índices foram apresentados nas regiões Sul, Cen tro-Oeste e Sudeste e os piores no Norte e Nordeste. O Brasil, embora de forma heterogênea entre as regiões, vem melhorando a capacidade de realizar o transplante de córnea nos últimos 16 anos, porém a demanda populacional por transplante de córnea ainda não é adequadamente atendida, principalmente devido ao baixo número de doações de córnea.

Análise crítica das diferentes fontes de dados sobre transplante de córnea no Brasil / Critical analysis of the different data sources on corneal transplantation in Brazil

Resumo As doenças da córnea são responsáveis por cerca de 4 a 5% da cegueira reversível no mundo. O transplante de córnea é o tecido mais transplantado em todo o mundo e o único tratamento amplamente aceito para promover a transparência corneana e restaurar a visão. O monitoramento incorporou-se ao campo da Saúde Pública, com o objetivo de acompanhar sistematicamente a atuação das equipes e os dados de produção, por meio da criação de normas, inspeções de avaliação periódicas e acompanhamento dos indicadores de qualidade. As análises críticas dos resultados objetivam apontar falhas e riscos envolvidos no processo, e empreender ações capazes de modificar os achados negativos, a fim de aprimorar a qualidade dos serviços prestados à população. No Brasil, existem diferentes fontes de dados sobre transplantes de córnea e bancos de tecidos oculares. Nesta revisão, foi avaliada a precisão dos dados e a confiabilidade das informações divulgadas pelo Sistema Nacional de Transplantes, pela Associação Brasileira de Transplante de Órgãos e pela Agência Nacional de Vigilância Sanitária sobre a situação do transplante de córnea no Brasil, a fim de nortear governos, gestores em saúde pública e pesquisadores.

Abstract Corneal diseases account for about 4 to 5% of reversible blindness in the world. Corneal transplantation is the most transplanted tissue in the world and the only widely accepted treatment to promote corneal transparency and restore vision. Monitoring was incorporated into the field of Public Health, with the objective of systematically monitoring teams' performance and production data, through the creation of norms, periodic evaluation inspections and monitoring of quality indicators. The critical analyzes of the results aim to point out flaws and risks involved in the process, and to undertake actions capable of modifying the negative findings, in order to improve the quality of the services provided to the population. In Brazil, there are different sources of data on corneal transplants and ocular tissue banks. In this review, the accuracy of the data and the reliability of the information disclosed by the National Transplant System by the Brazilian Organ Transplant Association and the National Sanitary Surveillance Agency on the situation of corneal transplantation in Brazil were evaluated in order to guide governments, public health managers and researchers.

Development of a Valid and Reliable Questionnaire to Identify Professional Opinion Regarding Organ Transplantation System.

BACKGROUND: Currently, the Nepalese law permits organ donation by an individual who falls into the category of a "close relative" of the recipient. There is a need for expansion of the live organ donor pool beside close relatives. Different systems of organ transplantation are followed by several countries and the professional opinions that underpin these systems need to be studied. OBJECTIVE: To generate a questionnaire related to different organ transplant systems and validate it so that it can be used to collect mass professional opinions. METHODS: Item generation, item reduction, item scaling, and pretesting were used to develop a questionnaire. The final version of the questionnaire was reviewed by experts for its content validity and then was used twice for participants at a 20-day interval to calculate Cronbach's alpha for testing its internal consistency and Intra-class correlation for testing its test and retest reliability. RESULTS: The questionnaire was found to be valid and reliable with an overall Cronbach's alpha of 0.701. Intra-class correlation scores for each question in both test and retest were correlated. CONCLUSION: A valid and reliable questionnaire was developed that can be used to collect mass professional opinions to assist policy makers to establish a better organ transplant system.

Doação de órgãos: tema bioético à luz da legislação / Organ donation: a bioethical issue in the light of legislation / Donación de órganos: tema bioético a la luz de la legislación

Resumo Objetivou-se analisar a opinião de profissionais de saúde que atuam no processo de doação e transplante de órgãos a respeito da implementação da Lei 10.211/2001, que regula o consentimento familiar para a doação de órgãos no Brasil. Trata-se de estudo qualitativo desenvolvido em hospital universitário do interior paulista. Os resultados mostram que a maioria dos profissionais de saúde concorda com o consentimento familiar para obtenção de órgãos para transplante. Contudo, há discordâncias quanto à forma de se obter esse consentimento. Conclui-se que são necessárias ações de conscientização urgentes direcionadas à população e a profissionais de saúde com relação à doação, buscando atingir o cumprimento efetivo da legislação e, sobretudo, aumentar substancialmente o número de órgãos disponíveis para transplante.

Abstract This study aimed to analyze the opinion of health professionals that work in the organ donation and organ transplant process regarding the implementation of Law 10,211/2001, which deals with family consent for organ donation in Brazil. It is a qualitative study conducted in a university hospital in the state of São Paulo. The results show that the majority of health professionals agree with family consent to obtain organs for transplantation. However, there is disagreement as to how to obtain this consent. The study concludes that it is necessary to promote urgent actions for awareness regarding donation amongst the public and health professionals, aiming to achieve compliance with the law, and, most of all, to increase the number of organs available for transplant.

Resumen Este estudio tuvo como objetivo analizar la opinión de los profesionales de la salud que trabajan en el proceso de donación y trasplante de órganos en relación a la aplicación de la Ley 10.211/2001, que se ocupa del consentimiento familiar para la donación de órganos en Brasil. Se trata de un estudio cualitativo realizado en un hospital universitario en el estado de São Paulo. Los resultados muestran que la mayor parte de los profesionales de la salud están de acuerdo con el consentimiento familiar para obtener órganos para trasplantes. Sin embargo, hay desacuerdo sobre cómo obtener este consentimiento. Se concluye que es necesario promover acciones de concientización urgentes sobre la donación de órganos, dirigidas a la población en general y a los profesionales de la salud, procurando alcanzar el cumplimiento efectivo de la legislación y, sobre todo, aumentar el número de órganos disponibles para trasplante.

Avaliação do Nível de Conhecimento de Docentes, Discentes e Leigos Sobre Utilização de Dentes Extraídos e Banco de Dentes Humanos / Evaluation of Awareness Level of Professors, Students and Lay People About Human Teeth Bank Functions and Purposes

Objetivo: Avaliar o nível de conhecimento de docentes e de discentes do Curso de Odontologia e de leigos sobre utilização de dentes extraídos e Banco de Dentes Humanos. Material e Métodos: Foi realizado um estudo observacional e prospectivo. A amostragem foi de 50 indivíduos para discentes e leigos e de 32 docentes. Os critérios de inclusão do estudo foram alunos de graduação de odontologia do 1° ao 10º período, docentes do curso de Odontologia da Universidade Federal da Paraíba e pessoas da população em geral, que estavam nas dependências da Universidade. Os critérios de exclusão foram indivíduos vinculados de alguma forma ao Banco de Dentes Humanos da Universidade Federal da Paraíba. Os dados foram coletados através de questionários e submetidos à análise estatística descritiva. Resultados: Entre os leigos, 88% foram a favor da doação de órgãos, porém 80% não representavam "doadores de órgãos". No que se refere ao conhecimento sobre o Banco de Dentes, 86% não sabiam da existência dele, porém 84% doariam seu dente extraído. Para 84% dos acadêmicos entrevistados, já havia sido solicitados dentes para uso laboratorial ou para pesquisa. Os dentes, por eles usados, foram obtidos através de diferentes meios, entre eles o BDH. Em relação aos docentes, 53,1% já solicitaram aos alunos dentes naturais para uso laboratorial ou para pesquisa na graduação. Conclusão: A desinformação dos leigos sobre a existência de Bancos de Dentes foi alta. Dentes extraídos foram solicitados na graduação para realizar atividades acadêmicas. Todos os discentes e os docentes consideraram importante a existência do Banco de Dentes para dar suporte ao ensino e à pesquisa. (AU)

Objective: To evaluate the awareness level of dental professors and students, and of lay people, about Human Teeth Bank (HTB) existence and operation, functions and purposes. Materials and Methods: A descriptive and prospective study was conducted, with a sample size of 50 students, 50 lay people, and 32 professors. The inclusion criteria for the study were: undergraduate dental students from the 1st to the 10th semester, dental professors at Federal University of Paraiba, and people from the general population who were at the university. The exclusion criteria were individuals linked somehow to the Human Teeth Bank of the Federal University of Paraiba. The data were collected using questionnaires and analyzed by descriptive statistics. Results: Most lay people reported to be in favor of organ donation (88%), but most of them (80%) were not "organ donors". Eighty-six percent did not know about the existence of the Teeth Bank, but 84% of them would donate his or her extracted teeth. Among the students, 84% had already been requested to provide natural teeth for laboratory use or for research purposes. The teeth were obtained through different means, including the HTB. As for professors, the majority (53.1%) had already requested natural teeth from their students for laboratory use or for graduate research purposes. Conclusions: The lack of knowledge about the existence of the Teeth Bank was found to be high among the lay people. At the undergraduate level, extracted teeth are frequently requested for the conduction of experimental studies and other academic activities. All students and professors considered the Teeth Bank important to support academic and research activities. (AU)

Knowledge, Attitude and Practice Regarding Organ Donation among Indian Dental Students.

BACKGROUND: Of the overall 9.5 million deaths annually in India, nearly 100,000 are due to organ failure. To save and extend lives, organ donation and organ transplantation have become the only hope. Health care professionals (HCPs) are a key element in facilitating cadaveric organ donation process. OBJECTIVE: To assess and compare the knowledge, attitude, and practice regarding organ donation among undergraduate dental students. METHODS: A cross-sectional study was conducted among 298 undergraduate dental students of the Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. A 27-item self-administered questionnaire, which assessed the levels of knowledge (Q1-13), positive attitude (Q14-24) and practice habits (Q25-27) regarding organ donation with dichotomous scale (Yes/No). RESULTS: As compared to males, females reported better mean±SD scores in knowledge (8.22±1.51) and practice (0.91±0.8); higher mean±SD attitude scores (8.55±1.56) were reported among males (p<0.001). While second year dental students had higher scores for their knowledge (8.55±1.56) and practice (1.02±0.44) compared to other year of training, third year students showed a significant higher mean attitude score (1.73±1.17) (p=0.02). Hindus and Muslims scored significantly lower mean knowledge, attitude and practice habits compared to others (Christians, Jains and Athesists) (p<0.001). There was a positive correlation between mean knowledge, attitude, and practice habits. CONCLUSION: There are an average level of knowledge and low levels of positive attitude and practice habits among studied dental students towards organ donation and transplantation.

Knowledge and Attitude Regarding Organ Donation among Relatives of Patients Referred to the Emergency Department.

INTRODUCTION: Organ donation is one of the surviving procedures, which can increase the life expectancy of end-stage patients. Inappropriate beliefs and attitude of individuals to organ donation, their poor knowledge, and the socio-economic level are one of the most important barriers for organ donation. Therefore, here knowledge and attitude levels among relatives of trauma patients regarding organ donation were evaluated. METHODS: This cross-sectional study was done on relatives of trauma patients referred to the emergency department of Sina Hospital, Tabriz, Iran, through 2013 to 2014. The questionnaire included parts of demographic data and socio-economic situations as well as status of knowledge and attitude regarding organ donation. A score between 0-7 was belonged to each person based on his/her level of knowledge. Attitude level had a score between 0-12. Chi- square, Fisher, and Mann-Whitney U test were performed to assess the relation between demographic variables and the level of knowledge and attitude. P<0.05 was considered as a significant level. RESULTS: 79 persons (57.1% male) with the mean age of 31.3±11.3 years were evaluated. 57 (73.1%) of subjects agreed with organ transplant. The main causes of disagreement among relatives regarding organ donation were dissatisfaction of the donor's relatives (25%) and religious issues (15%). 49 (62.02%) studied people had inappropriate attitude and 27 (34.2%) ones had good knowledge. male gender (OR=5.87; 95%CI: 3.32-8.42; p=0.001) and self-employed job (OR=7.78; 95%CI: 4.64-10.92; p=0.001) are independent factors associated with poor knowledge about organ donation. Self-employed job (OR=3.86; 95%CI: 1.41-6.11; p=0.009) and poor knowledge (OR=15.3; 95%CI: 9.03-21.57; p<0.001) were related to inappropriate attitude toward organ donation. CONCLUSION: The present study showed that 73.1% of participants agreed with organ donation. The major causes of disagreements were dissatisfaction of other relatives and religious beliefs. 62.0% of the studied people had positive view regarding organ donation and 34.2% of them well informed about. The most important causative factors for poor knowledge in this context were male gender and self-employed occupation. In addition, poor knowledge and self-employed job were two factors associated with inappropriate attitude toward organ donation.

Atuação de profissionais de saúde em doação de órgãos na perspectiva do familiar: uma análise problematizadora / Health professionals acting in organ donations in the family perspective: a problem-based analysis

Objetivou-se conhecer a atuação profissional no processo de doação de órgãos na perspectiva do familiar. Realizou-se metassíntese qualitativa de estudos brasileiros publicados entre 2001 a janeiro de 2015 veiculados na PubMed, SCOPUS, CINAHL, EMBASE, Web of Science, Science Direct, LILACS, BDENF. Resultando em 273 trabalhos, que após levantamento efetivo e exaustivos, resultaram sete artigos, os quais foram selecionados e submetidos à leitura criteriosa quanto à metodologia utilizada, sujeitos investigados, resultados obtidos e conclusões. Processaram-se sínteses, construídas da análise temática dos resultados, permitindo a definição de três categorias: a) Falta de confiança na atuação profissional; b) Atuação profissional sem compreensão e acolhimento no momento familiar; c) Falta de informação à família pelo profissional, desmembrada nas subcategorias: c.1) Falta de informação à família pelo profissional referente à possível morte encefálica; c.2) Falta de informação à família pelo profissional referente aos trâmites pós-doação. Depreendeu-se da complexidade de ações do processo de doação de órgãos, envolvendo: burocracia, demora, desgaste e cansaço, necessitando de investimentos na formação dos profissionais para melhoraria da atuação, considerada incipiente pelos familiares.

Our aim in this study was to evaluate the opinion of the family about the professional performance during the process of organs donation (POD). In order to do so, a qualitative meta-synthesis from Brazilian studies between 2001 and January 2013 was performed. Data were collected from (i) Pubmed, (ii) SCOPUS, (iii) CINAHL, (iv) EMBASE, (v) Web of Science, (vi) Science Direct, (vii) LILACS, and (viii) BDENF. A total of seven out of 273 papers were considered relevant. These were carefully read in order to assess methodology, subjects investigated, results and conclusions. The analyzes have allowed the definition of three categories: (a) lack of confidence in the professional, (b) professional performance without understanding of relatives emotional state, (c) professional apathy in providing information to the family. The last category was subdivided into (i) lack of information about a possible brain death, and (ii) subsequent procedures about POD. These studies revealed the complexity of actions in the POD, particularly on bureaucracy, delay, family fatigue and wear. Thus, it can be concluded that it is necessary to invest efforts on training the professional involved in the POD to protect the psychological state of the family.

Fatores envolvidos na negativa da doação de tecido ósseo / Factors involved in the refusal to donate bone tissue

Objetivo: Determinar as principais variáveis envolvidas na negativa da doação de tecido ósseo em familiares doadores de órgãos e a prevalência da doação desse tecido. Métodos: Trata-se de um estudo transversal, quantitativo. Foram estudadas variáveis referentes à solicitação da doação do tecido ósseo, compreendendo informações a respeito dos ossos que seriam captados, a reconstituição do corpo, os motivos que levaram à negativa da doação desse tecido, conhecimentos anteriores sobre doação e intencionalidade em ser doador. Resultados: Evidenciamos três fatores que influenciaram a negativa pelos familiares incluindo o desconhecimento sobre quais ossos seriam retirados (92,9%), como ocorreria a reconstituição destas estruturas (96,5%) e como se apresentaria o corpo após a captação. A prevalência de doadores de tecido ósseo foi de 17,2%. Conclusão: A decisão familiar de recusar a doação do tecido ósseo foi representada pelo desconhecimento do tema. A baixa prevalência foi devido à reduzida solicitação deste tipo de doação. .

Objective: To determine the main variables involved in the refusal to donate bone tissue among relatives of organ donors, and the prevalence of bone tissue donation. Methods: This was a cross-sectional, quantitative study. Variables related to donation requests for bone tissue were studied, comprising information about the bones that would be procured, the reconstruction of the body, the reasons that led to the refusal to donate bone tissue, prior knowledge about donation, and intention to become a donor. Results: We demonstrated three factors that influenced the refusal of family members, including: lack of understanding of which bones would be removed (92.9%), how the body would be reconstructed after bone removal (96.5%), and how the body would be presented after bone procurement. The prevalence of bone tissue donation was 17.2%. Conclusion: The family decision to refuse to donate bone tissue was represented by the lack of comprehension of the subject. The low prevalence was due to the reduced request of this type of donation. .

Successful lung transplantation from a donor with persistent lobar atelectasis.

BACKGROUND: Over the past 15 years, the number of recipients waiting for a lung transplant has increased and now far exceeds the number of available donors. Liberalization of donor criteria to include the use of extended donors remains an attractive option for expanding the donor pool. Numerous centers, including the authors' own, have begun exploring this relatively unknown territory of lung transplantation. CASE REPORT: Successful bilateral lung transplantation was performed for a patient with emphysema utilizing lungs from a donor with persistent lobar atelectasis. CONCLUSION: This report demonstrates that an acceptable outcome is possible from a donor with persistent lobar atelectasis if other parameters are acceptable. Larger studies would help further our understanding of the impact of donor radiographic abnormalities on outcomes following lung transplantation.

Análise dos aspectos epidemiológicos dos candidatos à doação de órgãos no Estado do Pará / Analysis of the epidemiological aspects of candidates for organ donation in the state of Pará

JUSTIFICATIVA E OBJETIVOS: A fila para transplante de alguns órgãos é quase seis vezes maior que o número de implantes realizados, sendo uma realidade alarmante e progressiva, com isso objetivou-se analisar aspectos epidemiológicos dos candidatos à doação de órgãos no estado do Pará.MÉTODO: Estudo transversal, com todo potencial doador no Pará, de acordo com o Registro Brasileiro de Transplantes. Baseados no dendrograma foram escolhidos São Paulo e Acre como extremos opostos de desempenho para comparação.RESULTADOS: Foi observado que o número de potenciais doadores,em pmp/ano, no Pará foi 15,4, no Acre 15 e em São Paulo60,5. Dentre as causas de não concretização, a não aceitação familiar no Pará representou 56% do total, no Acre 43% e em São Paulo 39%. Setenta e seis por cento dos doadores paraenses eram do sexo masculino, 42,3% tinham idade entre 18 e 40 anos e 57,7% vítimas de traumatismo cranioencefálico sendo o perfil dos candidatos paraenses.CONCLUSÃO: O desempenho em São Paulo foi muito superior ao dos outros em todos os aspectos, sendo que o principal motivo para não concretização da doação em todos os estados foi negação familiar.

BACKGROUND AND OBJECTIVES: The queue for some organs transplant is almost six times greater than the number of implants performed, being an alarming and progressive situation; therefore, this study aimed to analyze epidemiological aspects of candidates for organ donation in the state of Pará. METHOD: A cross-sectional study was performed, with all potential donors in Pará, according to the Brazilian Registry of Transplants. Based on the dendrogram, the states of Sao Paulo and Acre were chosen as opposite extremes of performance for comparison. RESULTS: We found that the number of potential donors, pmp/year, was of 15.4 in the state of Pará, 15 in the state of Acre and 60.5 in São Paulo. Among the causes for no achievement, no acceptance by the family was of 56% of the total in Pará, 43% in Acre and 39% in São Paulo. Seventy six per cent of donors from Pará were male, 42.3% were between 18 and 40 years of age and 57.7% were victims of traumatic brain injury, this being the profile of the candidates from Pará.CONCLUSION: The performance in São Paulo was far superior to the others in all aspects, with the family denial being the main reason for not accomplishing the donation in all states.

Avaliação das causas de recusa familiar a doação de órgãos e tecidos / Evaluation of the causes for family refusal to donate organs and tissue

OBJETIVO: Avaliação das causas de recusa familiar para a doação de órgãos e tecidos. MÉTODOS: Trata-se de um estudo transversal correlacional sobre as causas de recusa familiar para a doação de órgãos e tecidos. Para análise dos dados foi utilizado o teste Qui-Quadrado e o t-Student. RESULTADOS: A pesquisa destacou que os principais motivos de recusa relacionados são: não compreensão do diagnóstico de morte encefálica (21%), religiosidade (19%), falta de competência técnica da equipe (19%), tempo longo processo (10%), falecido não era doador (9%), medo da mutilação (5,2%), enterrado como veio ao mundo (3,4%), qualidade do atendimento (3,4%), decisão de um único membro da família (3,4%), experiência negativa em outro processo de doação (1,7%), transferência do corpo (1,7%). CONCLUSÃO: As causas de recusa familiar estão ligadas a não compreensão do diagnostico da morte encefálica pelos familiares, aspectos ligados a religião, despreparo do profissional que realizou a entrevista.

OBJECTIVE: Evaluate the causes for family refusal to donate organs and tissue. METHODS: Correlational cross-sectional study regarding the causes for the family refusal to donate organs and tissue. Data were analyzed using chi-square and Student's t test. RESULTS: The study emphasized that the main reasons for the refusal are: incomprehension regarding the brain death diagnosis (21%), religion (19%), lack of technical competence of the team (19%), long process (10%), the deceased was a non-donor (9%), fear of mutilation (5.2%), being buried as the person came to this world (3.4%), quality of the service (3.4%), decision of a single member of the family (3.4%), negative previous experience from another donation process (1.7%), body transfer (1.7%). CONCLUSION: The causes for family refusal are associated with the family members' lack of understanding regarding the brain death diagnosis, aspects related to religion and lack of preparation of the professional who performed the interview.

Aspectos ético-legais envolvidos no processo de doação/transplante / Ethical and lgall aspects involving the donation/transplantation roocess

A pesquisa evidencia os aspectos ético-legais de equipes intra-hospitalares no processo de doação/transplante de órgãos e tecidos, delineando os fatores que interferem no processo de doação/transplante na perspectiva desses profissionais. Participaram 11 profissionais que atuam nesse processo em oito hospitais autorizados para captação de órgãos no Noroeste do Paraná-Brasil. Tratou-se de uma pesquisa qualitativa, exploratória, utilizando-se de entrevista semiestruturada. Identificaram-se através da técnica do Discurso do Sujeito Coletivo, as seguintes Ideias Centrais: contato entre as famílias do doador e do receptor; autorização familiar; necessidade de preparo profissional; autorização legal para a retirada dos órgãos. Disto depreender-se que o contato entre os familiares pode trazer conflitos pós transplantes e, a clareza de como proceder diante um indigente, bem como a importância do preparo profissional para uma abordagem eficaz demonstram preocupação com a transparência nos procedimentos a serem realizados, após a autorização familiar.

The research emphasizes the ethical and legal aspects of intra-hospital teams in the donation and transplantation of organs and tissues, outlining the factors that interfere in the donation and transplantation process from the perspective of these professionals. A total of 11 professionals involved in this process in eight hospitals authorized for organ donation in the state of Paraná, Brazil, participated in the study. This was a qualitative exploratory study using semi-structured interviews. By using the Collective Subject Discourse technique, the following central ideas were identified: contact between the donor and receptor families; family authorization; need for professional training; legal authorization for the removal of organs. It could be conclude that this contact between family members can bring post-transplant conflicts and, the clarity about how to proceed in case of an indigent, as well as the importance of professional training for an effective approach, expressing concern about transparency in the procedures to be performed after the family consent is received.