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

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

A survey on insight of blood donors during COVID pandemic in Southern India

ABSTRACT Introduction: Knowledge, Attitude and Practices (KAP) surveys prove beneficial to the transfusion services by providing an insight into the donors and, thus, aiding in mobilizing and retaining voluntary blood donors. We aim to study the knowledge, attitude and practices of donors towards blood donation in a pandemic setting. Methods: A cross-sectional observational study to assess the knowledge, attitude and practices of blood donors was conducted between June to and October 2020. Non-parametric tests (Mann - Whitney U and Kruskal - Wallis) were performed to evaluate the relation of knowledge, attitude and practices overall scores with age group, gender and history of blood donations (first us. repeat). The Chi-Square test/Fisher's Exact test was used to evaluate the differences in the distribution of Knowledge, Attitude and Practices items within the groups. Results: A total of 403 of 2,748 individuals who came for whole blood donation participated in the study. The mean age of the study population was 31.1years (SD ± 8.4 range: 18 - 58), with 75% of the donors donating for the first time. The fear of acquiring COVID-19 infection was perceived as a major reason for the eligible population not to donate. The overall knowledge, attitude and practice score among the donors was satisfactory, being 76.14%, with a significant association with age. The overall positive attitude and practices scores of blood donors were 85.48% and 78.04%, respectively. Conclusion: The KAP scores were satisfactory among the donors. Timely communication of the precautionary measures at blood centers to contain the spread of the COVID-19 infection and effective counseling would help in motivating and retaining blood donors.

Bioética en donantes en asistolia controlada

Las campañas de prevención y promoción de salud, así como los avances en las medidas terapéuticas destinadas a los pacientes neurocríticos, han logrado reducir la incidencia de pacientes con injuria encefálica aguda (IEA) que evolucionan a la muerte encefálica (ME). Sin embargo, en la mayoría de los países de América Latina, los órganos perfusibles aptos para trasplante (TX) provienen de donantes fallecidos en ME. La donación en asistolia (DA), y en particular la donación en asistolia controlada (DAC), constituye una opción aceptada y válida para la obtención de órganos que contribuiría a la disminución de las listas de espera para trasplante. Durante el proceso de DAC, se aplican conceptos con fuerte impronta bioética cuya aplicación resulta fundamental en el momento de la toma de decisiones. El presente artículo tiene el objetivo de analizar dichos conceptos con la finalidad de otorgar herramientas válidas al equipo asistencial para aquellos procesos en los que existe deliberación moral, como ocurre en la donación de órganos en asistolia controlada, considerada parte integral de los cuidados al final de la vida.

Campaigns for health prevention and promotion, along with advancements in therapeutic measures for neurocritical patients, have succeeded in reducing the incidence of patients with acute brain injury (ABI) progressing to brain death (BD). However, in most Latin American countries, suitable perfusable organs for transplantation (TX) come from deceased donors in brain death (BD). Donation after circulatory death (DCD), particularly controlled donation after circulatory death (cDCD), represents an accepted and valid option for organ procurement that would contribute to reducing transplant waiting lists. During the cDCD process, strong bioethical principles are applied, and their implementation is crucial when making decisions. The purpose of this article is to analyze these concepts, aiming to provide valid tools to the healthcare team for processes involving moral deliberation, such as controlled circulatory death organ donation, considered an integral part of end-of-life care.

As campanhas de prevenção e promoção da saúde, bem como os avanços na medidas terapêuticas voltadas para pacientes neurocríticos conseguiram reduzir a incidência de pacientes com lesão cerebral aguda que evoluem para morte encefálica (ME). No entanto, na maioria dos países latino-americanos, os órgãos que podem ser perfundidos adequados para transplante (TX) vêm de doadores falecidos em ME. A doação em assistolia e em particular a doação em assistolia controlada (DAC),é uma opção aceita e válida para a obtenção de órgãos, o que contribuiria para a redução das listas de espera para transplantes. Durante o processo DAC, são aplicados conceitos com forte cunho bioético, que são fundamentais na o momento da tomada de decisão. Este artigo tem como objetivo analisar esses conceitos, com o objetivo de oferecer ferramentas válidas à equipe de saúde, para os processos em que há deliberação moral como ocorre na doação de órgãos em assistolia controlada considerada parte integrante dos cuidados de fim de vida.

Fertilización asistida en mujeres de edad reproductiva avanzada, ¿quo vadis?

La donación de ovocitos y embriones se ha convertido en un procedimiento frecuente en mujeres infértiles en edad reproductiva avanzada, con una elevada tasa de embarazo. En estos embarazos aumenta la incidencia de eventos obstétricos adversos, como trastornos hipertensivos, diabetes gestacional, parto operatorio, entre otros, y mortalidad perinatal. Los embarazos múltiples aumentan significativamente los riesgos, por lo que se recomienda la transferencia de un solo embrión. Las pacientes deben someterse inicialmente a un examen médico integral que incluya evaluación cardiovascular y psicológica, evitando el tratamiento en mujeres con enfermedades crónicas que aumentan significativamente los riesgos. En este simposio se revisará el manejo de la infertilidad en mujeres en edad reproductiva avanzada con ovocitos propios y donados, las complicaciones obstétricas y perinatales, así como los aspectos éticos y las consideraciones especiales para tener en cuenta en este tipo de tratamientos.

Oocyte and embryo donation has become a frequent procedure in infertile women of advanced reproductive age, with a high pregnancy rate. In these pregnancies, the incidence of adverse obstetric events (hypertensive disorders, gestational diabetes, operative delivery, among others) and perinatal mortality increases. Multiple pregnancies significantly increase the risks, so single embryo transfer is recommended. Patients should have a previous comprehensive medical examination including cardiovascular and psychological evaluation, avoiding treatment in women with chronic diseases that significantly increase risks. This symposium ill review infertility management in women of advanced reproductive age with own and donated oocytes, obstetric and perinatal complications as well as ethical aspects and special considerations to consider in this type of treatment.

Fertilización asistida con óvulos donados: indicaciones y resultados

Las mujeres retrasan cada vez más la maternidad por diferentes motivos, lo que les ocasiona recurrir a tratamientos de fertilización in vitro (FIV) con óvulos propios u óvulos donados para conseguir embarazo. En los tratamientos de FIV con óvulos donados se realiza una selección estricta de las donantes, quienes son sometidas a estimulación ovárica con posterior aspiración de los folículos. La edad recomendada para donar es entre 21 y 34 años. Se recomienda un máximo de 6 donaciones por donante. La receptora es la persona a quien se le realizará la transferencia del embrión y llevará el embarazo. Las tasas de embarazo con esta técnica de reproducción asistida son altas y las indicaciones más frecuentes son edad materna avanzada y falla ovárica precoz.

Women are increasingly delaying childbearing for different reasons, which causes them to resort to in vitro fertilization (IVF) treatments with their own oocytes or donated oocytes to achieve pregnancy. In IVF treatments with donated oocytes, donors are strictly selected and undergo ovarian stimulation with subsequent follicle aspiration. The recommended age to donate is between 21-34 years old. A maximum of 6 donations per donor is recommended. The recipient is the person to whom the embryo transfer will be performed and who will carry the pregnancy. Pregnancy rates with this assisted reproduction technique are high and the most frequent indications are advanced maternal age and early ovarian failure.

A Gift of Blood: Opinions and Experience of Voluntary Blood Donors on Repeat Blood Donation

Donating blood is an essential practice that can help save lives. Effective strategies are necessary to attract and keep blood donors to meet the demand for safe blood. To evaluate the experience of voluntary blood donors in Zanzibar, a survey was conducted, and purposive sampling was used to select participants who had donated blood multiple times. The study involved interviewing 15 repeat blood donors, and the data collected was analyzed thematically. Two main themes emerged from the analysis: motivators and barriers. Despite a few negative effects, most participants had positive experiences with repeat blood donation, and only few experienced physical reactions during or after the process. The study concludesthat blood donors in Zanzibar generally have good experience towards repeat blood donation, although community participation, education, and sensitization are needed to recruit and maintain more donors.

Ethics of the use of dead human bodies in anatomy teaching in India

The study of the human anatomy predominantly requires the use of remains of the dead. Unclaimed bodies are easily available in India; however, there is a lack of clear ethical guidelines governing their transport and exchange. We raise pertinent questions about the ethical implications of using unclaimed bodies in teaching anatomy, their transport, transfer and storage, ethical and legal issues regarding the voluntary donation of bodies and dry human bones, as well as the commercial aspects of body donation. We also examine existing practices in anatomy departments in India, and explore the available legal safeguards. We detail practical and ethical challenges in the existing practices and safeguards and attempt to provide solutions.

Diálogo sobre doação de órgãos e tecidos: gamification na educação permanente em saúde / A dialog on organ and tissue donation: gamification in permanent education in health / Diálogo sobre donación de órganos y tejidos: la gamificación en educación permanente para la salud

RESUMO Objetivo: sistematizar a experiência da parceria ensino-serviço na elaboração e aplicação de um jogo virtual sobre doação de órgãos e tecidos enquanto proposta de educação permanente em saúde. Método: sistematização de experiência, conduzida por análise documental, envolvendo o processo de elaboração e aplicação de uma prática educativa de gamification por estudantes, professores e profissionais da enfermagem, que desenvolveram a estratégia e aplicaram em um hospital universitário no Sul do Brasil em setembro de 2020. Resultados: ante o contexto sanitário imposto pela covid-19, o jogo virtual composto por 20 questões em torno do processo de doação de órgãos e tecidos para transplantes, enquanto estratégia de educação permanente em saúde, inspirou engajamento e motivação dos profissionais, que mostraram escasso conhecimento acerca da temática e avaliaram a estratégia como positiva. Conclusão: evidenciou-se um caminho potencial a ser replicado em diferentes contextos e temáticas, estimulando e encorajando o processo de cuidado e de educação.

ABSTRACT Objective: to systematize the teaching-service partnership experience in the creation and application of a virtual game on organ and tissue donation as a proposal for permanent education in health. Method: systematization of an experience, conducted through documentary analysis, involving the process to create and apply an educational gamification practice by Nursing students, professors and professionals who developed the strategy and applied it at a university hospital in southern Brazil in September 2020. Results: given the health context imposed by COVID-19, the virtual game consisting of 20 questions about the organ and tissue donation process for transplants, as a strategy for ongoing health education, inspired engagement and motivation among the professionals, who showed limited knowledge about the theme and evaluated the strategy as positive. Conclusion: a potential path to be replicated in different contexts and scenarios was made evident, stimulating and encouraging the care and education processes.

RESUMEN Objetivo: sistematizar la experiencia de la asociación entre enseñanza y servicio en la creación y aplicación de un juego virtual sobre donación de órganos y tejidos en términos de una propuesta de educación permanente para la salud. Método: sistematización de la experiencia, dirigida por análisis documental y abarcando el proceso de elaboración y aplicación de una práctica educativa de gamificación por parte de estudiantes, profesores y profesionales de Enfermería, que desarrollaron la estrategia y la aplicaron en un hospital universitario del sur de Brasil en septiembre de 2020. Resultados: frente al contexto sanitario impuesto por la COVID-19, en términos de estrategia de educación permanente para la salud, el juego virtual compuesto por 20 preguntas sobre el proceso de donación de órganos y tejidos para trasplantes inspiró compromiso y motivación en los profesionales, quienes demostraron escasos conocimientos acerca de la temática y evaluaron la estrategia como positiva. Conclusión: se evidenció un potencial camino a ser replicado en diferentes contextos y temáticas, estimulando y alentando el proceso de la atención y educación en salud.

Eye banking and keratoplasty trend analysis during the COVID-19 pandemic: A South Indian observational study

Purpose: To analyze the impact on eye donation and corneal transplantation during the COVID?19 pandemic in a tertiary eye hospital in south India. Methods: A retrospective analysis of the donor and recipient records during the study period from January 2020 to May 2021 was conducted and tabulated in Microsoft Excel 2013. Demographic details of the donor, utility rate, cause of death, culture characteristics, storage methods, wet lab usage, and the surgical donor outcomes were evaluated. Additionally, the postoperative workup of the recipients, diagnosis, graft infection and rejection episodes, development of COVID?19 postoperatively, and outcome in terms of visual acuity at one, three, and six months were also noted. Results: A total of 466 eyes from 249 donors were received during the study period. The mean age of the donor population was 62.43 years (20.9). The corneal transplantation utility rate was 36.4% (n = 170). Fifty?one percent of the total transplant surgeries were for therapeutic purposes. This was followed by penetrating optical keratoplasty (34%), Descemet’s stripping endothelial keratoplasty (9%), and patch grafts (3%). Seventeen (10%) graft rejection episodes were noted and nine (53%) had complete resolution after medical treatment. Conclusion: Proper preventive measures are key to carrying out safe and efficient eye banking activities even during a deadly pandemic, as COVID?19 transmission via transplantation is rare.

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

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

Study of Hindrances in Sustaining � Body Donation Programme in COVID-19 Era

Rationality : During the COVID-19 pandemic, there has been widespread confusion regarding the acceptance of donated bodies, especially those of COVID-19 unknown status. The present study aims to (1) quantify the fall in the body donation in COVID pandemic times & (2) explore the perception of the recipients of body donation (Anatomy faculties) and the facilitators of body donation (NGO members), regarding the problems they faced. Materials and Methods : A cross sectional study using a pre designed study schedule was conducted over period of two months. 30 Anatomy faculties from 3 Medical Colleges in Kolkata and 20 members from 2 NGOs were interviewed. The actual numbers of the body donation received has been documented from record in Anatomy Departments and actual numbers of the body donation facilitated by NGOs has been obtained from record maintained in NGO office. The responses were analysed accordingly. Results : There was significant decline in body donation activity in all the Medical Colleges during COVID times. 80% Anatomy faculties and 60% NGO members recommended posthumous RTPCR tests for COVID-19 unknown bodies. 93.33% faculties and 60% NGO members also wanted the Government to publish directives for posthumous RTPCR tests in donor抯 body. Most faculties (83.33%) were unsure as to whether embalming fluid can neutralize COVID-19 virus or not. Conclusion, Limitation & Future Scope : This study explored the hesitations, its causes and remedial measures of hindrances in body donation program in COVID times. Being an ICMR STS project, authors needed to wrap up it by only two months time; but it can be used as the pilot to continue same in larger scale. Further researches are required to assess the lethality of embalming fluid on COVID-19 virus in this perspective

La experiencia adquirida a 34 años del primer trasplante de corazón en México / Experience acquired after 34 years of the first heart transplantation in Mexico

Resumen El 21 de julio de 1988, en México se realizó con éxito el primer trasplante de corazón; 34 años después, diversos centros hospitalarios del país efectúan este procedimiento. Aquí se presenta información y comentarios de los resultados obtenidos en este periodo en el Hospital General "Dr. Gaudencio González Garza", Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, donde se han llevado a cabo 234 trasplantes (uno de cada tres efectuados en el país), con una supervivencia a corto y mediano plazo equiparable a la reportada en el resto del mundo. Ese hospital es el único centro que realiza trasplante simultáneo de corazón-riñón y retrasplante cardiaco electivo, con resultados favorables.

Abstract On July 21, 1988, a successful heart transplant was carried out for the first time in Mexico; 34 years later, several hospitals in the country have performed this procedure. We present information and comments on the results obtained within this period at Mexican Social Security Institute La Raza National Medical Center "Dr. Gaudencio González Garza" General Hospital, where 234 transplants have been performed (one out of every three carried out throughout the country), with a short- and mid-term survival comparable to that reported in the rest of the world. This hospital is the only center that performs simultaneous heart-kidney transplantation and elective heart re-transplantation, with favorable results.

Influencing of high sodium donor liver transplantation from the death of a citizen′s organ donation on the prognosis of recipients / 中华消化外科杂志

Objective:To investigate the influencing of high sodium donor liver transplan-tation from the death of a citizen′s organ donation (DCD) on the prognosis of recipients.Methods:The retrospective cohort study was constructed. The clinicopathological data of 125 pairs of donors and recipients who underwent DCD liver transplantation in Xijing Hospital of Air Force Military Medical University from January 2015 to June 2021 were collected. Of the 125 donors, there were 93 males and 32 females. Of the 125 recipients, there were 92 males and 33 females, aged 48(41,55)years. According to the last time of serum sodium level of donor liver in the 125 recipients, 9 donor livers with serum sodium level ≥170 mmol/L were divided into group 1 (extremely high sodium), 33 donor livers with serum sodium level ≥150 mmol/L and <170 mmol/L were divided into group 2 (moderate high sodium), and 83 donor livers with serum sodium level <150 mmol/L were divided into group 3 (normal sodium), respectively. Observation indicators: (1) postoperative recover situations; (2) follow-up and survival analysis. Measurement data with normal distribution were represented as Mean± SD. Repeated measures were analyzed by repeated measures ANOVA. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was analyzed using the Kruskal-Wallis test. Count data were described as absolute numbers, and Pearson chi-square test or Fisher exact probability were used for data test. The Kaplan-Meier method was used to draw survival curves and Log-rank test was used for survival analysis. Results:(1) Postoperative recover situations. The changes of alanine transaminase (AlT), aspartate aminotransferases (AST), total bilirubin (TBil), alkaline phosphatase (ALP), prothrombin time (PT), international normalized ratio (INR), albumin (Alb) and creatinine (Cr) from the first day to the 14th day after operation were (736±972)IU/L to (75±46)IU/L, (1 290±1 651)IU/L to (38±20)IU/L, (102±98)μmol/L to (33±11)μmol/L, (66±34)IU/L to (104±54)IU/L, (19.9±3.3)seconds to (11.3±1.0)seconds, 1.76±0.31 to 1.00±0.08, (34±5)g/L to (38±3)g/L and (91±41)μmol/L to (76±19)μmol/L, respectively, in the recipients of group 1. The above indicators were (505±377)IU/L to (48±46)IU/L, (855±727)IU/L to (24±17)IU/L, (64±42)μmol/L to (32±22)μmol/L, (68±51)IU/L to (91±46)IU/L, (16.8±3.5)seconds to (11.9±1.2)seconds, 1.47±0.30 to 1.04±0.09, (33±4 g/L) to (40±5)g/L and (106±32)μmol/L to (97±27)μmol/L in the recipients of group 2 and (637±525)IU/L to (65±60)IU/L, (929±1 193)IU/L to (33±27)IU/L, (66±48)μmol/L to (33±36)μmol/L, (64±28)IU/L to (125±64)IU/L, (17.2±4.7)seconds to (13.3±12.8)seconds, 1.51±0.42 to 1.05±0.13, (35±6)g/L to (39±4)g/L, (105±44)μmol/L to (94±40)μmol/L in the recipients of groups. Results of overall effect showed there were significant differ-ences in the change trend of TBil (time effect, inter-group effect, interaction effect) in recipients among the three groups after liver transplantation ( Fgroup=5.42, Ftime=22.78, Finteraction=3.85, P<0.05). There were significant differences in the time effect of ALT, AST, ALP, PT, INR, Alb, Cr in recipients among the three groups after liver transplantation ( Ftime=50.17, 36.24, 19.24, 10.55, 59.61, 41.94, 10.82, P<0.05). (2) Follow-up and survival analysis. All recipients were followed up. Cases with early postoperative liver dysfunction, cases with donor liver failure 1 year after operation, cases with biliary complica-tions 1 year after operation, cases with vascular complications 1 year after operation, cases with rejection 1 year after operation were 2, 1, 0, 0, 0 in the recipients of group 1. The above indicators were 2, 1, 3, 0, 1 in the recipients of group 2 and 10, 8,20, 1, 6 in the recipients of group 3. There was no significant difference in the above indicators among the three groups ( χ2=1.58, 0.60, 5.19, 1.62, 0.97, P>0.05). The 1-year and 3-year cumulative survival rates of the donor liver were 100.00% and 100.00% in the recipients of group 1 after liver transplantation. The above indicators were 94.74% and 77.16% in the recipients of group 2 and 91.57% and 89.30% in the recipients of group 3. There was no significant difference in the cumulative survival rate of donor liver among the three groups ( χ2=2.69, P>0.05). The 1-year and 3-year cumulative survival rates were 100.00% and 100.00% in the recipients of group 1 after liver transplantation. The above indicators were 93.74% and 77.16% in the recipients of group 2 and 89.40% and 86.00% in the recipients of group 3. There was no significant difference in the cumulative survival rate among the three groups ( χ2=1.94, P>0.05). Conclusion:Donor livers with high serum sodium level can be used in the DCD liver transplantation.

Construction of post competency model of human organ donation coordinators based on onion model / 器官移植

Objective To construct a scientific and rational post competency model of human organ donation coordinators. Methods Based on the onion model, the index pool was initially constructed by literature research and behavioral event interview. The index system was screened, modified and improved using Delphi method. The weight of indexes at all levels was determined by analytic hierarchy process. Results The effective response rates of two rounds of Delphi expert inquiries were both 100%, indicating that the expert opinions were highly dependable. The experts' judgment coefficient (Ca), familiarity (Cs) and authoritative coefficient (Cr) were all above 0.7, indicating that the experts' opinions were highly reliable. The expert coordination coefficients (W) were 0.294 and 0.342 (both P<0.001), indicating that experts delivered coordinated opinions and yielded slight difference in understanding the importance of indexes. Finally, according to the "onion model" theory and experts' opinions, a set of coordinator's post competency model including 6 first-level and 55 second-level indexes was established, which comprised an index surface layer, a middle layer and a core layer. Among them, the core layer represented core professional values, the middle layer was personal quality and professional ethics and quality, and the surface layer was interpersonal communication capability, organizational cooperation capability and professional knowledge and lifelong learning capability. Conclusions The post competency model of organ donation coordinators established in this study consists of 6 first-level and 55 second-level indexes, which is highly effective and reliable.

Attitudes and influencing factors of transplantation-related populations towards kidney xenotransplantation / 器官移植

Objective To investigate the attitudes and influencing factors of transplantation-related populations towards kidney xenotransplantation. Methods From June 2022 to January 2023, stratified random sampling was performed from patients awaiting kidney transplantation, patients after kidney transplantation, patients' relatives and medical students. Four hundred subjects were collected from each population and 1600 subjects were investigated using a self-designed questionnaire. Baseline data of the respondents, their attitudes towards kidney xenotransplantation and the reasons of rejecting kidney xenotransplantation were analyzed. The influencing factors of attitudes towards kidney xenotransplantation were also identified. Results A total of 1 493 valid questionnaires were collected, and the questionnaire retrieval rate was 93.31%. About 93.10% of the respondents accepted allogeneic kidney transplantation, and 66.78% had heard of kidney xenotransplantation. Seven hundred and ninety-five respondents suggested that they could accept kidney xenotransplantation "when kidney xenotransplantation and allogeneic kidney transplantation yielded the same results and risks". Six hundred and ninety-eight respondents indicated that they were "unable" or "uncertain" whether they could accept kidney xenotransplantation (χ2=16.409，P=0.001). Among these 698 respondents, the proportion of them who were willing to accept kidney xenotransplantation when they did not meet the conditions of allogeneic kidney transplantation was 10.9%. About 35.8% of respondents were willing to accept kidney xenotransplantation if it yielded less risk and better prognosis compared with allogeneic kidney transplantation. If the time of awaiting kidney xenotransplantation was shorter than that of allogeneic kidney transplantation, 21.2% were willing to accept kidney xenotransplantation. If the cost of kidney xenotransplantation was less than that of allogeneic kidney transplantation, 24.5% of them were willing to accept kidney xenotransplantation. The main reasons of rejecting kidney xenotransplantation included surgical risk and other unknown risks. Multivariate analysis showed that respondents residing in cities and towns for a long period of time, those who accept allogeneic kidney transplantation and those who have heard of kidney xenotransplantation showed more positive attitudes towards kidney xenotransplantation. Conclusions Different transplantation-related populations have different attitudes towards kidney xenotransplantation, and the overall attitudes are positive. Active promotion of kidney xenotransplantation research and carrying out relevant popular science education contribute to improving public attitudes towards the acceptance of kidney xenotransplantation.

Effect of perioperative clinical application of enhanced recovery after surgery on elderly recipients undergoing liver transplantation / 器官移植

Objective To evaluate the application value of perioperative interventional strategy guided by enhanced recovery after surgery (ERAS) in elderly recipients undergoing liver transplantation. Methods Clinical data of 405 liver transplant recipients were retrospectively analyzed. According to age, all recipients were divided into the elderly (≥60 years, n=122) and non-elderly groups (< 60 years, n=283). All patients received perioperative interventions under the guidance of ERAS. Intraoperative and postoperative indexes, incidence of postoperative complications and discharge were analyzed between two groups. Results There were no significant differences in the duration of anesthesia, operation time, anhepatic phase, hemorrhage volume, blood transfusion volume, lactic acid level before abdominal closure, ventilator-assisted time, the length of intensive care unit (ICU) stay, Caprini score, CHIPPS score, time of gastric tube, urinary tube and drainage tube removal, time to first drinking, time to first physical activity and time to first flatus between two groups (all P > 0.05). In the elderly group, the time to first feeding was later than that in the non-elderly group (P < 0.05). There were no significant differences in the incidence of fever, ascites, pulmonary infection, delayed gastric emptying, hemorrhage and inactive venous thrombosis between two groups (all P > 0.05). No significant differences were observed in the levels of aspartate aminotransferase, total bilirubin, direct bilirubin, serum creatinine before discharge and total length of hospital stay between two groups (all P > 0.05). The alanine aminotransferase level in elderly recipients was lower than that in non-elderly counterparts, and the difference was statistically significant (P < 0.05). No unplanned reoperation was performed within postoperative 30 d in two groups. There was no significant difference in the re-hospitalization rate within 30 d after discharge (P > 0.05). Conclusions ERAS-guided interventional strategy contributes to perioperative recovery of elderly recipients undergoing liver transplantation, and yields equivalent postoperative recovery between elderly and non-elderly recipients.

Análise de lacunas e perspectivas sobre programas de doação de corpos: relato de experiência no Brasil / Gap analysis and perspectives on body donation programs: experience report in Brazil

Resumo: Introdução: As recomendações internacionais reforçam o estímulo à prática da doação voluntária para a disponibilidade de corpos destinados à formação de profissionais de saúde, substituindo o sistema de corpos não reclamados nas instituições de ensino superior (IES). Relato de experiência: Este trabalho reuniu informações sobre programas de doação de corpos (PDC) brasileiros, analisou lacunas e fatores impeditivos à doação do corpo, e propôs estratégias para ampliar as informações sobre o cadastro de participantes em PDC e a efetivação da doação. Discussão: No Brasil existem 39 PDC em funcionamento - seis no Nordeste, quatro no Centro-Oeste, um no Norte, 11 no Sul e 17 no Sudeste - e duas comissões de distribuição de corpos para ensino. O cadastro como participante no PDC pode agilizar as providências documentais, mas não garante a doação na ocasião da morte. No geral, as IES recebem o corpo doado e a documentação necessária. Quando o óbito acontece no município da IES, é possível ter o translado do corpo providenciado por parcerias com funerárias e prefeitura. Conclusão: Embora a legislação tenha regulamentado desde 2002 a doação do próprio corpo em vida, é necessária a implementação de campanhas de esclarecimento à população geral sobre essa possibilidade, além de mecanismos que possam promover a celeridade nos prazos de para obtenção das documentações com a finalidade de doação de corpo para fins científicos, a isenção das taxas cartoriais e a viabilização do translado do corpo doado por carro de funerária das prefeituras, sem custo. O apoio da IES por meio do cadastro do PDC como atividade de extensão universitária colabora para assegurar aspectos éticos relacionados à participação dos doadores no programa em vida, no que se refere ao tratamento com respeito e dignidade dos doadores e de suas famílias.

Abstract: Introduction: International recommendations reinforce the practice of voluntary donation for providing bodies for the training of health professionals, replacing the system of unclaimed bodies in medical courses (MC). Experience report: This work gathered information on Brazilian body donation programs (BDP), analyzed gaps and difficulties to the effectiveness of body donation, and proposed strategies to expand the information offered on the registration of participants in BDP and the effectiveness of the donation. Discussion: In Brazil, there are 39 BDP - six in the Northeast, four in the Midwest, one in the North, 11 in the South, and 17 in the Southeast - and two committees for body donation. Documents may be easily available through registration during life as a participant in the BDP, but it does not guarantee donation. In general, Brazilian's institutions receive the donated body along with the documentation. When the death occurs in the same city of the institution, it is possible to have the transfer of the body provided by partnerships with funeral services and the city hall. There is no fee to be paid or received either for registration during life or for donation after death. Conclusion: Although the legislation has regulated the donation of body in life since 2002, it is necessary to implement campaigns to inform about the donation, in addition to mechanisms that can promote speed in the deadlines for obtaining documentation for the purpose of donating body for scientific purposes, the exemption of notary fees and the possibility of transporting the body donated with no fees by funeral home of municipal governments. The MC support through the registration of the PDC as an extension activity collaborates to ensure ethical aspects related to the participation of donors in the living program, with regard to the treatment with respect and dignity of donors and their families.

Evaluación estadística relacionada con la donación de sangre a nivel mundial

Objetivo: Dar a conocer las estadísticas relacionadas con la donación de sangre humana a nivel mundial. Métodos: El estudio es de tipo descriptivo comparativo exploratorio de carácter unidimensional. La información fue recopilada de la Organización Mundial de la Salud, World Population Review and Statistical. Para el análisis de la información se empleó la técnica multivariada de clúster. Resultados: Alemania presenta la mayor tasa de donación de sangre, seguido de Dinamarca. En general se aprecia que en los países de Europa existe mayor cultura de donación, mientras en naciones ubicadas en África y algunos países de Asia, se dan las estadísticas más bajas en relación al tema. Conclusiones: Es fundamental incentivar en las naciones programas de educación relacionados con la importancia de donar sangre, asegurando una buena comunicación para derribar algunas barreras entre los posibles donantes.

Objective: To report statistics related to human blood donation worldwide. Methods: the study is a one-dimensional exploratory comparative descriptive study. The information was compiled from the World Health Organization, World Population Review and Statistical. The multivariate clustering technique was used for data analysis. Results: Germany has the highest blood donation rate, followed by Denmark. In general, it can be seen that in European countries there is a greater culture of donation, while in countries located in Africa and some Asian countries, there are lower statistics on the subject. Conclusions: It is essential to encourage education programs in the countries related to the importance of donating blood, ensuring good communication to break down some barriers among potential donors.

Perspectivas de uma comunidade universitária acerca da doação de corpos para estudo em anatomia humana / Perspectives of a university community about body donation for human anatomy study

Resumo: Introdução: O cadáver é uma peça insubstituível no aprendizado da anatomia humana, pois permite uma visão tridimensional das estruturas anatômicas. Entretanto, observa-se um cenário de escassez e aumento da demanda das peças cadavéricas nas universidades brasileiras. Logo, diversas instituições, amparadas no artigo 14 da Lei nº 10.406/2002 do Código Civil brasileiro, implementaram programas de doação de corpos interessados em trazer melhorias significativas na qualidade de ensino da disciplina de anatomia. Objetivo: Este estudo teve como objetivo analisar o grau de conhecimento e as perspectivas de uma comunidade universitária a respeito da doação voluntária de corpos cadavéricos para fins educacionais e de pesquisa. Método: Trata-se de um estudo observacional, transversal e prospectivo com abordagem quantitativa e coleta de dados por meio de questionário individual. Os sujeitos incluídos foram os docentes e discentes da Universidade Federal do Maranhão (Ufma), campus Dom Delgado. Os questionários eram relativos à obtenção de informações sobre o conhecimento e a opinião acerca da temática da doação de corpos. Resultado: Obteve-se um total de 264 questionários respondidos, os quais mostraram que 85,65% dos discentes e 87,1% dos docentes tinham conhecimento acerca da possibilidade da doação do próprio corpo. Contudo, observou-se que 94% dos entrevistados não sabiam que procedimentos eram necessários para a doação, e 86% não possuíam conhecimento acerca da legislação que permitia tal prática. Ademais, 27,65% dos participantes estavam aptos a doar o próprio corpo, 33,7% apontaram que não doariam e 38,9% informaram que não tinham opinião formada. O principal motivo apontado para doar foi: "para contribuir com o avanço da educação na área da saúde", e para não doar: "quero ser enterrado ou cremado". Conclusão: Existe um alto percentual de indivíduos que não conhecem os meios para realizar a doação de corpos, sendo evidenciado que os participantes apresentam baixa aptidão para doação. Contudo, existe um percentual significativo de indivíduos que não tem opinião formada sobre o assunto, demonstrando que a divulgação dessa temática é um meio para aumentar a adesão a tal prática. É importante realizar o desenvolvimento de programas de doação de corpos para solucionar a problemática.

Abstract: Introduction: The cadaver is an irreplaceable piece in the learning of human anatomy, allowing a three-dimensional view of anatomical structures. However, there is a scenario of scarcity and increased demand for cadaveric parts in Brazilian universities. Therefore, several institutions, supported by article 14 of Law 10.406/2002 of the Brazilian Civil Code, implemented body donation programs aimed at bringing significant improvements in the teaching quality of the anatomy discipline. Objective: To analyze the level of knowledge and perspectives of a university community regarding the voluntary donation of cadaveric bodies for educational and research purposes. Method: This is an observational, cross-sectional and prospective study with a quantitative approach and data collection through an individual questionnaire. The subjects included in the study were teachers and students from the Federal University of Maranhão, Campus Dom Delgado - UFMA. The questionnaires were related to obtaining information about knowledge and opinions on the topic of body donation. Result: A total of 264 answered questionnaires were obtained, which showed that 85.65% of students and 87.1% of teachers were aware of the possibility of donating their own bodies. However, it was observed that 94% of the interviewees did not know what procedures were necessary for the donation, and 86% did not have knowledge about the legislation that allowed this practice. Furthermore, 27.65% of the participants were able to donate their own body, 33.7% indicated that they would not donate and 38.9% reported that they had no formed opinion. The main reason given for donating was: "to contribute to the advancement of education in the health area", and for not donating: "I want to be buried or cremated". Conclusion: There is a high percentage of individuals who do not know how to carry out the donation of their own bodies, being evidenced that the participants have low aptitude for donation. However, there is a significant percentage of individuals who do not have a formed opinion on the subject, demonstrating that the dissemination of this topic is a means to increase adherence to this practice. It is important to carry out the development of body donation programs to solve the problem.

Pre-and post-donation ferritin level of blood donors attending University of Calabar Teaching Hospital, Donor Clinic in Southern Nigeria

While trying to save the patient via blood transfusion, the safety of the blood donor is paramount. This study evaluated the pre-and post-donation ferritin and packed cell volume (PCV) of donors attending University of Calabar Teaching Hospital.Method: The study adopted descriptive longitudinal approach. A total of 18 donors with age range of 18 ­48years were enrolled and followed up for 30 days post-donation. The serum ferritin was analyzed using ELISA method while the PCV was analyzed using the microhematocrit method. Difference between means was performed using repeated measure ANOVA while post hoc was done using Bonferroni adjustment. Prediction of return to baseline values were performed using logistic regression. Alpha value was placed at 0.05 There was a decline in ferritin and packed cell volume from pre-to post-donation. The decline in ferritin was imminent until day 14 when recovery was initiated. Significant difference was observed between the pre-donation ferritin and the rest of the days except day 30. There was also a decline in PCV from pre-donation all through with recovery noticeable after day 7. The PCV of the pre-donation was only comparable to the day 30 post-donation. Approximately 5.6% (n=1) of the subjects was iron deficient pre-donation.Approximately 25% (n=4) of the subject have returned to baseline PCV while 0% of the subjects have returned to baseline ferritin at day 30 post-donation.Conclusion: For the safety of the donor, donation interval should be widened, and iron supplement followed up