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.

The Macrophage Landscape Across the Lifespan of a Human Cardiac Allograft.

BACKGROUND: Much of our knowledge of organ rejection after transplantation is derived from rodent models. METHODS: We used single-nucleus RNA sequencing to investigate the inflammatory myocardial microenvironment in human pediatric cardiac allografts at different stages after transplantation. We distinguished donor- from recipient-derived cells using naturally occurring genetic variants embedded in single-nucleus RNA sequencing data. RESULTS: Donor-derived tissue resident macrophages, which accompany the allograft into the recipient, are lost over time after transplantation. In contrast, monocyte-derived macrophages from the recipient populate the heart within days after transplantation and form 2 macrophage populations: recipient MP1 and recipient MP2. Recipient MP2s have cell signatures similar to donor-derived resident macrophages; however, they lack signatures of pro-reparative phagocytic activity typical of donor-derived resident macrophages and instead express profibrotic genes. In contrast, recipient MP1s express genes consistent with hallmarks of cellular rejection. Our data suggest that recipient MP1s activate a subset of natural killer cells, turning them into a cytotoxic cell population through feed-forward signaling between recipient MP1s and natural killer cells. CONCLUSIONS: Our findings reveal an imbalance of donor-derived and recipient-derived macrophages in the pediatric cardiac allograft that contributes to allograft failure.

Testing of tissue specimens obtained from SARS-CoV-2 nasopharyngeal swab-positive donors.

Risk for transmission of SARS-CoV-2 through allogeneic human tissue transplantation is unknown. To further evaluate the risk of virus transmission, tissues were obtained from deceased donors who had tested positive for SARS-CoV-2 RNA via nasopharyngeal swab. This study evaluated an array of human tissues recovered for transplantation, including bone, tendon, skin, fascia lata, vascular tissues, and heart valves. Tissue samples and plasma or serum samples, if available, were tested for viral RNA (vRNA) using a real time PCR system for the presence of virus RNA. All samples were tested in quadruplicate for both subgenomic (sgRNA) and genomic (gRNA) RNA encoding the SARS-CoV-2 nucleocapsid gene. Amplification of a cellular housekeeping gene served as the positive control for every sample. A total of 47 tissue samples from 17 donors were tested for SARS-CoV-2 RNA. Four donors had plasma or serum available for paired testing. SARS-CoV-2 RNA was not detected from any tissue or plasma/serum sample tested. Based on these findings, risk of transmission through the transplantation of tissue types studied from SARS-CoV-2 infected donors is likely to be low.

The effect of granulocyte colony stimulating factor on genotoxicity in allogeneic peripheral blood stem cell transplantation donors: a prospective case-control study.

BACKGROUND: Every year, thousands of donors are exposed to granulocyte-colony stimulating factor (G-CSF) for stem cell mobilization in hematopoietic stem cell transplantations (HSCT). Previous studies about the genotoxicity of G-CSF were inconclusive. In this study, the genotoxic effects of G-CSF in peripheral blood stem cell (PBSC) donors were evaluated prospectively by using three different validated and reliable methods for the first time in the literature to the best of our knowledge. METHODS: Donors of PBSC transplantation (n=36), who received G-CSF were evaluated for genotoxicity by micronucleus test (MNT), nuclear division index (NDI), and comet assay (CA). Genotoxic effects are expected to cause an increase in MNT and CA values and decrease in NDI. Blood samples were collected at three timepoints (TP): before starting G-CSF (TP1), after G-CSF for five days (TP2), and one month after the last dose (TP3). Sixteen controls were included for baseline comparison of genotoxicity tests. CD34 cell counts and hemograms were also analyzed. RESULTS: MNT and CA parameters; comet and tail length, tail DNA%, and tail moment, showed no change in time whereas another CA parameter, Olive`s tail moment (OTM) was increased significantly at TP3 compared to both baseline and TP2 (p=0.002 and p=0.017, respectively). Nuclear division index decreased significantly at TP2 (p < 0.001), then increased above baseline at TP3 (p=0.004). Baseline comparison with controls showed higher MN frequency in donors without statistical significance (p=0.059). Whereas, CA results were significantly higher in controls. CD34 cell count showed moderate positive correlation with white blood cell count at TP2 (Pearson R=0.495, p=0.004). CONCLUSIONS: Our results showed the genotoxic effect of G-CSF in healthy donors, in two of the three tests performed, short-term effect in NDI, and long-lasting effect in OTM. So, this study provides novel information for the debate about the genotoxicity of G-CSF and supports the need for further studies with a larger sample size and longer follow-up.

Rethinking Donor and Recipient Risk Matching in Europe and North America: Using Heart Transplant Predictors of Donor and Recipient Risk.

BACKGROUND: In Europe, there is greater acceptance of hearts from higher-risk donors for transplantation, whereas in North America, the donor heart discard rate is significantly higher. A Donor Utilization Score (DUS) was used to compare European and North American donor characteristics for recipients included in the International Society for Heart and Lung Transplantation registry from 2000 to 2018. DUS was further evaluated as an independent predictor for 1-year freedom from graft failure, after adjusting for recipient risk. Lastly, we assessed donor-recipient risk matching with the outcome of 1-year graft failure. METHODS: DUS was applied to the International Society for Heart and Lung Transplantation cohort using meta-modeling. Posttransplant freedom from graft failure was summarized by Kaplan-Meier survival. Multivariable Cox proportional hazard regression was applied to quantify the effects of DUS and Index for Mortality Prediction After Cardiac Transplantation score on the 1-year risk of graft failure. We present 4 donor/recipient risk groups using the Kaplan-Meier method. RESULTS: European centers accept significantly higher-risk donor hearts compared to North America. DUS 0.45 versus 0.54, P<0.005). DUS was an independent predictor for graft failure with an inverse linear relationship when adjusted for covariates (P<0.001). The Index for Mortality Prediction After Cardiac Transplantation score, a validated tool to assess recipient risk, was also independently associated with 1-year graft failure (P<0.001). In North America, 1-year graft failure was significantly associated with donor-recipient risk matching (log-rank P<0.001). One-year graft failure was highest with pairing of high-risk recipients and donors (13.1% [95% CI, 10.7%-13.9%]) and lowest among low-risk recipients and donors (7.4% [95% CI, 6.8%-8.0%]). Matching of low-risk recipients with high-risk donors was associated with significantly less graft failure (9.0% [95% CI, 8.3%-9.7%]) than high-risk recipients with low-risk donors (11.4% [95% CI, 10.7%-12.2%]) Conclusions: European heart transplantation centers are more likely to accept higher-risk donor hearts than North American centers. Acceptance of borderline-quality donor hearts for lower-risk recipients could improve donor heart utilization without compromising recipient survival.

Detección de ansiedad y depresión en el binomio receptor-donador durante el protocolo de trasplante renal / Anxiety and depression in the recipient-donor binomial during the kidney transplant protocol

ABSTRACT Introduction: Detection of anxiety and depression in the recipient-donor pair (BinRD) during the kidney transplant protocol (KT) is important to establish psychoeducational interventions that help achieve success during and after KT. Objective: To determine the presence of anxiety and depression symptoms in the BinRD during the RT protocol and to identify characteristics and associated factors. Methods: Cross-sectional study, including 174 binomials being evaluated for TR. The Beck Depression Scale (BDI-II) and the Hospital Anxiety and Depression Scale (HADS) were applied at the beginning of the RT protocol. Results: Anxiety and depression symptoms were more frequent in recipient candidates than in donors ([anxiety 39% vs 21%] [depression 46% vs 15%]) (p<0.0001). The recipients presented a higher risk of depression (OR=4.770, 95% CI 2.854-7.974, p<0.0001) and anxiety (OR=2.383, 95% CI 1.478-3.841, p<0.001). Undertaking hemodialysis in private units (OR 0.264, 95%CI 0.106-0.662, p=0.004) or being on automated peritoneal dialysis (OR 0.386, 95%CI 0.173-0.862, p=0.020 was associated with less anxiety in recipients. Conclusions: a high frequency of anxiety and depression symptoms in the BinRD, so it is important to offer effective psychological interventions focused especially on the recipient during the donation evaluation process.

RESUMEN Introducción: La detección de ansiedad y depresión en el binomio receptor-donador (BinRD) durante el protocolo de trasplante renal (TR) es importante, para establecer intervenciones psicoeducativas que ayuden a lograr el éxito durante y después del TR. Objetivo: Determinar presencia de síntomas de ansiedad y depresión en el BinRD durante el protocolo de TR e identificar características y factores asociados. Métodos: Estudio transversal, incluye 174 binomios en evaluación para TR. Se aplicó la Escala de Depresión de Beck (BDI-II) y la Escala de Ansiedad y Depresión Hospitalaria (HADS) al inicio del protocolo de TR. Resultados: Síntomas de ansiedad y depresión fueron más frecuentes en candidatos a receptores que en donadores ([ansiedad 39% vs 21%] [depresión 46% vs 15%]) (p<0.0001). Los receptores, presentaron mayor riesgo de depresión (OR=4.770, IC 95% 2.854-7.974, p<0.0001) y ansiedad (OR=2.383, IC 95% 1.478-3.841, p<0.001). Realizarse hemodiálisis en unidades privadas (OR 0.264, IC95% 0.106-0.662, p=0.004) o estar en diálisis peritoneal automatizada (OR 0.386, IC95% 0.173-0.862, p=0.020 se asoció a menor ansiedad en receptores. Conclusiones: Se evidenció una alta frecuencia de síntomas de ansiedad y depresión en el BinRD, por lo que es importante ofrecer intervenciones psicológicas eficaces enfocadas especialmente al receptor durante el proceso de evaluación para la donación.

The impact of COVID-19 on kidney transplant activities in Brazil: a descriptive study

ABSTRACT BACKGROUND: The coronavirus 19 (COVID-19) pandemic has reached services, systems, and world society. Despite its certified efficiency, the Brazilian National Transplant System is not exempt from the side effects of COVID-19. OBJECTIVE: To compare kidney transplantation activity registered in Brazil between the pandemic (2020) and pre-pandemic (2019) periods. DESIGN AND SETTING: A descriptive study was conducted in March 2021. The annual reports of the Brazilian Transplantation Registry for 2019 and 2020 were included in this study. METHODS: We conducted a descriptive study of kidney transplant activity in Brazil in 2019 and 2020. RESULTS: A 23.9% decrease in kidney transplants per million population was observed during the pandemic period (22.9 in 2020 versus 30.1 in 2019). Kidney transplants with a living donor (-58.8%) and in the North Region (-79.5%) experienced the greatest declines. The pandemic waiting list increased by 6.8%, and deaths during the waiting period increased by 36.8%. The number of patients on the waiting list and transplant teams decreased by 31.3% and 9.5%, respectively. CONCLUSION: The COVID-19 pandemic drastically affected Brazil and had a significant negative impact on KT activities in the country.

Low rate of detection of SARS-CoV-2 RNA in deceased tissue donors.

Given the possibility for disease transmission, this study was performed to determine whether there is detectable SARS-CoV-2 viral RNA in the blood of deceased tissue donors. A retrospective analysis of blood samples from eligible deceased tissue donors from Oct 2019 through June 2020 was performed. Plasma aliquots were initially tested with a SARS-CoV-2 NAT Assay; positive samples were further tested using an alternate NAT and an antibody assay. The proportion of donors with confirmed RNAemia and 95% confidence intervals were computed. Of donor samples collected in 2019, 894 yielded valid results, with 6 initially positive, none of which confirmed positive by alternate NAT. Of donor samples collected in 2020, 2562 yielded valid initial NAT results, with 21 (0.8%) initially positive. Among those, 3 were confirmed by alternate NAT, 17 were not confirmed, and 1 had an invalid alternate NAT result. The rate of SARS-CoV-2 RNAemia in deceased tissue donors is approximately 1 per 1000, and it is unknown whether this RNAemia reflects the presence of infectious virus. Given these results, the risk of transmission through tissue is thought likely to be low.

Experiência de famílias de doadores falecidos durante o processo de doação de órgãos: um estudo qualitativo / Experiencia de familias de donantes fallecidos durante el proceso de donación de órganos: un estudio cualitativo / Deceased donor's family experience during the organ donation process: a qualitative study

Resumo Objetivo A família é o principal componente da doação de órgãos. Este estudo descreve a experiência da família do doador com os cuidados de enfermagem durante o processo de doação. Métodos Foi realizado um estudo fenomenológico. Os participantes eram familiares que aceitaram a doação de órgãos de um parente em hospitais, e foram recrutados por meio de amostragem intencional. Foram realizadas entrevistas em profundidade e anotações em campo, além de uma análise temática. Resultados Três temas foram identificados: Aspectos positivos do cuidado de enfermagem na unidade de terapia intensiva (UTI); Aspectos positivos do cuidado do enfermeiro coordenador de transplantes (ECT); e Aspectos improváveis do cuidado de enfermagem durante o processo de doação de órgãos. A flexibilidade dos horários na unidade de terapia intensiva para favorecer o acompanhamento dos familiares e fornecer informações adequadas e adaptadas sobre a doação são cuidados diferenciados para as famílias. Elas destacaram áreas para melhorias relacionadas à intimidade e privacidade durante o processo de doação. Conclusão As famílias dos doadores prezam e valorizam os cuidados de enfermagem no processo de doação de órgãos.

Resumen Objetivo La familia es el principal componente de la donación de órganos. Este estudio describe la experiencia de la familia del donante con los cuidados de enfermería durante el proceso de donación. Métodos Se realizó un estudio fenomenológico. Los participantes fueron familiares que aceptaron la donación de órganos de un pariente en hospitales, reclutados por medio de muestreo intencional. Se realizaron entrevistas en profundidad y anotaciones en campo, además de un análisis temático. Resultados Se identificaron tres temas: Aspectos positivos del cuidado de enfermería en la unidad de cuidados intensivos (UCI); Aspectos positivos del cuidado del enfermero coordinador de trasplantes (ECT); y Aspectos improbables del cuidado de enfermería durante el proceso de donación de órganos. La flexibilidad en los horarios en la unidad de cuidados intensivos para favorecer el acompañamiento de los familiares y suministrar informaciones adecuadas y adaptadas respecto a la donación constituyen cuidados diferenciados con las familias. Destacaron áreas para mejoras relacionadas con la intimidad y la privacidad durante el proceso de donación. Conclusión Las familias de los donantes precian y valoran los cuidados de enfermería en el proceso de donación de órganos.

Abstract Objective The family is the main component for organ donation. This study describes the experience of the donor's family with the nursing care during the donation process. Methods A phenomenological study was applied. Participants were family members who accepted the donation of organs from a relative in hospitals, using purposeful sampling. In-depth interviews and field notes were conducted. A thematic analysis was performed. Results Three themes were identified: Positive aspect of intensive care unit nurses' care; Positive aspects of nurses transplant coordinators' care; and Improvable aspects of nursing care during the organ donation process. The flexibility of hours in the intensive care unit to favor the accompaniment of family members, and to provide adequate and adapted information about the donation are outstanding care for families. They highlight areas for improvement related to intimacy and privacy during the donation process. Conclusion Donor's families appreciate and value nursing care within the organ donation process.

Correlation of in vivo/ex vivo imaging of the posterior eye segment.

BACKGROUND: For an understanding of the pathology of retinal diseases, direct comparisons of high-resolution in vivo retinal imaging and ex vivo histological preparations are desirable. MATERIAL AND METHODS: Multimodal in vivo and ex vivo imaging of a human donor eye with secondary alterations showing atrophic retina due to central retinal arterial occlusion. The subsequent correlation with the histological examination was carried out on identical tissue localizations. RESULTS: Appropriate custom-built retinal imaging devices facilitate in vivo and ex vivo correlations and the examination of human eye tissue and acquisition of retinal images, e.g. SD-OCT. The precise alignment of the tissue enables a histological analysis on identical sites. CONCLUSION: The direct correlation of clinical in vivo imaging with ex vivo imaging including histopathology can further enhance our understanding in the pathogenesis of retinal diseases; however, the proposed method is currently limited due to restricted availability of human donor tissue.

A review of kidney transplantation from HCV-viremic donors into HCV-negative recipients.

The safety and efficacy of direct-acting antiviral therapies have allowed the transplantation of organs from hepatitis C virus (HCV)-viremic donors into uninfected recipients. This novel strategy contrasts with the previous standard-of-care practice of limiting the transplantation of HCV infected-donor organs to HCV-infected recipients, or all too often, discarding viable organs. In this review, we summarize the published literature about the safety and feasibility of transplanting organs from HCV-viremic donors, the challenges that hinder wider adoption of this strategy, and future research needs.

Presence of SARS-CoV-2 Nucleoprotein in Cardiac Tissues of Donors with Negative COVID-19 Molecular Tests.

The 2019 Coronavirus disease (COVID-19) outbreak had detrimental effects on essential medical services such as organ and tissue donation. Lombardy, one of the most active Italian regions in organ/tissue procurement, has been strongly affected by the COVID-19 pandemic. To date, data concerning the risk of SARS-CoV-2 transmission after tissue transplantation are controversial. Here, we aimed to evaluate the presence/absence of SARS-CoV-2 in different cardiac tissues eligible for transplantation obtained from Lombard donors. We used cardiovascular tissues from eight donors potentially suitable for pulmonary valve transplantation. All donor subjects involved in the study returned negative results for the SARS-CoV-2 RNA molecular tests (quantitative real-time reverse-transcription PCR, qRT-PCR, and chip-based digital PCR) in nasopharyngeal swabs (NPS) or bronchoalveolar lavage (BAL). None of the eight donors included in this study revealed the presence of the SARS-CoV-2 viral genome. However, evaluation of the protein content of pulmonary vein wall (PVW) tissue revealed variable levels of SARS-CoV-2 nucleoprotein signal in all donors. Our study demonstrated for the first time, to the best of our knowledge, that viral nucleoprotein but not viral RNA was present in the examined tissue bank specimens, suggesting the need for caution and in-depth investigations on implantable tissue specimens collected during the COVID-19 pandemic period.

Association Between Serum Lactate and Unsatisfactory Outcomes in Critically Ill Children in the Immediate Post-operative Period of Liver Transplantation.

OBJECTIVES: Serum lactate is a useful biomarker of tissue perfusion in critically ill patients. We evaluated the behavior of serum lactate in children in the pediatric intensive care unit (PICU) immediately after liver transplantation and its association with surgical complications, graft dysfunction and 90-day mortality. MATERIALS AND METHODS: A prospective observational study carried out between November 2009 and December 2019. Multidisciplinary PICU at the University Children's Hospital, Fundación Cardioinfantil-IC, Bogotá, Colombia. MEASUREMENTS AND MAIN RESULTS: Patients between 1 month and 18 years of age who were in the immediate post-operative period following living-donor or cadaveric liver transplantation were included. A total of 145 patients with a median age of 14 months (IQR 8-60) met the inclusion criteria. Biliary atresia was the main diagnosis in 56.5% of the cases. A serum lactate level > 3.0 mmol/L on admission to the PICU was associated with biliary complications (AUC 0.73 95% CI 0.54-0.93; p = 0.05) and mortality (AUC 0.72 95% CI 0.63-0.8; p = 0.01). A lactate level > 2 mmol/L after 6 h in the PICU was associated with mortality (AUC 0.70 95% CI 0.54-0.83; p = 0.02). Higher lactate levels and lack of clearance were associated with the presence of tardus et parvus waveforms (p = 0.001) on liver Doppler, primary dysfunction (p < 0.001), arterial thrombosis (p < 0.001) and neurological complications (p = 0.04). There was an inverse correlation between admission lactate and the volume of fluids administered during surgery (rho = 0.36; p < 0.001). A total procedure time > 350 min, along with a vasopressor score > 7 and elevated lactate, were associated with worse outcomes (p < 0.001). CONCLUSIONS: In post-operative pediatric liver transplant patients, the level of serum lactate is associated with post-operative surgical complications and mortality.

First results of investigations of SARS-CoV-2 RNA in human corneal tissue.

Preliminary investigations of human corneal tissues from coronavirus disease 2019 (COVID-19) cadaveric donors indicated that no severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is present. Current eye banking guidelines do not recommend any type of routine testing for SARS-CoV­2 RNA in post-mortem donor tissue. This is partly based on factors that can influence the test results of the reverse transcription polymerase chain reaction (RT-PCR).

Cambios fisiológicos y morfológicos tempranos en el riñón remanente de donantes vivos / Early physiological and morphological changes in the remnant kidney of living donors

RESUMEN Con el objetivo de describir los cambios funcionales y morfológicos tempranos en el riñón remanente de donantes vivos, se realizó un estudio retrospectivo en el Hospital Cayetano Heredia, en el que se incluyeron 55 individuos. De las historias clínicas, se obtuvieron los datos clínicos y demográficos, así como la depuración de creatinina, la proteinuria, la presión arterial y las dimensiones renales a los 1, 2, 3, 6 y 12 meses después de la donación del riñón. La edad media fue de 40,88 (±9,84) años; el 80% eran mujeres y el índice de masa corporal medio fue de 25,68 (±3,5) kg/m2. Se utilizaron modelos lineales y cuadráticos para estudiar las variables fisiológicas y morfológicas. Durante el tiempo de seguimiento, la tasa de filtración glomerular, la proteinuria, la presión arterial diastólica y la longitud de los riñones mostraron cambios significativos (p < 0,05).

ABSTRACT In order to describe the early functional and morphological changes in the remnant kidney of living donors, a retrospective study was carried out at the Cayetano Heredia Hospital. Data from 55 individuals was included. Clinical and demographic data were obtained from the clinical records, as well as data for creatinine clearance, proteinuria, blood pressure and renal dimensions at 1, 2, 3, 6 and 12 months after kidney donation. The mean age was 40.88 (±9.84) years; 80% were women and the mean body mass index was 25.68 (±3.5) kg/m2. Linear and quadratic models were used to study physiological and morphological variables. During the follow-up time, glomerular filtration rate, proteinuria, diastolic blood pressure, and kidney length showed significant changes (p < 0.05).

Facilitators and Barriers in the Organ Donation Process: A Qualitative Study among Nurse Transplant Coordinators.

BACKGROUND: Spain is the world leader in organ donation, with a rate of 49.0 donations per million population. Nurse transplant coordinators fulfill key roles for the success of the complex donation process. Our aims were: (a) to describe the experience of nurse transplant coordinators and (b) to identify barriers and facilitators during the process of organ donation. METHODS: A qualitative phenomenological study was conducted within the National Transplant Organization. A purposive sampling method was used, and data collection methods included semistructured interviews, researcher field notes, and participants' personal letters. A systematic text condensation analysis was performed. The study was approved by the Clinical Research Ethics Committee. RESULTS: A total of 16 participants were recruited and four themes were identified: (a) a different job for nurses, (b) facilitators and barriers of the coordinator's job, (c) not a job for a novice nurse, and (d) coordinators facing a paradigm shift. Coordinators described their job as being characterized with uncertainty and having to face emotional and institutional barriers. The facilitators identified were high educational level and training, and feelings of pride for being part of the National Transplant Organization. CONCLUSIONS: The organ donation process requires specialized training to avoid organizational barriers.

[Correlation of in vivo/ex vivo imaging of the posterior eye segment]. / Vergleichende In-vivo­/Ex-vivo-Bildgebung des hinteren Augenabschnitts.

BACKGROUND: For an understanding of the pathology of retinal diseases, direct comparisons of high-resolution in vivo retinal imaging and ex vivo histological preparations are desirable. MATERIAL AND METHODS: Multimodal in vivo and ex vivo imaging of a human donor eye with secondary alterations showing atrophic retina due to central retinal arterial occlusion. The subsequent correlation with the histological examination was carried out on identical tissue localizations. RESULTS: Appropriate custom-built retinal imaging devices facilitate in vivo and ex vivo correlations and the examination of human eye tissue and acquisition of retinal images, e.g. SD-OCT. The precise alignment of the tissue enables a histological analysis on identical sites. CONCLUSION: The direct correlation of clinical in vivo imaging with ex vivo imaging including histopathology can further enhance our understanding in the pathogenesis of retinal diseases; however, the proposed method is currently limited due to restricted availability of human donor tissue.

[First results of investigations of SARS-CoV­2 RNA in human corneal tissue]. / Erste Ergebnisse zu Untersuchungen der menschlichen Hornhaut auf SARS-CoV­2-RNA.

Preliminary investigations of human corneal tissues from coronavirus disease 2019 (COVID-19) cadaveric donors indicated that no severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA is present. Current eye banking guidelines do not recommend any type of routine testing for SARS-CoV­2 RNA in post-mortem donor tissue. This is partly based on factors that can influence the test results of the reverse transcription polymerase chain reaction (RT-PCR).

Development and evaluation of formal guidelines for donor selection for human milk banks.

AIM: Donor selection for milk banks is essential to ensure the safety and nutritional quality of the donor milk, and to ensure that the prospective donor and her breastfeeding infant do not come to harm through donating. Australian Red Cross Lifeblood Milk went through a robust process to develop a set of criteria for the selection and screening of potential breast milk donors, which included development of a Donor Questionnaire (DQ), supported by a formal set of Guidelines for the Selection of Milk Donors. Key screening questions from the DQ were made available to prospective donors to self-screen prior to the formal assessment process. The aim of this study was to review the outcomes of milk donor screening at Lifeblood Milk. METHODS: We reviewed the outcomes of our donor screening process over the first 12-months (July 2018-June 2019) of operations. RESULTS: A total of 50 out of 327 donors who responded to the self-screening questions were not able to proceed further; 201 donors were formally screened using the DQ and Guidelines for the Selection of Milk Donors, with 9 of 201 deferred based on their responses. An additional two donors were deferred (failed phlebotomy (n = 1) and reactive infectious disease serology (n = 1)), with 190 of 201 (95%) of prospective donors accepted after screening. CONCLUSIONS: Our experience highlighted international differences in practice between milk banks and lack of strong research to inform milk donor selection. Making a set of key screening questions available to donors for self-screening resulted in a high acceptance rate (95%) for donors who began the formal screening process. Further work is needed to better understand the impact of deferral on prospective milk donors.

Prediction of liver regeneration in recipients after living-donor liver transplantation in using preoperative CT texture analysis and clinical features.

PURPOSE: The aim of the study is to predict the rate of liver regeneration in recipients after living-donor liver transplantation using preoperative CT texture and shape analysis of the future graft. METHODS: 102 donor-recipient pairs who underwent living-donor liver transplantation using right lobe grafts were retrospectively included. We semi-automatically segmented the future graft from preoperative CT. The volume of the future graft (LVpre) was measured, and texture and shape analyses were performed. The graft liver was segmented from postoperative follow-up CT and the volume of the graft (LVpost) was measured. The regeneration index was defined by the following equation: [(LVpost-LVpre)/LVpre] × 100(%). We performed a stepwise, multivariate linear regression analysis to investigate the association between clinical, texture and shape parameters and the RI and to make the best-fit predictive model. RESULTS: The mean regeneration index was 47.5 ± 38.6%. In univariate analysis, the volume of the future graft, energy, effective diameter, surface area, sphericity, roundnessm, compactness1, and grey-level co-occurrence matrix contrast as well as several clinical parameters were significantly associated with the regeneration index (p < 0.05). The best-fit predictive model for the regeneration index made by multivariate analysis was as follows: Regeneration index (%) = 127.020-0.367 × effective diameter - 1.827 × roundnessm + 47.371 × recipient body surface area (m2) + 12.041 × log(recipient white blood cell count) (× 103/µL)+ 18.034 (if the donor was female). CONCLUSION: The effective diameter and roundnessm of the future graft were associated with liver regeneration. Preoperative CT texture analysis of future grafts can be useful for predicting liver regeneration in recipients after living-donor liver transplantation.