China organ donation and transplantation update: the Hangzhou Resolution

The much-anticipated change in the practice of organ donation and transplantation in China is now underway and affirmed by an important Hangzhou Resolution promulgated at the 2013 China Transplant Congress.Support of the National Health and Family Planning Commission On October 29,2013,in a meeting of the National Health and Family Planning Commission (NHFPC)officials with Jie-Fu Huang,Head of National Organ Transplant Committee(OTC), Hai-Bo Wang,Director of China Organ Transplant Response System (COTRS)

A New Lease of Life Organ donation gains wider acceptance in China as an efficient donation system raises awareness

Wu Yue, a lung transplant recipi ent. now regards August 31, the day she underwent surgery, as her re-birth day. In the eyes＇ of many people, the 30-year- old woman is an embodiment of love, dili gence and intelligence.

Organ Donation in China

CHINA’S first voluntary organ donation system is in the midst of its trial run. The program is being tested in 11 pilot regions around the country, having harvested organs from more than 100 donors in this inaugural year. Overseen by the Red Cross Society of China and the country’s Ministry of Health, the system follows cardiac death standards in organ donation

Regulations governing clinical application of human organ transplant in China

To regulate human organ transplant, guarantee the quality and safety of the operation, protect the health of the people, the Health Ministry of China issued Regulations governing Clinical Application of Human Organ Transplant on March 27, 2006, which is to be put into effect on the coming July 1. The regulations contain 5 chapters and 47 articles including general principles, registration of diagnosis and treatment, clinical management, supervision, and supplementary items.

Critical care specialists,the missing link in organ procurement for transplantation

The procurement process for organ donation begins with the identification of potential organ donors in emergency or critical care units(CCU),followed by their clinical evaluation,diagnostic procedures,and therapeutic interventions,mostly conducted in CCUs.It concludes with the request for organ donation and,if accepted,the retrieval of organs.Despite most interventions occurring in detection units,there has been a neglect of the strategic role played by critical care specialists(CCS)in managing and caring for brain-dead or near-brain-death patients.Questions arise:Are they willing to undertake this responsibility?Do they fully comprehend the nature of organ procurement?Are they aware of the specific interventions required to maintain possible organ donors in optimal physiological condition?Our objective is to examine the role of CCS in organ procurement and propose ways to enhance it,ultimately aiming to increase and enhance organ donation rates.

The organ donation in China

Obrgan transplantation is one of the greatest achievements in the history of medicine during the 20th century. It has changed the practice of traditional medicine wherein the treatment of diseases relies mainly on drugs. Organ transplantation has saved the lives and restored the health in many patients with fatal illness or end-stage organ failure. It has brought a revolutionary change in medical practice and reflects true human wisdom and knowledge. Due to the advances in the organ transplant technology and the basic research in transplant immunology as well as the development of a variety of immunosuppressive agents, organ transplantation has been an effective treatment for patients with organ failure.

The New Era of Organ Transplantation in China

On June 13, 2016, the US congress passed the bill H. Res. 343 based on the false statements regarding organ transplantation in China, which indicated serious miscommunication and misjudgment between China and the US on the issue. The bill is preceded and followed by a series distorted media reports by the Cable News Network and the New York Times.II,21 It is a typical act ofdemonizing China with colored glasses that boldly ignored the facts and fabricated the evidence for political purposes.

Extended criteria brain-dead organ donors:Prevalence and impact on the utilisation of livers for transplantation in Brazil

BACKGROUND Despite its association with higher postoperative morbidity and mortality,the use of extended criteria donor(ECD)livers for transplantation has increased globally due to the high demand for the procedure.AIM To investigate the prevalence of ECD in donation after brain death(DBD)and its impact on organ acceptance for transplantation.METHODS Retrospective analysis of DBD organ offers for liver transplantation between 2017 and 2020 in a high-volume transplant centre.The incidence of the Eurotransplant risk factors to define an ECD(ET-ECD)among DBD donors and the likelihood of organ acceptance over the years were analysed.The relationship between organ refusal for transplantation,the occurrence,and the number of ET-ECD was assessed by simple and multiple logistic regression adjustment.RESULTS A total of 1619 organ donors were evaluated.Of these,78.31%(n=1268)had at least one ET-ECD criterion.There was an increase in the acceptance of ECD DBD organs for transplantation(1 criterion:from 23.40%to 31.60%;2 criteria:from 13.10%to 27.70%;3 criteria:From 6.30%to 13.60%).For each addition of one ETECD variable,the estimated chance of organ refusal was 64.4%higher(OR 1.644,95%CI 1.469-1.839,P<0.001).Except for the donor serum sodium>165 mmol/L(P=0.310),all ET-ECD criteria increased the estimated chance of organ refusal for transplantation.CONCLUSION A high prevalence of ECD DBD was observed.Despite the increase in their utilisation,the presence and the number of extended donor criteria were associated with an increased likelihood of their refusal for transplantation.

Randomized intervention to assess the effectiveness of an educational video on organ donation intent among Hispanics in the New York metropolitan area

BACKGROUND The Hispanic community has a high demand for organ donation but a shortage of donors.Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions.Factors acting as barriers to organ donation registration have been classified as:(1)Bodily integrity;(2)medical mistrust;(3)“ick”-feelings of disgust towards organ donation;and(4)“jinx”-fear that registration may result in one dying due to premeditated plans.We predict that by providing necessary information and education about the donation process via a short video,individuals will be more willing to register as organ donors.AIM To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metropolitan area.METHODS This study was approved by the Institutional Review Board at Northwell Health.The approval reference number is No.19-0009(as presented in Supplementary material).Eligible participants included Hispanic New York City(NYC)residents,18 years of age and above,who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents.The survey an 85-item Redcap survey measured participant demographics,attitudes,and knowledge of organ donation as well as the intention to register as an organ donor.Attention checks were implemented throughout the survey,and responses were excluded for those who did fail.Participants were randomly assigned two-between subject conditions:To view a short video on organ donation and then proceed to complete the survey(i.e.,video first)and view the same video at the end of the survey(video last).No intra-group activities were conducted.This study utilized an evidenced-based emotive educational intervention(video)which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles.Results were analyzed using Jamovi statistical software.Three hundred sixty-five Hispanic individuals were included in the analysis.Once consent was obtained and participants entered the survey(the survey sample is presented in Supplementary material),participants were asked to report on demographic variables and their general impression of organ donation after death.The video depicted stories regarding organ donation after death from various viewpoints,including from the loved ones of a deceased person who died waiting for a transplant;from the loved ones of a deceased person whose organs were donated upon death;and,from those who were currently waiting for a transplant.RESULTS Using a binomial logistic regression,the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors.The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions(odds ratio:2.05,95%confidence interval:1.06-3.97).Motivations for participation in organ donation were also captured with many stating the importance of messages coming from“people like me”and a message that highlights“the welfare of those in need”.Overall,the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous.Future studies should explore using targeted messaging that resonates with specific cultural groups,highlighting the welfare of others.CONCLUSION This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.

Attitudes toward organ donation in China

Background Organ transplantation represents an important advance in modern medical science,and it has benefited many patients with organ failure; however,the severe deficiency of organ sources has been a bottleneck that has limited the benefits -this technology can bring.The aim of this study was to show the results of a survey on Chinese people＇s awareness and attitudes toward organ donation.Methods We designed a questionnaire regarding organ donation consisting of 20 short questions,which were distributed to 10 groups.Most of the questions were multiple-choice; the core question related to people＇s attitudes to organ donation and the development of organ donation.The survey was held in the outpatient hall of Beijing Chao-Yang Hospital,a commercial district,and four professional colleges.Participants were randomly selected,and answered questions about gender,age,educational background,profession,and study major.Results In all,2930 valid responses were received.Male：female ratio was nearly 1：1.2 （mean age 38 years）.Over 90.0% of participants knew about organ transplantation and which organs could be transplanted; more than 95.0% knew about organ donation,but the time they had been aware of it varied.Nearly 90.0% of the participants approved of deceased organ donation; 73.0% indicated they would like to donate their organs post mortem.Participants who knew more about organ failure and organ transplantation were more likely to support organ donation.College students were very positive about organ donation,though as they gain professional knowledge their attitudes may change.Altogether,65.3% of participants approved of living organ donation,which was obviously lower than the figure for deceased organ donation （P 〈0.05）.In all,85.7% of participants approved of compensation to the deceased donor＇s family.To promote organ donation in China,62.9% of participants indicated that the public＇s knowledge about organ donation should be increased via the media and various kinds of education.Only 20.0% of the participants believed that legislation was required.Conclusions We conclude that at present the Chinese public has a basic understanding about organ transplantation and donation.The majority respondents were in favor of deceased organ donation and were willing to donate their own organs after death.

Current attitudes toward organ donation after cardiac death in northwest China

Background People＇s attitude toward organ donation after cardiac death （DCD） has not come to an agreement in different countries and regions.Influenced by the local culture in China for thousands of years,the general public has different ideas about this issue.The purpose of this study was to investigate the current attitudes trend and characteristics of transplantation with organs donated after cardiac death in northwest China.Methods This largest single-center cohort study was performed by an interview or by telephone using a questionnaire.The family members of potential DCD donors were recruited from the First Affiliated Hospital,medical college of Xi＇an Jiaotong University located in a metropolitan area of northwest China.The 12-item attitude questionnaire was specifically developed from the literature review with coordinator,physician,and donor＇s family feedback.The participants were asked to rate the queries on a 5-point Likert intensity scale.Results The 174 participants included 56 （32.2％） women and 118 （67.8％） men.Most people were aged between 41 and 50 years （n=63,36.2％）,31 and 40 years （n=59,33.9％）,and less than 30 years （n=36,20.7％）.The top five attitudes of participants were the best person to suggest organ donation to a family was ranked as the DCD coordinator of Red Cross Organization （RCO,n=160,92％）,donor is a hero （n=143,82.2％）,honor to be a donor＇s family member （n=136,78.2％）,improved relationship with colleagues （n=124,71.3％）,and with recipient after donation （n=123,70.7％）.The best person to suggest organ donation to a family was ranked as the coordinator of RCO （n=160,92％）,doctor unrelated to transplantation （n=104,59.8％）,social worker （n=36,20.7％）,and doctor related to transplantation （n=25,14.4％）.The top two reasons for non-consent to donation were that the family insisted on intact body after patient death and did not want to have surgery again （n=51,41.5％）,and feared that they would be misunderstood by neighbors,relatives,and friends about donation （n=28,22.8％）.Conclusions This study revealed initial attitudes toward DCD in China.Some data afford insight into the decision-making procedure.The concerns of potential DCD donors and their families may help professionals provide better interventions in the future.

Differences in willingness to donate cadaveric organ between young donor families and adult donor families： evidence from the Hunan Province, China

Background The Red Cross of China and Ministry of Health jointly started a pilot program of organ donation after cardiac death to overcome the shortage of available organs since 2010. The purpose of this qualitative study were to compare the consent rate of organ donation between young donor families and adult donor families; to explore and determine factors associated with differences in willingness to donate organs between them. Research objective was to provide a rationale for further preparation of professionals involved in this sensitive work. Methods Between March 2010 and June 2012, 24 young deceased patients including donors and non-donors and 96 potential adult donors were collected, and consent rates of young donors＇ families and adult donors＇ families were calculated. A X2 test analysis to compare the consent rates of the two groups was conducted. We studied through semi- structured interviews 15 parents of young donors and 15 relatives of old donors who were interviewed for petition of consent. Data collection and analysis of the overall study were performed according to the grounded theory methodology. Factors that influenced the families＇ decisions were identified and classified. We found the differences in willingness to donate organs between the two groups. Results The consent rate of young donor families was 66.67%, while the consent rate of adult donor families was 26.04%. Young donor families easily consented to organ donation than adult donor families （P〈0.005）. The donors＇ families had been affected by various factors throughout the process of deciding to give consent for donation. The findings led to the formulation of an empirically based model of interlinking categories that influence families＇ decision-making process in organ donation. These factors are grouped into five main categories： （1） personal factors, （2） conditions of organ request, （3） interpersonal factors, （4） ethical factors, and （5） traditional views. The funeral tradition influenced the young donor parents＇ consent to donation, but had no relation with family decision of adult donors. And the family members of young donors are relatively less, who are more likely to reach a consensus. Conclusions Young donor families influenced by traditional funeral beliefs are easier to consent to organ donation than adult donor families. Family members of young donors are relatively less who are more likely to reach a consensus. Acceptance of the expanded criteria donors may improve the organ donation rates, especially those of the advanced age.

Cold ischemia time in liver transplantation:An overview

The standard approach to organ preservation in liver transplantation is by static cold storage and the time between the cross-clamping of a graft in a donor and its reperfusion in the recipient is defined as cold ischemia time(CIT).This simple definition reveals a multifactorial time frame that depends on donor hepatectomy time,transit time,and recipient surgery time,and is one of the most important donor-related risk factors which may influence the graft and recipient’s survival.Recently,the growing demand for the use of marginal liver grafts has prompted scientific exploration to analyze ischemia time factors and develop different organ preservation strategies.This review details the CIT definition and analyzes its different factors.It also explores the most recent strategies developed to implement each timestamp of CIT and to protect the graft from ischemic injury.

Ethical frontiers in liver transplantation

Liver transplantation represents a pivotal intervention in the management of end-stage liver disease,offering a lifeline to countless patients.Despite significant strides in surgical techniques and organ procurement,ethical dilemmas and de-bates continue to underscore this life-saving procedure.Navigating the ethical terrain surrounding this complex procedure is hence paramount.Dissecting the nuances of ethical principles of justice,autonomy and beneficence that underpin transplant protocols worldwide,we explore the modern challenges that plaques the world of liver transplantation.We investigate the ethical dimensions of organ transplantation,focusing on allocation,emerging technologies,and decision-making processes.PubMed,Scopus,Web of Science,Embase and Central were searched from database inception to February 29,2024 using the following key-words:“liver transplant”,“transplantation”,“liver donation”,“liver recipient”,“organ donation”and“ethics”.Information from relevant articles surrounding ethical discussions in the realm of liver transplantation,especially with regards to organ recipients and allocation,organ donation,transplant tourism,new age technologies and developments,were extracted.From the definition of death to the long term follow up of organ recipients,liver transplantation has many ethical quandaries.With new transplant techniques,societal acceptance and perceptions also play a pivotal role.Cultural,religious and regional factors including but not limited to beliefs,wealth and accessibility are extremely influential in public at-titudes towards donation,xenotransplantation,stem cell research,and adopting artificial intelligence.Understanding and addressing these perspectives whilst upholding bioethical principles is essential to ensure just distribution and fair allocation of resources.Robust regulatory oversight for ethical sourcing of organs,ensuring good patient selection and transplant techniques,and high-quality long-term surveillance to mitigate risks is essential.Efforts to promote equitable access to transplantation as well as prioritizing patients with true needs are essential to address disparities.In conclusion,liver transplantation is often the beacon of hope for individuals suffering from end-stage liver disease and improves quality of life.The ethics related to transplantation are complex and multifaceted,considering not just the donor and the recipient,but also the society as a whole.

Attitudes, knowledge levels and behaviors of Islamic religious officials about organ donation in Turkey: National survey study

BACKGROUND The most important factors affecting the decision of organ donation are socioeconomic,educational,cultural,and religious factors.AIM To evaluate Islamic religious officials’attitudes and behaviors toward and level of knowledge on organ donation and transplantation.METHODS This study surveyed 2350 Islamic religious officials in Turkey.To ensure a representative sample,we used and modified the Nomenclature of Territorial Units for Statistics.Based on the Nomenclature of Territorial Units for Statistics-II,Turkey was divided into 26 regions.The number of Islamic religious officials in each city and town in each of the 26 regions was proportionate to the population.A stratified sampling method based on demographic factors,such as age,marital status,and educational level,was used.Data were collected by PRP Research and Consultancy Company using computer-assisted personal interviewing.RESULTS Of the 2350 religious officials surveyed,59.9%were in the age group of 35-54 years;84.7%had either a bachelor’s or a master’s degree;99.7%never donated an organ;and 75.4%were not considering donating in the future.About 22%of the religious officials said religious belief was their reason for not donating;45.3%did not indicate any reason.Although 41.5%of participants considered cadaveric organ donation as the best source of organ transplantation,36.3%deemed living donor transplantation as the best option.Meanwhile,52.9%of participants considered donating an organ from a brain dead relative in case they were asked for permission;80.1%considered donating to a relative,if necessary;81.6%considered undergoing organ transplantation,if necessary.About 83.7%of participants deemed organ donation as a proper human behavior;60.5%believed that it is allowed by Islam;55%said they preach for organ donation at their mosque;and 41.1%said their views of organ donation were influenced by their leaders in society.CONCLUSION Religious officials are unsure whether or not organ donation is respectful of their religious belief,but they consider donating an organ if a relative need to undergo organ transplantation.

Posthumous organ donation beliefs of college students:A qualitative study

Objective:To explore the perspectives and beliefs of college students toward posthumous organ donation,and the factors influencing their beliefs.Methods:This was a descriptive phenomenology study conducted with semi-structured indepth interviews.Nine college students attending three universities in Beijing who agreed to participate in this study were interviewed.Data were analyzed following the guideline suggested by Colaizzi(1978).Briefly,statements identified as noteworthy were coded and organized.A description was then written to formalize their meaning and returned to the participants for validation of the description.Results:In general,the participants exhibited positive attitudes toward posthumous organ donation.However,not all subjects indicated that they would become an organ donor.Based on the provided responses,four main themes emerged:(1)knowledge about organ donation,participants reported a general lack of education or understanding of organ transplantation and donation;(2)core beliefs on organ donation,despite believing it is valuable public service,participants were unwilling to go against the cultural beliefs held by parents and elders;(3)factors influencing beliefs on organ donation,including cultural and peer opinion,posthumous care of the body,legal registration,and publicity;(4)institutional and policy context,lack of guarantee for proper use of organs after donation was a concern.Conclusion:Despite positive attitudes towards posthumous organ donation,college students are hesitant to become donors because of lack of knowledge/publicity;cultural disdain;and lack of governmental assurance.

Philosophy of organ donation: Review of ethical facets

Transplantation ethics is a philosophy that incorporates systematizing, defending and advocating concepts of right and wrong conduct related to organ donation. As the demand for organs increases, it is essential to ensure that new and innovative laws, policies and strategies of increasing organ supply are bioethical and are founded on the principles of altruism and utilitarianism. In the field of organ transplantation, role of altruism and medical ethics values are significant to the welfare of the society. This article reviewsseveral fundamental ethical principles, prevailing organ donation consent laws, incentives and policies related to the field of transplantation. The Ethical and Policy Considerations in Organ Donation after Circulatory Determination of Death outline criteria for death and organ retrieval. Presumed consent laws prevalent mostly in European countries maintain that the default choice of an individual would be to donate organs unless opted otherwise. Explicit consent laws require organ donation to be proactively affirmed with state registries. The Declaration of Istanbul outlines principles against organ trafficking and transplant tourism. World Health Organization's Guiding Principles on Human Cell, Tissue and Organ Transplantation aim at ensuring transparency in organ procurement and allocation. The ethics of financial incentives and non-financial incentives such as incorporation of non-medical criteria in organ priority allocation have also been reviewed in detail.

Donating in good faith or getting into trouble? Religion and organ donation revisited

There is worldwide shortage of organs for solid-organ transplantation. Many obstacles to deceased and live donation have been described and addressed, such as lack of understanding of the medical process, the issue of the definition of brain death, public awareness of the need for transplants, and many others. However, it is clear that the striking differences in deceased and live donation rates between different countries are only partly explained by these factors and many cultural and social reasons have been invoked to explain these observations. We believe that one obstacle to both deceased and live donation that is less well appreciated is that of religious concerns. Looking at the major faiths and religions worldwide, it is reassuring to see that most of them encourage donation. However, there is also scepticism amongst some of them, often relating to the concept of brain death and/or the processes surrounding death itself. It is worthwhile for transplant teams to be broadly aware of the issues and also to be mindful of resources for counselling. We believe that increased awareness of these issues within the transplant community will enable us to discuss these openly with patients, if they so wish.

The Role of Strategic Communication for Organ Donations

One big achievement in the last decade is the rapid development in transplantation medicine, enabling seriously ill people to live longer. However, in the year 2014, 12 people in the European Union have died every day because of the lack of available organs. Nearly, 70,000 people were waiting for a matching graft. An analysis of donation and transplantation variation across the European member states shows that since many years, Spain occupies a pioneer role, whereas Germany and Austria are lagging behind. From the legal and administrative perspective, Spain and Austria are quite similar with their presumed consent system （opting out）, whereas Germany has an informed consent system （opting in）. Hence, there must be other influencing factors like the way of multilevel communication leading to the following research question： How does multilevel communication influence organ donations in Spain, Germany, and Austria？ On the basis of a cross-country study, it can be shown that strategic communication on the （inter）personal and organizational level supported by the creation of public awareness on the national level is crucial for succeeding in closing the gap between demands and realized organ transplantation.

Is the near coming xenotransplantation era relieving us from needing to look for more non-living organ donors?

Despite organ transplantation being the most successful treatment for end-stage organ dysfunction,the number of annual solid organ transplantations is much lower than that required to satisfy the demand of patients on waiting lists.The explanation for this phenomenon is the relative scarcity of non-living organ donors due to several factors,such as:(1)Late arrival of patients with a neurocritical condition to an emergency service;(2)lack of detection of those patients as possible organ donors by health professionals dedicated to procurement or by clinicians at emergency and intensive care units,for instance;(3)late transfer of the patient to an intensive care unit to try to recover their health and to provide hemodynamic,ventilatory,and metabolic support;(4)lack of confirmation of the physiological status of the possible donor;(5)late or incorrect positive diagnosis of the subject’s death,either due to brain or cardiac death;(6)difficulty in obtaining legal authorization,either by direct relatives or by the authority,for the extraction of organs;and(7)deficient retrieval surgery of the organs actually donated.The recent reports of relatively successful xenotransplants from genetically modified pigs open the possibility to fix this mismatch between supply and demand,but some technical(organ rejection and opportunistic infections),and economic issues,still remain before accepting a progressive replacement of the organ sources for transplantation.An approximate economic cost analysis suggests that the hypothetical acquisition cost of any genetically modified pig derived organ is high and would not even satisfy the solid organ demand of the wealthiest countries.