Critical pathway for deceased donors: An analysis in three regions of Colombia / Ruta crítica de donantes fallecidos: un análisis de tres regiones en Colombia

Introduction. The critical pathway for deceased donation offers a methodical framework for guiding the donation process. It not only serves to assess performance but also to identify areas of potential improvement. Therefore, the identification and selection of potential organ donors (POD) is a key process. This study aims to describe the critical pathway for deceased donation in a cohort of POD in three regions (CRT1, CRT2, and CRT5) of Colombia. Methods. We retrospectively reviewed data of POD assessed from January 2022 to December 2022. General characteristics of POD, diagnosis, contraindication causes, and organ procurement were described. Analysis was conducted using the Chi-squared test for categorical variables and the Mann-Whitney test for quantitative variables. Results. Within the cohort of 1451 assessed POD, 441 (30.3%) were diagnosed with brain death. Among potential donors after brain death, 198 (44.9%) were eligible donors (medically suitable). Of these, 157 donors (79.3%) became actual donors (undergoing operative incision for organ recovery), with 147 (93,6 %) having at least one organ recovered (actual donors with organ recovery). Ultimately, 411 utilized organs were utilized. Additionally, there were observed differences in the characteristics of donors from different regions. Conclusion. This study reports the critical pathway for deceased donation in a cohort of POD in three regions of Colombia. This provides useful information and helps to gain insight and understanding into the process of organ donation and organ procurement in order to take actions that could improve the donation rates.

Introducción. La ruta crítica de donantes fallecidos permite un enfoque sistemático para la donación de riñón, y, proporciona una herramienta para evaluar el rendimiento de áreas de mejora potencial. La selección de posibles donantes de órganos (PDO) es un proceso clave. El objetivo de este estudio fue describir la ruta crítica para la donación de fallecidos en una cohorte de PDO en tres regiones de Colombia. Métodos. Estudio retrospectivo de PDO evaluados durante 2022. Se describieron las características generales de los PDO, el diagnóstico y las causas de contraindicación. El análisis se llevó a cabo utilizando la prueba de Chi-cuadrado para las variables categóricas y la prueba de Mann-Whitney para las variables cuantitativas. Resultados. Entre los 1451 POD evaluados, 441 (30,3 %) fueron diagnosticados con muerte cerebral. De los posibles donantes después de la muerte cerebral, 198 (44,9 %) fueron donantes elegibles (adecuados desde el punto de vista médico). Entre ellos, 157 donantes (79,3 %) fueron donantes reales (en quienes se realizó una incisión operatoria con la intención de recuperar órganos) y 147 (93,6 %) tuvieron al menos un órgano recuperado (donantes reales con recuperación de órganos). Finalmente, se identificaron 411 órganos utilizados. Conclusión. Este estudio reporta la ruta crítica para la donación de fallecidos en una cohorte de POD en tres regiones de Colombia. Esto proporciona información útil, ayuda a obtener conocimientos y comprender el proceso de donación y obtención de órganos, para tomar medidas que puedan mejorar las tasas de donación.

Capacity Building of Ethical Review of Organ Transplantation Ethics Committee in China / 中国医学伦理学

The construction of clinical application and ethics committee of human organ transplantation technology is constantly improving in China. The review of clinical application and ethics committee of human organ transplantation technology should follow the principle of prudence, with high requirements for timeliness and cumbersome preparation, and living organ transplantation needs to weigh the risk benefit ratio of both donors and recipients. According to the problems often existing in China’s clinical application and ethics committee of human organ transplantation technology, such as lack of supervision and guidance, lack of unified standard operating procedures, insufficient attention to the rights and interests of organ donors after citizens’death, the difficulties to judge and implement of brain death, lack of psychological assessment requirements and procedures, inadequate informed consent, etc. It can be solved from the following aspects: ensuring the independence of ethical review, strengthening the risk benefit ratio assessment of both donors and recipients of living organ transplantation, standardizing the review content, strictly implementing informed consent and medical psychological assessment to reduce the risks of both sides, enriching review methods to ensure timeliness, and strengthening the ethical review and supervision of organ donation.

Experience and Reflection on the Ethical Review of Organ Donation and Transplantation after Citizens’ Death in Medical Institution / 中国医学伦理学

In order to explore the ethical review experience of organ donation and transplantation after the death of citizens, and provide reference value for medical institutions to carry out corresponding ethical review. By using descriptive research, purpose sampling method and the principle of data saturation, 10 members and secretaries of ethics committee on clinical application of organ transplantation technology were finally selected as respondents for semi-structured interviews. The Colaizzi 7-step analysis method was adopted to analyze, summarize and refine the theme. The results showed that the ethical review experience of organ donation and transplantation after the death of citizens included four themes: the responsibilities of ethics committee, the key points of ethics review, the form of ethics review conference and its advantages and disadvantages, and the construction of the ethics committee of organ transplantation. Therefore, there are defects in the ethical review of organ donation and transplantation in medical institutions at present. These can be remedied by enriching elements of the ethical review following the four principles of medical ethics, refining the laws related to organ donation after citizens’ death, constructing a reasonable and efficient pattern of ethical review conference, and establishing a robust and appropriate operation mode of organ transplantation ethics committee.

Discussion on Difficulties of Ethical Review of DCD Organ Donation and Transplant based on Cases / 中国医学伦理学

The ethics committee of organ transplantation technology and clinical application in a hospital has encountered some difficulties and typical cases in its review work and practice for many years. Sometimes, it is difficult to make a decision in these dilemmas. Based on the previous experience of the hospital in the ethical review of organ donation and transplantation, combined with two typical cases, this paper discussed and analyzed two review points of whether the voluntary unpaid donation and the principle of informed consent were met, and whether the risk-benefit ratio was reasonable, and put forward relevant ethical and legal countermeasure for further research by institutional ethics committees and other parties, in order to provide reference for discussing the practical problems and ethical confusion of ethical review of organ donation and transplantation.

Ethical Thoughts on the Quality Evaluation of the Kidneys from Expanded Criteria Donors / 中国医学伦理学

In the case of extremely shortage of donor kidney sources, the number of Expanded Criteria Donors (ECD) with relatively poor kidney quality and transplantation effect is increasing. In order to alleviate the contradiction between supply and demand by using transplantable kidneys as much as possible and avoid the failure or poor effect of transplantation caused by poor quality kidneys, the quality assessment and evaluation criteria of ECD kidney have become a research hotspot in the field of kidney transplantation. This paper analyzed the possible ethical defects in the research process, and put forward some suggestions for the transplantation team to strictly follow the ethical principles of "no harm", "beneficial" and "informed consent", and the organ transplantation ethics committee to pay attention to the ethical review of the quality evaluation process of ECD donor kidney.

Qualitative Study on the Cognition Status of Organ Donors’ Family Members to Advance Care Planning / 中国医学伦理学

Discussing the cognition, attitude and influencing factors of the family members of organ donors towards advance care planning (ACP) to provide a basis for the further promotion of ACP in the field of organ donation. Using qualitative research methods, 8 family members of organ donors were selected purposefully for semi-structured interviews, and the 7-step of Colaizzi was used to analyze and summarize the themes of the interview data. The results showed that the cognition status of the family members of organ donors of ACP could be summarized into 3 themes: problems faced by ACP implementation, positive recognition of the implementation of ACP, factors affecting the promotion of ACP. Organ donors’ family members are unfamiliar with the concept of ACP and have unclear cognition, but think that the implementation of ACP is of positive significance. It is suggested to further strengthen the publicity of ACP, medical autonomy, death education, so as to promote the development of ACP and improve the willing to donate organ.

Organ Donation in the New Era under the Influence of Traditional Culture / 中国医学伦理学

The "Chinese model" of organ donation and transplantation in China has gradually been praised by the world. However, the shortage of organ is still the biggest difficulty at present, so it is urgent to improve the organ donation rate among the public and the number of individual organ donations. Through combing and analyzing some important values in Chinese traditional culture, this paper tried to help today’s organ donation find an appropriate value guidance, in order to promote the development of organ donation and transplantation in China.

Progress in quality management and control of donor organ procurement in foreign countries / 器官移植

Since the 20th century, organ transplantation has become a breakthrough technology to effectively save the lives of patients with end-stage organ failure, which has significantly enhanced the quality of life of patients. Organ donation is an important source of organ transplantation. Improving the quality of donor organ procurement is the key to promote the translation of donor organs and improve the prognosis of organ transplantation recipients. The United States, Spain and other countries have put forward a series of policies and standards in the quality management and control of donor organ procurement and achieved positive results. In this article, related concepts of medical quality management and control, advanced strategies and models of international donor organ procurement quality management, and quality control measures of Organ Procurement Organization, donors and donor organs were reviewed, aiming to provide reference for establishing a quality management and control system of donor organs with "Chinese characteristics" and advancing high-speed and high-quality development of donor organ procurement.

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.

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.

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.

Internal audit of Organ Procurement Organization under the requirements of high-quality development / 器官移植

High-quality development is the primary task of building a socialist modern country in an all-round way. Organ donation and transplantation in China are evolving from high-speed growth to high-quality development, which put forward new requirements for the safe, stable and healthy operation of Organ Procurement Organization (OPO). Safety is the foundation and prerequisite for achieving the goal of high-quality development. As an independent and comprehensive department, internal audit should create new achievements in the new era. The department should include OPO and organ donation into the scope of internal audit, shift the emphasis upon the overall development of organ donation. Besides, it should fully consider the actual situation in different places, conduct all-round, objective and fair evaluation, provide evaluation and consulting services for OPO to properly implement organ donation, and give full play to the supervision and prevention role of internal audit.

Exploration on standardized management of ethical review of organ donation after citizen’s death / 器官移植

Objective To explore the standardized management mode of the Ethics Committee for organ donation after citizen’s death in hospitals. Methods The situations of ethical review before and after the standardized adjustment of the Ethics Committee of human organ donation in the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. Baseline data of donors before and after standardized adjustment of the Ethics Committee of human organ donation were compared. The influence of standardized adjustment of the Ethics Committee on the attendance rate of committee members and duration of ethical review were analyzed. Results No significant differences were observed in donors' ethical review data, such as gender, age and death determination, before and after standardized adjustment of Ethics Committee structure (all P>0.05). Significant difference was noted regarding the cause of death in ethical review (P<0.05). Univariate analysis showed that there were significant differences in the impact of Ethics Committee standardization adjustment and cause of death on the attendance rate of committee members (both P<0.05). Multivariate analysis revealed that gender, cause of death and standardized adjustment of the Ethics Committee were the influencing factors of the attendance rate of committee members, and the attendance rate of committee members after standardized adjustment was higher than that before adjustment (P<0.05). Univariate analysis showed that there were statistically significant differences in the effects of Ethics Committee standardized adjustment, attendance rate of committee members and cause of death on the duration of ethical review (all P<0.05). Multivariate analysis indicated that standardized adjustment of the ethics committee was the influencing factor of the duration of ethical review, and the duration of ethics review after standardized adjustment was shorter than that before adjustment (P<0.05). Conclusions Appropriate arrangement of the total number of ethics committee members and standardizing the review process may improve the efficiency of ethical review. Scientific evaluation mechanism for ethical committee members should be established by dynamically adjusting the ethical committee members, clarifying the responsibilities and tasks of members and secretaries, aiming to further improve standardized management level of ethical review for organ donation after citizen’s death.

Ethical construction of recipients’ rights and interests protection in organ transplantation from expanded criteria donors / 器官移植

Under the background of severe shortage of donor organs and organ donation after citizen's death becoming the main source of donor organs in China, expanded criteria donor (ECD) has been widely applied in clinical practice. However, ECD has the disadvantages of basic diseases, old age, trauma, shock or infection, which will affect the quality of donor organs to varying degrees and become one of critical factors affecting clinical efficacy of organ transplantation. The recipients of ECD organ transplantation will also bear the additional risk and uncertainty of efficacy brought by ECD organs. Hence, it is necessary to pay attention to the protection of the recipients’ rights and interests. In this article, ethical issues faced by ECD organ transplantation in recipient protection and the shortcomings in the ethical review of organ ethics committee were reviewed, and suggestions on the ethical review institution and system construction of the rights and interests of organ transplantation recipients were elucidated, aiming to provide reference for promoting the advancement of ECD organ transplantation.

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.

Current research status and prospect of organ donation discipline construction in China: a bibliometric analysis / 器官移植

Objective To refine and summarize the research status and development trend of organ donation discipline in China. Methods Relevant Chinese and English literatures related to organ donation were searched from China National Knowledge Infrastructure (CNKI) and Web of Science core collection database from January 1, 2018 to December 31, 2022. Visual analysis was performed by the CiteSpace software from the number of published articles, keywords, journal source distribution, cooperation network of core authors, main research institutions, and citation of key literatures, etc. Results A total of 792 articles were published from 2018 to 2022, with an average annual number of 158 articles, which showed a rapidly upward trend. Among them, 182 articles were published in the form of postgraduate dissertation, accounting for 23%. Common keywords included organ transplantation, brain death, cardiac death, willingness/cognition/attitude, legal system, influencing factor/risk factor, infection/complication, Organ Procurement Organization, prognosis/quality, education for college students/medical students, extracorporeal membrane oxygenation, children, ischemia-reperfusion injury, donor-derived infection, ethics, expended criteria donor, nursing and coordinator, etc. Keyword clustering hotspots focused on the theme of “organ donation” and branched into multiple disciplines. The publications of research results were characterized with pluralism and diversity, and the research contents were centered on medicine and spanned a wide range of disciplines. A large proportion of researches were published by the teams from large-scale organ transplantation institutions, and relatively close cooperative relationship was formed within the institutions. However, the intensity of cooperation among different institutions was relatively low, and the cooperative relationship among authors was insufficient, which failed to form an intimate academic network. The top five countries worldwide regarding the number of published articles were the U.S. (n=940), U.K. (n=377), Spain (n=263), Canada (n=241) and China (n=181), indicating that the achievements of Chinese researchers have been gradually recognized in the international academic community. Conclusions From the quantity and content of published articles in recent years, “organ donation” has laid certain research foundation in China. It is one of the topics concerned and widely studied by multiple academic communities in China. Relevant research issues have multidisciplinary, plural and diverse characteristics.

Establishment of a long-term operation mechanism for sustainable development of united OPO / 器官移植

Human Organ Procurement Organization (OPO) is an indispensable part of organ donation. In recent years, with rapid development of organ donation in China, united OPO has been established based on China's national conditions and establishment of global OPO. This innovative model serves as favorable supplement and exploration for the development of OPO, promoting the development of organ donation to enter a new stage. However, there are still some shortcomings during the process of development. Efforts should be made to catch up with the development of organ donation, aim at long-term goals, and promote development in a targeted manner. In this article, by analyzing the advantages and disadvantages of united OPO in the development of organ donation, the establishment of a long-term operation mechanism of united OPO was analyzed from policy support, talent training, technology upgrading, quality control, ethical review, financial management and full-course supervision, aiming to provide reference for further development of united OPO in China.

Discussion on the establishment of the discipline of "organ donation" / 器官移植

Vivid and abundant social practice constantly creates new understanding, which will inevitably lead to the emergence of new disciplines. Organ donation discipline is involved with multiple disciplines, such as ethics, law, medicine, sociology and psychology, etc. After entering a new stage of high-quality development, whether it is necessary to establish the discipline of "organ donation" is worthy of discussion. According to the basic standards for establishing a new discipline, groundbreaking achievements in organ donation could lay a solid foundation for the establishment of "organ donation" discipline. However, current conditions for the establishment of "organ donation" are not fully mature, and the process of discipline establishment will absolutely encounter resistance. In the future, the scope and orientation of organ donation should be further elucidated, and a series of measures should be taken, such as establishing independent academic organizations, offering organ donation courses, carrying out special research and innovation, and strengthening international cooperation and exchanges, aiming to promote the establishment of organ donation discipline. The cooperation between academic community and governments is the key to promote the establishment of the discipline of organ donation. Governments will make final decisions by comprehensively considering the investment of resources, development needs of the discipline and the relationship among existing disciplines.

Assessing Countries’ Deceased Organ Donation and Transplantation Performance

@#Introduction: Donors per million population and transplantations per million population are standardized, widely used indicators to assess and compare countries’ performance in organ donation and transplantation. This study aims to investigate these two particular metrics of organ donation and transplantation performance, and to introduce a new index, namely, ‘transplantations per patients on the waiting list’. Methods: Secondary analyses of data on 23 countries in 2016 were used to construct the transplantations per patients on the waiting list indicator for kidney, liver, pancreas, heart, and lung transplantation, as well as for the transplantation of any of the five aforementioned organs. Results: According to the transplantations per patients on the waiting list, the best-performing countries in terms of organ donation and transplantation are Belarus for kidney transplantation, Finland for liver and pancreas transplantation, Australia for heart transplantation, and France for lung transplantation. Considering all five organs together, Sweden, Australia, Finland, Austria, and Poland were the top five best-performing countries, followed by Spain in the sixth position. Conclusion: The deceased transplantations per patients on the waiting list can be an alternative indicator to assess performance, along with the widely-used donors and transplantations per million population, but still has its limitations in certain scenarios.

Exploration of human resource management practice for organ donation coordinators in public hospitals / 中华医院管理杂志

The human resource management of organ donation coordinators in China is still in its infancy stage, plagued by such problems as unclear career orientation, poor management and unclear career planning. In March 2010, a tertiary public hospital was approved as a medical institution in a national pilot province for organ donation. In recent years, the hospital had kept exploring human resource management of coordinators and established a relatively complete management mode for organ donation coordinators. This mode featured the establishment of full-time recruitment positions, development of human resource management plans, refinement of job descriptions, establishment of performance evaluation plans, optimization of assessment and incentive mechanisms, and innovation of talent cultivation modes. The management practice had achieved certain results, ensuring the sustainable development of hospital organ donation operation, and providing a reference for the scientific and standardized development of organ donation and transplantation in China.