With a focus on Asia and a global perspective: sustainable development of donation after brain death

Organ shortage is a prevalent problem within the global transplantation community. World Health Organization (WHO) calls on all countries to achieve self-sufficiency in organ transplantation by reducing the burden of diseases and expanding the effective source of organs in line with ethical principles. Donation after brain death (DBD) remains the major source of transplant organs. In recent years, some Asian countries, including China, have actively promoted the development of donation from deceased organs, which are gradually reshaping the situation of living organ donation as the main source of transplant organs in Asia. The outbreak of COVID-19 in 2020 slowed down the growth trend of global organ donation and transplantation in the past decade. On the premise that the burden of disease and the need for transplantation have not been significantly reduced, the work of organ donation and transplantation in China has been steadily carried out under the guidance of the general policy of epidemic prevention and control and relevant policies of “Put people and their lives first, and adhere to the dynamic zero-Covid policy”. This proves to a certain extent that under the continuous drive of the people’s medical demands and transplant demands, China has formed an organ donation and transplant work system with resilience, pressure resistance, operational inertia and the survival of the industry. Look at Asia from China, and look at the world from Asia. In this article, by compiling relevant data of organ donation and transplantation in Asia and around the world, the changes of the overall pattern of organ donation and transplantation in Asia during the new developmental trend of global organ transplantation were illustrated, the influencing factors of DBD were identified by analyzing the developmental characteristics and practical experience, and corresponding effective strategies were proposed, aiming to provide professional reference for sustainable and healthy development of organ donation and transplantation in China and throughout Asia. (English) [ FROM AUTHOR]

Organ donation after cardiac death in Japan

In Japan, since the revision of the Organ Transplant Law in July 2010, donation after brain death (DBD) has increased, while donation after cardiac death (DCD), which has been mainly used by kidney transplantation, has decreased. The number of DCD donors decreased from 98 in 2009 to 28 in 2019. There is no clear reason for the decrease in DCD donors. Furthermore, since 2020, there has been a marked decrease in DCD due to the influence of the COVID-19 pandemic. On the other hand, the outcomes after kidney transplantation from DCD donors are improving year by year. The outcomes of kidney transplantation from DCD donors in Japan are comparable to those of kidney transplantation from DBD donors in Western countries. In order to further improve transplantation outcomes from DCD donors, the clinical introduction of continuous machine perfusion preservation technology, for the purpose of reducing ischemic reperfusion injury, is expected in Japan.

Anesthetic Considerations During Heart Transplantation Using Donation After Circulatory Death.

Worldwide, the majority of heart transplant organs are from donation after brain death. However, the shortage of suitable donors places severe limitations on this route. One option to increase the donor pool is to use organs from donation after circulatory death (DCD). Transplant centers for solid organs have been using DCD organs for years. At this time, 40% of solid organ transplantation in the United Kingdom uses organs from DCD. Use of DCD for solid organ transplants in Canada is also rising. Recently, there has been interest in using DCD organs for heart transplantation. The authors will discuss their experience of 4 heart transplants with organs from DCD donors after normothermic regional perfusion (NRP). The authors' first heart transplant using a DCD organ was in January 2020, and the fourth was in March 2020, just before the coronavirus disease 2019 (COVID-19) pandemic. The authors' protocol using NRP allows adequate evaluation of the donor heart to confidently determine organ acceptance. The co-location of the donor and the recipient in neighboring operating rooms limits ischemic times. Avoidance of an expensive ex vivo organ perfusion machine is an additional benefit for programs that may not have the resources required to purchase and maintain the machine. Some hospitals may not have the resources and space to be able to co-locate both the donor and recipient. Use of cold storage may be an option to transport the procured organ, similar to donation after brain death organs. The authors hope that this technique of NRP in DCD donors can help further increase the donor pool for heart transplantation in the United States.

Online education about end-of-life care and the donation process after brain death and circulatory death. Can we influence perception and attitudes in critical care doctors? A prospective study.

Impact of training on end-of-life care (EOLC) and the deceased donation process in critical care physicians' perceptions and attitudes was analysed. A survey on attitudes and perceptions of deceased donation as part of the EOLC process was delivered to 535 physicians working in critical care before and after completion of a online training programme (2015-17). After training, more participants agreed that nursing staff should be involved in the end-of-life decision process (P < 0.001) and that relatives should not be responsible for medical decisions (P < 0.001). Postcourse, more participants considered 'withdrawal/withholding' as similar actions (P < 0.001); deemed appropriate the use of pre-emptive sedation in all patients undergoing life support treatment adequacy (LSTA; P < 0.001); and were favourable to approaching family about donation upon LSTA agreement, as well as admitting them in the intensive care unit (P < 0.001) to allow the possibility of donation. Education increased the number of participants prone to initiate measures to preserve the organs for donation before the declaration of death in patients undergoing LSTA (P < 0.001). Training increased number of positive terms selected by participants to describe donation after brain and circulatory death. Training programmes may be useful to improve physicians' perception and attitude about including donation as part of the patient's EOLC.