Organ Donation and Obstacles: University Student Survey

Background: Organ transplantation has helped improve the quality of life of patients with lethal terminal organ failure. This success is owed to the progress made in many fields such as surgery, immunology…However, in our country Morocco, we are faced with reluctance to donate. The study’s objective is to evaluate the perception of organ donation among university students. Methods: We conducted this cross-sectional study with descriptive and analytical aims. Our target population consisted of 991 university students from eight higher education structures. An anonymous questionnaire was distributed to those students by a single interviewer. The questions of the survey answered four main themes. Thus, two types of studies were done. The first was a descriptive study of the socio-demographic characteristics of the selected population and their knowledge and attitudes about organ donation. The second was an analytical study of the correlation between the socio-demographic characteristics, type and level of education of the target population and their knowledge and attitudes towards organ donation. Results: 97.2% of the respondents have already heard about organ donation. If 836 of the students (84.4%) thought that transplantation could be an effective therapeutic alternative, 155 of the students (15.6%) were not aware of this possibility. Furthermore, 298 students, which means 30.1% of the students, did not know that organ transplantation was practiced in Morocco. The causes of refusal found in our study were numerous. 68.5% of students blamed the lack of information as the main cause of their reluctance. 64.7% were afraid of organ trafficking. 41.1% refused the idea of mutilating the body of the deceased, which could impact the funeral. 37.3% thought that donation would be a violation of the human body according to religious values. 33.9% were against donation because they hoped that the brain-dead patient could wake up. The main results of our survey showed the very favorable attitude towards organ donation and transplantation, despite the lack of knowledge on the subject. Conclusion: This study revealed the absence of information on the practice of organ transplantation in Morocco and the underestimation of the number of people waiting for transplantation. On the other hand, like the data found in the literature, our study highlights the religious obstacles and the lack of confidence in the legislation governing donation and transplantation in our country.

Attitudes,awareness,and knowledge levels of the Turkish adult population toward organ donation:Study of a nationwide survey

BACKGROUND The most important factors affecting attitudes on organ donation are socioeconomic, educational, cultural, and religious factors in many countries.AIM To evaluate the attitudes, awareness, and knowledge levels of the Turkish adult population toward organ donation.METHODS This nationwide study surveyed 3000 adults(≥ 18 years) in Turkey. To ensure a representative sample, the Nomenclature of Territorial Units for Statistics-Ⅱ(modified for Turkey) was used. Turkey was divided into 26 regions based on social, economic, and geographic criteria as identified by the Turkish Statistical Institute. A stratified sampling method was used with an even distribution of adults across cities and towns based on population data. Data were collected by the PRP Research and Consultancy Company using computer-assisted personal interviews.RESULTS Out of 3000 individuals represented in the study population, 1465(48.8%) were male and 1535(51.2%) female. The results showed that most participants were under 45 years(59.0%) and married(72.1%), some had a bachelor’s degree or higher(21.9%), and very few(1.5%) had any direct experience with organ transplantation-whether in the family, or a family member on a transplantation waiting list. Most of the study population(88.3%) had not considered donating an organ, however, most(87.9%) said that they would accept an organ from a donor if they needed one. Among the individuals surveyed, 67% were willing to donate an organ to a close relative, while 26.8% would donate an organ to an unrelated person. Only 47.2% said they had adequate information about brain death, and 85.2% refused to consent to donating organs of family members declared brain dead. Only 33.9% thought they had adequate information about organ donation. The main source of information was the television. The two main reasons for refusing organ donation were that it was too soon to think about organ donation and the importance of retaining the integrity of the dead person’s body.CONCLUSION This study showed that Turkey’s adult population has inadequate knowledge about organ donation. The study advocates for public education programs to increase awareness among the general population about legislation related to organ donation.

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)

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.

Nurses’ Recognition in Nursing for Patients and Families about Organ Donation after Brain Death, Care for Family Members and Supports for Nurses

Background: Globally, there a problem of disequilibrium between donation and organ transplantation, this equilibrium is remarkable in Japan. Especially there are few donations from brain death, and researches from the view point of nurses in clinical situation were needed. Purpose: The purpose of this study was to clarify the recognition of nurses in organ transplantation nursing, required care for families of patients, and required support for nurses to promote quality of nurses in organ donation. Methods: We conducted this research within 2 months in 2019 in Western Japan. A researcher conducted a semi-qualitative interview for nurses in organ transplantation nursing about their recognition of nursing, required care for family members, and required support for nurses once. Results: Nurses recognized that some family members who knew patients’ thoughts made decision easily and some who didn’t know had difficulties. Many nurses felt insufficiency for family cares and some confronted ethical problems. Though some nurses felt conflict about their own thoughts or religion, they took care of patients or family members with responsibility. As for care for families, nurses thought practice of care considering families’ feeling, support of decision making, and care for family to live positively after transplantation as required care. About support for nurses, nurses required education of transplantation, increase of staff members, chance to share dilemma, and mental care. Discussion: Nurses recognized the importance of decision making, and felt an insufficiency for family care or dilemmas. To propose high quality of nursing and organ donation or transplantation, education about transplantation including family care, management about resolution of dilemma or mental health may be required.

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

Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant

BACKGROUND With an ongoing demand for transplantable organs,optimization of donor management protocols,specifically in trauma populations,is important for obta-ining a high yield of viable organs per patient.Endocrine management of brain-dead potential organ donors(BPODs)is controversial,leading to heterogeneous clinical management approaches.Previous studies have shown that when levo-thyroxine was combined with other treatments,including steroids,vasopressin,and insulin,BPODs had better organ recovery and survival outcomes were increased for transplant recipients.AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients.METHODS A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed.Exclusion criteria included patients who were not solid organ donors,patients who were not declared brain dead(donation after circulatory death),and patients who did not receive steroids in their hospital course.Levothyroxine and steroid administration,the number of organs donated,the types of organs donated,and demographic information were recorded.Univariate analyses were performed with P<0.05 considered to be statistically significant.RESULTS A total of 88 patients met inclusion criteria,69(78%)of whom received levothyroxine and steroids(ST/LT group)vs 19(22%)receiving steroids without levothyroxine(ST group).No differences were observed between the groups for gender,race,pertinent injury factors,age,or other hormone therapies used(P>0.05).In the ST/LT group,68.1%(n=47)donated a high yield(3-5)of organ types per donor compared to 42.1%(n=8)in the ST group(P=0.038).There was no difference in the total number of organ types donated between the groups(P=0.068).CONCLUSION This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population.Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria.This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.

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.

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.

Pragmatic solution for organ donation in response to challenges faced by the Chinese society： summary for the National Donation after Circulatory Death Pilot Program

Oygan transplant is an advanced medical technology brought to China from the West in the latter half of the 20th century. Thanks to the strenuous efforts of generations, it has become a mature clinical practice, having saved the lives of a great number of patients suffering from end-stage organ failure. Different from other medical technologies, an organ transplant requires a donated transplantable organ, and the donation and allocation are embedded in social issues such as culture, tradition, ethics, and law.

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.

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.

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.

Pathological Characteristics of Liver Allografts from Donation after Brain Death Followed by Cardiac Death in Pigs

Donation after brain death followed by circulatory death （DBCD） is a unique practice in China. The aim of this study was to define the pathologic characteristics of DBCD liver allografts in a porcine model. Fifteen male pigs （25-30 kg） were allocated randomly into donation after brain death （DBD）, donation after circulatory death （DCD） and DBCD groups. Brain death was induced by aug- menting intracranial pressure. Circulatory death was induced by withdrawal of life support in DBCD group and by venous injection of 40 mL 10% potassium chloride in DCD group. The donor livers were perfused in situ and kept in cold storage for 4 h. Liver tissue and common bile duct samples were col- lected for hematoxylin and eosin staining, TUNEL testing and electron microscopic examination. Spot necrosis was found in hepatic parenchyma of DBD and DBCD groups, while a large area of necrosis was shown in DCD group. The apoptosis rate of hepatocytes in DBD [（0.56±0.30）%] and DBCD [（0.50 ±0.11）%] groups was much lower than that in DCD group [（3.78±0.33）%] （P〈0.05）. And there was no significant difference between DBD group and DBCD group （P〉0.05））. The structures of bile duct were intact in both DBD and DBCD groups, while the biliary epithelium was totally damaged in DCD group. Under electron microscope, the DBD hepatocytes were characterized by intact cell membrane, well-organized endoplasmic reticulum, mild mitochondria edema and abundant glycogens. Broken cell membrane, mild inflammatory cell infiltration and sinusoidal epithelium edema, as well as reduced glycogen volume, were found in the DBCD hepatocytes. The DCD hepatocytes had more profound cell organelle injury and much less glycogen storage. In conclusion, the preservation injury of DBCD liver allografts is much less severe than that of un-controlled DCD, but more severe than that of DBD liver allografts under electron microscope, which might reflect post-transplant liver function to some extent.

COVID-19 pandemic:Building organisational flexibility to scale transplant programs

The prevailing coronavirus disease 2019 pandemic has challenged our lives in an unprecedented manner.The pandemic has had a significant impact on transplantation worldwide.The logistics of travel restrictions,stretching of available resources,unclear risk of infection in immunosuppressed transplant recipients,and evolving guidelines on testing and transplantation are some of the factors that have unfavourably influenced transplant activity.We must begin to build organisational flexibility in order to restart transplantation so that we can be mindful stewards of organ donation and sincere advocates for our patients.Building a culture of honesty and transparency(with patients,families,colleagues,societies,and authorities),keeping the channels of communication open,working in collaboration with others(at local,regional,national,and international levels),and not restarting without rethinking and appraising all elements of our practice,are the main underlying principles to increase the flexibility.

Adnexal tumor found during a brain-dead donor organ retrieval:a case report

Pre-donation evaluation of organ donors is important.Organ quality directly affects both short-and long-term survival rates of transplanted organs and recipients after transplantation.Contraindications to donation are directly related to recipient survival and medical ethics.The following information is included in this organ donation case report:detailed medical history(primary disease and surgical history),blood type,infectious diseases,coagulation function,biochemical function,tumor biomarker,indicators related to tuberculosis infection,microbial culture indicators,lung computed tomography(CT)scan,and abdominal ultrasound(heart,liver,gallbladder,pancreas,spleen,kidneys,ureters,bladder,adnexa).We found a 10 cm×10 cm space-occupying lesion in the abdominal cavity in this donor organ retrieval surgery.Frozen or paraffin sections showed that the space-occupying lesion was malignant.The organ donor was not suitable due to the malignant tumor,and the transplantation surgery was canceled.We analyzed this case of organ donation to provide a reference for the follow-up donation evaluation process.This case study reveals the limitations of preoperative non-invasive assessment,the necessity of preoperative multi-dimensional assessment of organ function,and the exclusion of donation contraindications.

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.

Marginal donor liver versus standard donor liver: A single-center observational study

Background:The effectiveness and safety of marginal donor livers remain controversial.This study aimed to investigate the clinical efficacy of marginal donor livers in patients with liver transplantation(LT).Methods:This study included 199 liver donors(including 16 split donors)and 206 liver recipients from January 1,2018 to January 27,2020,with case follow-up until July 31,2021.Clinical data of donors and recipients were retrospectively analyzed and were divided into the marginal donor and standard donor groups according to the criteria of marginal donor livers.Indices of liver and kidney functions,complications,and survival curves of the two groups were compared.Results:Compared with the standard donor group,the blood creatinine levels were significantly higher in the marginal donor group in the first week after operation(P<0.05);there were no significant differences in alanine aminotransferase,aspartate aminotransferase,and total bilirubin levels after LT(all P>0.05);there was no significant difference in the incidence of complications after LT(P>0.05);there was also no significant difference in the survival curve(P=0.335).Conclusions:There were no significant differences in liver and kidney function and survival curve between the standard donor and marginal donor groups.The marginal donor liver appears safe and reliable for LT and may be an important strategy to expand the donor pool and solve the shortage of organs.

Machine perfusion of the liver:Putting the puzzle pieces together

The realm of extended criteria liver transplantation created the'adjacent possible'for dynamic organ preservation.Machine perfusion of the liver greatly expanded donor organ preservation possibilities,reaching before unattainable goals,including the mitigation of ischemia-reperfusion injury,viability assessment,and organ reconditioning prior to transplantation.However,current scientific evidence lacks uniformity between studies,perfusion protocols,and acceptance criteria.Construction of collaborative research networks for sharing knowledge should,therefore,enable the development of high-level evidence and guidelines for machine perfusion utilization,including donor acceptance criteria.Finally,this approach shall guarantee conditions for further progress to occur.