Awareness Of Organ Donation Research Articles

Does the Media Contribute to Raising Awareness of Organ Donation? Evidence From Brazil

Background: Brazil has the second biggest transplant system in the world. The organ donation rates, however, are still low. To persuade the population towards the theme, media interventions are broadcast regularly. Thus, this article analyses how media intervention in the form of advertising campaigns, telenovelas, and TV news can raise the rates of donations, and then, reduce the shortage of organs in Brazil. Method: We obtained data from the Brazilian Association for Organ Transplantation (ABTO), the Brazilian Health Ministry (HM), the Brazilian Institute for Geography and Statistics (IBGE), Globoplay, and other media sources to build a panel with quarterly data from 2009 to 2019, by state. Then we used fixed-effect panel regression models, with healthcare supply, and demographics as control variables to ascertain the effect of the media variable on organ donations during this period. Findings: The results indicate that media interventions can increase the number of organ donations. The coefficient of media interventions is significant and positive for telenovelas (95% C.I 0.156-0.164), not significant individually for news or government advertising campaigns. It makes telenovela's representations of organ donation an effective tool of awareness. We tested the combinations of the different types of interventions, and the joint effect of telenovelas and news reaches the highest impact on organ donations (99% C.I 0.198-0.208). Some important variables were found significantly related to organ donation as well; as the numbers of brain death notifications (99% C.I 0.113-0.117) and transplant beds (95% C.I 0.153-0.161). Interpretation: Institutional campaigns can learn several strategies from the entertainment media. Empirically, the presence of media interventions in the form of telenovelas impacts organ donation as much as improvements in the healthcare system. This suggests that one of the main problems affecting organ shortage is public opinion, and that opinion is responsive to the right incentives. Funding Information: There was no funding source for this study. Declaration of Interests: We declare no competing interests.

Lung Transplant is Feasible in Developing Countries with Severe Shortage of Organ Donors: Experiences from Vietnam

Purpose One of the most challenging obstacles for lung transplants in developing countries is the severe shortage of organ donors, which can only be improved over a long period of time with significant changes in laws, community awareness and network for organ donation and sharing. However, there is one practical solution to increase the chance of matching a rare donor with a suitable recipient is to have a rich pool of well-prepared lung transplant candidates. We share our initially successful step of developing a lung transplant waiting list in Vietnam. Methods A lung transplant center has been set up at a tertiary lung hospital in Vietnam. We screen our patients with end-stage lung diseases for lung transplant candidacy. The inclusion and exclusion criteria are from the consensus of ISHLT. The patients on our waiting list are managed in accordance with protocols from one of the best lung transplant centers in the US. In addition, we have weekly online consultations with faculties from this center to give optimal care to our lung transplant candidates. We also work closely with the national coordination center for organ donation to frequently update the most recent information of our patients on the national waiting list. Results From June to September 2020, we have screened over 500 patients and recruited 20 ones who are medically eligible and socially suitable for a lung transplant. ILD accounts for 75% of patients’ diagnosis and the rest are diagnosed with COPD (15%) and silicosis (10%). We were notified about 3 potential donors in July, August, and September 2020 but the first two lungs were of poor quality and could not be utilized. The donor's lungs in September were very good and luckily his blood group was matched with four lung transplant candidates on our waiting list. All four candidates were contacted in a timely manner to come back to the hospital to do physical cross-matches. We had the opportunity to choose the best match after the careful review of the multi-disciplinary selection committee. Conclusion Having a rich and updated waiting list connected to the national network of organ donation is crucial to our initial success. Despite the shortage of donors, lung transplant is still feasible with appropriate recruitment and management of lung transplant candidates per international standards with technical support from experienced lung transplant centers.

P0453 / #1084: DO DISCUSSIONS REGARDING ORGAN DONATION OCCUR IN PAEDIATRIC AND NEONATAL TRANSPORT WHEN WITHDRAWAL OF CARE IS ADVISED IN DISTRICT GENERAL HOSPITALS?

Aims & Objectives:According to NHS Blood and Transplant (NHSBT) in September 2019, 192 children were awaiting an organ across the UK1. Children pending transplant wait longer than adults1. Discussing organ donation in a child is seen as a difficult conversation2due to high emotional stakes; consequently staff fear upsetting parents2. The audit aims to identify patients referred from district general hospitals to Embrace, Yorkshire and Humber Infant and Children’s Transport Service, a specialised critical care transport team in the UK, who were too unstable or had severe brain injury and were unlikely to survive and reorientation of care was advocated and analyse whether organ donation was discussed. Methods:Retrospective analysis of Embrace transport records from December 2009-July 2019, where care was reoriented and no transfer happened. These notes were reviewed to see whether organ donation discussions occurred. Results: 1347 cases of uplift in care where no transport occurred were identified. 267 cases met inclusion criteria. Only 10 had clear documentation that organ donation was mentioned/discussed. One child became a donor. Conclusions: This audit suggests that few organ donation conversations occur. Given the need for paediatric organ donors, this needs further exploration. Interventions to increase awareness, education and acceptability of paediatric organ donation amongst healthcare professions and the wider public may enable the embedding of organ donation into paediatric end of life care, as recommended by NHSBT1.

Organ donation perception and beliefs: a cross sectional study amongst degree college students and teachers in Mumbai, Maharashtra, India

Background: Studies have shown that there is a lack of understanding about deceased organ donation. An adequate knowledge and the right attitude towards organ donation helps create a positive influence on people which may increase the organ donation rate. Since young students are less prejudiced and easily accept new ideas, it is necessary to educate the youth about organ donation through their teachers. At the same time, it is imperative to train teachers who will be responsible for spreading awareness so that they can include this topic in their lessons.Methods: A cross- sectional study was conducted among the degree college teachers and students in Mumbai city from November 2017- January 2018, after obtaining the institutional ethical approval and written informed consent. Using purposive sampling, teachers and students of degree colleges in Mumbai were approached, out of which 40 students and 40 teachers consented to participate in the study. A self-administered questionnaire was used to assess the pre-existing understanding, beliefs, perception and attitude about deceased organ donation. Results: Limited number of degree college teachers and students were aware of the various terminologies related to organ donation. Organ donation definition was correctly answered by 23 teachers (57.5%) and 17 students (42.5%). The correct meaning of brainstem death was known to 19 teachers (47.5%) and 2 students (5%). There are certain misconceptions and perceptions about deceased organ donation among both the teachers and the students. 13 teachers (32.5%) and 16 students (40%) believed that donor family will be revealed about the recipient’s details. 7 teachers (17.5%) and 18 students (45%) were of the opinion that government provides monetary support to donor families. decision of organ donation after death rests on relatives was known to 33 teachers (82.5%) and 21 students (52.5%). About 6 teachers (15%) and 18 students (45%) wrongly believed that if conflicts arise between relatives’ organs can still be donated. There’s no possibility of buying /selling of organs in India was known 27 teachers (67.5%) and 31 students (77.5%). About 34 teachers (85%) and 31 students (77.5%) wanted to pledge for organ donation after death. 90% teachers and 80% students said they think deceased organ donation awareness should be incorporated in the education curriculum.Conclusions: 85% of the study subjects (both teachers and students) felt the need of intensifying organ donation awareness programmes. Thus, organ donation awareness should be effectively incorporated in the educational curriculum.

Knowledge and Attitudes of Health Care Professionals and Laypeople in Relation to Brain Death Diagnosis and Organ Donation in Hungary: A Questionnaire Study

The aim of the present work was to assess the knowledge and attitudes of different health care workers and laypeople toward the donation and transplantation procedure. A survey consisting of questions regarding brain death diagnosis, legal organization or organ donation, and the transplantation procedure were sent to participants: 56 intensive care unit (ICU) doctors, 76 ICU nurses, 188 sixth-year medical students, and 320 general practitioners (GPs). Laypeople were also asked to complete the survey. The majority of participants reported being aware of legal regulations for organ donation in Hungary (88.5%). Roughly 25% of GPs and 60% of laypeople were unaware of the opt-out system effective in the country. Less than one-third of ICU physicians (26.9%) and nurses (34.7%) were able to list the organs that may be transplanted from a deceased donor; GPs (22.4%) and medical students (20%) performed even worse on this item. The willingness of ICU specialists (57%) and ICU nurses (45%) to support donating their own organs was moderate. The results of this survey indicate a need for graduate and postgraduate education and regular teaching programs regarding organ donation and transplantation. More active use of modern media is proposed to improve public awareness and acceptance of organ donation.

A Questionnaire Based Study Evaluating Awareness for Organ and Body Donation and Cadaveric Dissection among the General Population Attending Medical and Dental Hospital

Introduction: This study intended to assess the awareness among subjects regarding body donation andcadaveric dissection and their willingness to donate body.Methodology: A cross sectional study conducted in Anatomy Department, SBKS Medical Institute andResearch Centre, Vadodara. A self-administered questionnaire containing 18 questions was to be filled bythe participants in 15 minutes. Responses of participants were collected and analysed.Results: 130 participants were enrolled, 47.69% were males while 52.31% were females. Majority (38.46%)were ?45 years in age. Around 41.54% of the participants had received no schooling. Majority of theparticipants were unaware of the Organ (54.62%) and Body donations (63.85%), however, around 51.54%of the subjects were aware of the cadaveric dissections occurring in medical colleges. Also, 50.77% agreedfor body donations. As compared to males, higher proportion of females were aware of the organ (47.1%)and body (38.2%) donations and 61.8% females were willing to donate bodies. Higher proportion of subjectsin the age groups of 26-45 years were aware of organ (52.3%) and body (38.6%) donation and cadavericdissection (65.9%), however, proportionately more subjects in the age group of 18-25 years (77.8%) werewilling to donate body. A higher proportion of subjects with college education were aware of the organ(84.6%) and body (92.3%) donation and cadaveric dissection (92.3%) and were also willing to donate body(92.3%).Conclusion: Gender, education and socioeconomic background have an impact on organ/body donation andwillingness to donate body

How to set a heart transplantation unit in India - A narrative review

Cardiovascular diseases (CVDs) have become the leading cause of mortality in India. This epidemiological transition is largely because of the increase in the prevalence of CVDs and CVD risk factors in India. In 2016, the estimated prevalence of CVDs in India was estimated to be 54.5 million. Heart failure (HF) is a major health problem in India with a postadmission mortality of 20%–30%. Heart transplant is the final treatment for HF if intractable to medical management. Number of heart transplantations done in India is still very less compared to the disease burden and may be attributed to less awareness for organ donation in India. As the number of heart transplantation is increased drastically in the past decade, we need to have proper information about heart transplantation program in India. This is our attempt to simplify information regarding heart transplantation for cardiothoracic units planning to start such a program.

Acceptance and awareness of Saudi population about organ donation and lung transplantation

Background: Organ transplantation is saving the lives of thousands. Organ donation is a complex multi-factorial issue involving medical, legal, ethical, organizational, and social factors. This study aimed at providing public awareness and acceptance of organ donation in different areas of Saudi Arabia. Methodology: A cross-sectional study was conducted during the period from 1 June to 31 August 2019 in different provinces of Saudi Arabia. Representative samples from male and female Saudi nationals from different age group were included in the study. Data were collected using an online questionnaire which covers the needed items to fulfill the study objectives. Results: The study included 1,508 participants. The majority of participants (87.4%) support organ donation, more than half 53.5% said that they are ready to donate any organs. 46.2% of cases think that organ donation could be after death, 39.7% reported it could be during life or after death. The majority of subjects, 89.3%, do not know the organ donation policies. Regarding knowledge of organs that can be donated, half of the participants choose kidney, 32.2% liver, 22% lungs, 9.2% pancreas, 7.8% eye, 7.4% bones, 6.8% skin, and only 5.8% for the heart. There was a significant relationship between supporting organ donation and age and educational level (p< 0.05), but insignificant relation with the gender (p = 0.05). Conclusion: The majority of the Saudi population, from both males and females, support organ donation but do not know the organ donation policies. So, we recommend health education settings to educate the public about organ donation policies and give them more detailed good information.

The new ‘opt-out’ organ donation English law: Is the NHS ready for this?

In May 2020, the new 'opt-out' organ donation law was passed in England. This law is a crucial step to help battle the long waiting lists of patients awaiting a transplant. This article aims to explore some of the challenges that the transplant teams may face with the new law, as well as raising awareness among the junior doctors, especially with the new COVID-19 transplant guidelines. Successful transplantations require immense training of healthcare professionals, fast retrieval services, pre- and postoperative care of patients, intensive care management, life-long follow-up and management of patients. Organ transplant surgery is a life-changing moment for a patient. Ultimately, commissioning groups, clinicians and managers need to work together, evaluate the changes required and enact thorough business plans to ensure the NHS is not overwhelmed. Together with increasing the awareness of organ donation within the public, the government needs to support the NHS to fund, train and manage transplant centres to welcome this much-awaited 'opt-out' organ donation law in England successfully.

Social media and organ donation - A narrative review

Increasing demand for organ transplantation which is often the lifesaving treatment for organ failure and a shortage of organs is a crisis prevalent in many countries. Proactive engagement of the society by improving awareness about organ donation is perceived to be the key to address the problem of organ shortage. In the current digital era, social media (SoMe) organ donation campaigns are one of the most practical and effective ways to disseminate information and promote collaboration among participants. Many governmental and nongovernmental organizations and social activists are utilizing popular SoMe platforms such as Facebook, Twitter, YouTube, and Instagram to promote organ donation awareness. Although such SoMe campaigns are impactful and open unique possibilities to address organ shortage, one should also be aware of the challenges of maintaining confidentiality, the potential for misuse, misinformation, and negative framing. In this narrative review, we review the use of SoMe to promote organ donation including its benefits, pitfalls, and attempt to list some recommendations.

Causes of donation failure and improvement measures analyzed based on data from domestic deceased donors in 2019.

In 2019, 1,630 organs were recovered from 450 brain death donors nationwide and were transplanted into 1,612 transplant recipients. However, considering that the number of potential brain-dead linked to the Korea Organ Donation Agency (KODA) information center was 2,484, only 18.1% of the linked brain-dead donated successfully. Of the 1,606 people who were available for family interviews, 67.0% refused to donate, so their cause analysis and countermeasures are needed. In particular, 203 reported cases died during the early period of donor evaluation, so we need a special concern on these cases. After consent, 67 cases failed to donate due to death or poor organ condition, and this raises the question of the possibility of shortening brain death management time. The average time interval from the first investigation to the completion of the second investigation (11.5 hours), until obtaining a flat electroencephalogram (5.3 hours) and conclusion of the brain death committee is 5.9 hours. Reducing unnecessary brain death management time is expected to improve the quality of organs and increase the number of organs to be recovered. Therefore, efforts to accurately identify and report potential brain death, and efforts to reduce the time spent in confirming brain death together with improving awareness of organ donation in people across the country are necessary to increase the number of deceased donors even in the current brain death management system. Implementation of donation after circulatory death for mortality case during the donor management is also urgent.

Awareness of body and organ donation amongst first year MBBS students of Indira Gandhi Institute of Medical Sciences, Patna

Introduction: Cadaver dissection is the backbone of Anatomy. With the increasing number of medical colleges in India there is severe scarcity of cadavers for dissection. The realistic experience of dissection is gradually being replaced by prosected dissection, virtual techniques and audio visual aids. As the medical science is progressing in leaps and bounds the transplant surgeries are achieving great success. However there is a tremendous gap between the recipients and the donars. This gap has to be bridged by the health care professionals. Hence it is important to educate them from their early training period and onwards. The aim of the present study was to find out the extent of awareness among newly admitted first year MBBS students regarding body donation and organ donation. Materials and Methods: After a brief introduction towards organ and body donation data collection was done based on a structured questionnaire and analysed. Result: 82.02% of students were aware of body and organ donation. 56.18% of students were aware that the organ donation was from living and cadaver both. 60.67% of students were self motivated towards willingness for organ and body donation and 50.56% of students were positive regarding promotion of organ and body donation. Conclusion: Education and motivation of health care providers towards organ donation and body donation will go a long way to minimise the scarcity in the field of organ transplant and cadaver procurement for dissection purpose. Keywords: Awareness, Anatomy act, Body Donation, Cadaver, Organ donation, Transplant.

Investigation and Strategic Analysis of Family Barriers to Organ Donation in China

BackgroundFamilies play a prominent role in the eventual organ donation decision. Because the deceased cannot directly express their wishes, their families become the actual decision makers. In China, families are permitted to make decisions regarding organ donation that may not be in accordance with the wishes of the deceased family member, and objections by families are a main bottleneck in the donation process. MethodsFace-to-face questioning was conducted with organ procurement organization coordinators. At the same time, questionnaires were distributed in 11 cities in Zhejiang Province. ResultsOf the respondents, 69.9% considered family consent necessary and 77.1% thought that the view of their family had a great, even decisive, influence on them to decide to become donors. If the deceased family member had registered as an organ donor, 65.2% of families decided that they would respect the wishes of the deceased person. Adult children (58.6%) were more likely to donate than parents (37.4%; χ2 = 123.009, P < .001). Those born after 2000 and after 1990 (62.5% and 52.8%, respectively) were much more likely to donate than those born after 1960 (18.1%; χ2 = 191.485, P < .001). The interviews indicated that there were high rates of donation refusals within potential donation families. Most donor families chose to make hidden donations, and the majority of donor families had a simple family structure. ConclusionsTo promote organ donation, China needs to reconsider the role of families in the decision-making process. It is essential to increase organ donation awareness within the younger generation and encourage them to discuss with their families their willingness to donate.

Is Prosocial Behavior Associated With Increased Registration for Deceased Organ Donation? A Cross-sectional Study of Ontario, Canada.

Background.A community that promotes prosocial behaviors such as organ donor registration or charitable giving could reinforce those behaviors among its residents. Understanding the nature of the relationship between prosocial behaviors at the community level and an individual’s decision to engage in prosocial behavior can help in the targeting of communities with lower rates of prosocial activities. The objective of this study was to assess if the likelihood that an individual is a registered deceased organ donor in Ontario, Canada, is associated with community-level charitable giving.Methods.This cross-sectional population-based study involved individual- and community-level data from multiple administrative data sources from ICES and Statistics Canada. To assess the unadjusted and adjusted effects of community-level charitable giving on organ donor registration, we ran 4 sequential multilevel random intercept logistic regression models and used a number of individual- and community-level confounding factors.Results.Statistically significant between-community variance (0.322, SE = 0.020) and interclass correlation coefficient (0.089) suggest that substantial variation in organ donor registration can be attributed to the between-community differences. Community-level charitable giving was correlated with organ donor registration (odds ratios, 1.351; 95% confidence intervals, 1.245-1.466) in the model containing only individual-level confounding factors. However, this relationship became statistically nonsignificant (odds ratios, 0.982; 95% confidence intervals, 907-1.063) when a series of community-level confounding factors were added to the model. Among these confounding factors, individuals’ immigration status and community-level ethnic/immigrant concentration had the most pronounced association with organ donor registration.Conclusion.The identification of the characteristics of populations and communities with low organ donor registration rates may inform future initiatives in the area of organ donation awareness and promotion to make them more effective among those particular groups.

Community based comparative study about awareness and perception of organ donation in Urban and Rural population

Community based comparative study about awareness and perception of organ donation in Urban and Rural population

Characteristics and Motivation of Solid Organ Transplant Recipients Attending the Canadian Transplant Games

BackgroundThe Canadian Transplant games (“Games”) were created to increase awareness of organ donation and highlight the importance of staying active and healthy post-transplant. It is unclear what motivates solid organ transplant (SOT) recipients to participate and whether the games serve as an incentive for SOT recipients to increase their physical activity (PA) levels. Objectives1. To describe the characteristics of participants from past games and their motivation for attending and 2. to determine whether there was an interest in participating in goal-based, pre-games exercise training programs. MethodsA web-based questionnaire was sent to adult SOT recipients who were members of the Canadian Transplant Association. The survey included questions about why participants attended, their PA levels, and their interest in a pre-games training program. ResultsOf the 157 participants, more were male than female; the 35-54-year-old age group was the most common; and 62% of respondents received a liver or kidney transplant. The most common reasons for participating in the games were to showcase health post-transplant, promote awareness of organ donation, sports competition, and social reasons. Sixty-five percent of respondents reported that they would be interested in an exercise program to be more physically prepared for the competition. ConclusionPre-games training programs could be developed to motivate participation and help participants achieve higher training intensities and foster social interaction. Directing resources to individuals who do not attend the games and to those who are not physically active should be considered.

Knowledge of medical students on organ donation.

To analyze the spontaneous knowledge of medical students about organ donation. 518 students of a medical school in Sao Paulo city, from the first-year to internship, answered an objective questionnaire applied through electronic media to assess their spontaneous theoretical knowledge and organ donation awareness. Organs that can be donated after brain death, such as the cornea, kidneys, heart, liver, and lung were mentioned by the students. Regarding in-life transplantation, they answered it was possible to donate mainly the kidney (91.3%), part of the liver (81.1%), and bone marrow (79.7%). Although it was not expressive, we also noted that their knowledge gradually increased as they reached the end of the course. Medical students knowledge on organ donation in life and after death was a little superior to 60%. The students had limited exposure to this subject during the course (<40% of them before the internship). The authors suggest that students should be more exposed to the theme of "organ donation" in the medical curriculum.

ESTABLISHMENT OF LIVER TRANSPLANTATION IN THE UNITED ARAB EMIRATES FROM DECEASED AND LIVING DONORS

Liver transplantation (LT) in the Middle East remains confined to a few countries and relies heavily on the availability of living donors. In many countries in the region, definition of brain death remains unclear, impeding the establishment of deceased donor organ transplantation. Since the first deceased donor liver transplant (DDLT) in the region in 1990, growth of DDLT has been slow, accounting for less than 20% of all LT as of 2013. This report summarizes the formal establishment of LT in the UAE from living and deceased donors. The passage of the brain death law in May 2017 enabled the formal establishment of deceased organ donation in the UAE. This landmark law enabled the transplant community in the UAE to establish a network of donor hospitals to identify potential donors who met criteria for brain death. Efforts to bring this to fruition involved close collaboration of key stakeholders, including Cleveland Clinic Abu Dhabi (CCAD), Ministry of Health and Prevention, Department of Health in Abu Dhabi, Dubai Health Authority, UAE national transplant committee, Cleveland Clinic Foundation, Mubadala Healthcare and the Abu Dhabi health services company. This collaborative effort enabled the successful establishment of a multi-organ transplant center at CCAD and initiation of LT from deceased donors within 9 months of the laws’ passage. The first multi-organ procurement and transplant from a brain dead donor in the UAE occurred on July 15, 2017. The first deceased donor LT in the UAE was performed on Feb 1, 2018 as part of a multi-organ procurement and transplant process. We have since performed an additional ten LT from deceased donors, of which 7 recipients have completed a year of follow-up post-transplant. An extensive collaborative effort with our colleagues at Cleveland Clinic’s main campus in Cleveland, Ohio resulted in the first successful Living donor LT (LDLT) in the UAE on July 29, 2018. We have since performed an additional 14 LDLTs (overall: four right lobe and 10 left lobe grafts), with seven LDLT recipients having completed a year of follow-up post-transplant. Figure 2 highlights key milestones in LT in the UAE and figure 3 illustrates activity since inception of LT at CCAD, highlighting the challenges related to deceased donor organ availability and underscoring the role of LDLT in meeting the growing demand for LT in the country.In conclusion, we report the successful establishment of LT in the UAE, from both deceased and living donors. LDLT has enabled us to meet clinical demand, while efforts to improve deceased donor organ donation bear fruit. Continued growth and success of transplantation in the UAE is contingent upon increasing awareness of organ donation. Ongoing initiatives include creation of a national digital organ donor registry, inclusion of consent for donation in the Emirates national ID card, regional organ sharing agreements for critically ill patients and establishment of donation after circulatory death.

DECEASED ORGAN DONATION IN SYRIA: CHALLENGES AND SOLUTIONS

The first living-donor kidney transplant in Syria was performed 41 years ago; by 2019, 5407 renal transplants had been performed there. Three heart transplants from deceased donors were performed in the late 1980s; cardiac transplant activities have since discontinued. In 2003, a new, national Syrian legislation was enacted authorizing the use of organs from living unrelated donors and from deceased donors. This important law was preceded by another big stride in this regard: the acceptance by the higher Islamic religious authorities in Syria in 2001 of the principle of procurement of organs from deceased donors, provided that consent is given by a first- or second-degree relative. After the enactment of this law, kidney transplant rates increased from 7 per million population in 2002 to 17 per million population in 2007. Kidney transplants performed abroad for Syrian patients declined from 25% in 2002 to < 2% in 2007. Kidney transplants continued at comparable rates until 2010, before the beginning of the political crisis in 2011. Four decades after the first successful kidney transplant in Syria, however, patients needing an organ transplant must rely on living donors only. Moreover, 17 years after the law authorizing use of organs from deceased donors, a program is still not in place in Syria, and additional improvement of the legal framework is needed. The war, limited resources, and lack of public awareness about the importance of organ donation and transplant appear to be major factors inhibiting initiation of a deceased-donor program in Syria. A concerted and ongoing education campaign is needed to increase awareness of organ donation, change negative public attitudes, and gain societal acceptance. Every effort must be made to initiate a deceased-donor program to lessen the burden on living donors and to enable national self-sufficiency in organs for transplant.

Heterotopic heart transplant: relevance as Bio-VAD in emerging economies.

Despite the introduction of mechanical circulatory assist systems in India two decades ago, there has not been their wide usage due to two main reasons: (1) economic-financial unaffordability and (2) lack of social support. There have been a number of significant steps taken by the government and by the media for augmenting awareness for organ donation. A sizeable donor pool in India falls into the category of marginal donors, due to a variety of reasons like geographical distances, lack of rapid transport, suboptimal donor management due to the lack of resources, and trained manpower in hospitals where donor harvest is done. Consequently, the usage of the heart as a donor organ is less than 20% in India. There is a lack of statistical data regarding the usage of heterotopic heart transplants, due to the absence of a registry, since the procedure is rarely performed, and comparative results are difficult to obtain due to different subsets of both donors and the recipients. The original papers by Barnard and Cooper cannot be extrapolated in the modern context, as these publications were in the pre-cyclosporin era. Orthotopic heart transplantation (OHT) is a well-established and commonly utilized procedure for patients with end-stage heart failure. Heterotopic heart transplantation (HHT) is a surgical procedure that allows the graft to be connected to the native heart in a parallel fashion to provide a kind of biological biventricular or univentricular (left ventricular support). It was performed first in human beings by Barnard in 1974 [S, J., 49:, Afr, Med, 1975, 303-12].