Research progress in cognition, attitude and willingness for organ donation among ICU staff in China / 器官移植

In recent years, organ donation and transplantation have entered a stage of steady development in China. Nevertheless, the shortage of transplant organs and the contradiction between supply and demand of organs are still the bottlenecks to achieve the strategy of "self-sufficiency in organ transplantation" advocated by the World Health Organization (WHO). The key reasons for donor loss described in the "critical pathway of organ donation" defined by the WHO include the identification and referral of potential donors and the maintenance and repair of organs. Smooth development, high efficiency and high-quality development of organ donation cannot be achieved without the support of intensive care medicine, which are highly associated with the cognition, recognition and participation of intensive care unit(ICU) staff. In this article, research progress in ICU staff’s cognition, attitude and willingness for organ donation were reviewed and relevant influencing factors were discussed, aiming to offer targeted suggestions on how to resolve these difficulties.

Expert consensus on communication with families of organ and tissue donors / 器官移植

Communication with families of donors is the critical procedure of organ and tissue donation, which is the key to determine the success of donation. Expert Consensus on Communication with Families of Organ and Tissue Donors was formulated by multidisciplinary experts to help the families of potential organ and tissue donors to understand the right of independent decision of organ donation given by law, improve the communication efficiency with families, fully showcase the humanistic care, enable relevant practitioners to maintain professional working status and healthy psychological state in the long term, share and summarize the optimal clinical experiences in different places, and discuss and resolve the difficulties during the communication with families. This expert consensus focuses on the key issues during the communication with families of organ and tissue donors and formulated by multidisciplinary experts after literature review. The expert panel has reached consensus by Delphi method for voting. Eighteen key elements and recommendations for communication with families of potential organ and tissue donors have been proposed, aiming to provide guidance for communication with families of organ and tissue donation. This consensus has been registered both in Chinese and English on International Practice Guidelines Registry Platform.

Single-center data analysis of organ donation and utilization after citizen's death / 器官移植

Objective To get a knowledge of the current status of organ donation and utilization after citizen's death in Wuxi District, and thereby provide ideas and basis for further development of organ donation work in local areas. Methods Clinical data from 151 organ donors, included 37 successful donors and 114 potential donors, were retrospectively analyzed. The reasons for donation failure of potential donors were analyzed. The general information for successful donors was collected. And the information on organ donation and organ utilization in successful donors were analyzed. Results Among the 151 organ donors, 37 were successful donors, with the conversion rate reaching 24.5%. For the 114 donors with failed organ donation, the reasons for failure included family disagreement, failure to meet donation status criteria, insufficient evaluation time, and unresolved work injury disputes. The categories for organ donation included 34 cases of donation after brain death followed by cardiac death (DBCD), 3 cases of donation after brain death (DBD), and no case of donation after cardiac death (DCD). The reasons for death of donors includes 19 cases of craniocerebral trauma, 14 cases of stroke and 4 cases of others. Among the 37 cases of successful donors, the majority were floating population. A total of 154 major organs and tissues were donated, of which 124 were major organs. The number of major organs and tissues donated per citizen was (4.2± 1.6) and the number of major organs donated per citizen was (3.4± 1.1). The utilization rate of the 154 donated organs reached 96.7% (149/154), with Nanjing, Wuxi, Suzhou and Changzhou ranking the top 4 of organ distribution. Conclusions The rate for successful organ donation and conversion after citizen's death is low in Wuxi District. The organ donation work networks in local areas should be established. And organ donation promotion efforts and skills training for coordinators should be developed.

Exploration and practice of organ donation prevention and control management under COVID-19 epidemic / 器官移植

Novel coronavirus pneumonia (COVID-19) is currently raging worldwide, and the prevention and control situation is very grim. Gratifying achievements of organ donation have been made in China since its implementation. Due to the characteristics of potential donors, such as complicated personnel structure, sudden onset and critical illness, it is necessary for multi-department to contact with the donors and their families during the work link of donor evaluation, family communication, donor transportation, organ function maintenance and organ procurement, which raises higher requirement for the screening and management of potential donors under COVID-19 epidemic. During the outbreak, Beijing Youan Hospital, Capital Medical University has completed 9 cases of organ donation, formulated the relevant screening process, established the prevention and control requirements, and gained certain experience and effects, which benefits the orderly and smooth development of organ donation under the COVID-19 epidemic.

Key strategies of ICU in promoting organ donation: a relay for life / 器官移植

Organ transplantation is an effective treatment for end-stage organ failure. However, organ shortage has always been a common problem faced by countries around the world. The recognition and active participation of intensive care unit (ICU) medical staff in organ donation contributes to promoting the development of organ donation, thereby alleviating the shortage of donor organ. In this article, the key strategies of ICU donor management to promote organ donation and the key strategies of ICU medical staff management to promote organ donation were summarized, aiming to provide reference for organ donation practitioners (especially ICU medical staff) and jointly facilitate the professional development of organ donation.

Program to Activate the Notification of the Potential Donors

Transplantation has developed as an established treatment modality for endstage organ diseases. However, the shortage of available organs remains the main obstacle to organ transplantation. The big discrepancy between the number of potential recipients on the waiting list and cadaveric transplantations has become a serious issue in Korea. The first step in the process of cadaveric organ donation is the identification of potential donors. The identification and notification of potential donors are essential for the activation of cadaveric organ donations. To increase the number of brain dead donors following components are critical: the increase of public understanding of organ donation, improvement of legal and systematic processes, establishment of a donor action program, interests and cooperation of attending physicians, and management of an organ donation process focused on donor families. Public education and campaign are also crucial to the understanding of brain death and organ donation. To improve legal and systematic processes, required referrals or routine notifications are advisable. Also, presumed consent is necessary to decrease the psychological stress on donor families during the agreement process. For the effective management of a donor action program, an education program to well-train medical staff and medical record reviews should be maintained. In conclusion, a comprehensive donor action program including a practical donor detection system, an education program, and improvement of the organ donation system are mandatory to increase the cadaveric organ donations effectively.

Improvement of Hypoxemia by Repetitive Alveolar Recruitments in Brain-dead Donor: A case report / 대한마취과학회지

Brain-dead potential donors manifest devastating physiological changes associated with pulmonary edema, profound hemodynamic and metabolic abnormalities. These derangements may be more significant after apnea tests which result in severe hypoxemia and cardiovascular complications. De-recruitment can occur following apnea tests in the brain-dead donor whose ventilator support has been maintained with high positive end-expiratory pressure (PEEP), and recruitment maneuvers are intended to open collapsed lung units. We report a brain-dead potential donor with severe hypoxemia and hemodynamic instability after apnea tests, which improved after multiple alveolar recruitments with adequate vasoactive drugs. Multiple high-pressure recruitment maneuvers will be helpful for expansion of lung collapse with improvement of severe hypoxemia after de-recruitment which could be developed with apnea tests in brain-dead organ donor.