Deceased Donation Research Articles

Outcome After Intestinal Transplantation From Living Versus Deceased Donors: A Propensity-matched Cohort Analysis of the International Intestinal Transplant Registry.

To describe the worldwide experience with living donation (LD) in intestinal transplantation (ITx) and compare short-term and long-term outcomes to a propensity-matched cohort of deceased donors. ITx is a rare life-saving procedure for patients with complicated intestinal failure (IF). Living donation (LD)-ITx has been performed with success, but no direct comparison with deceased donation (DD) has been performed. The Intestinal Transplant Registry (ITR) was created in 1985 by the Intestinal Transplant Association to capture the worldwide activity and promote center's collaborations. Based on the ITR, 4156 ITx were performed between January 1987 and April 2019, of which 76 (1.8%) were LD, including 5 combined liver-ITx, 7 ITx-colon, and 64 isolated ITx. They were matched with 186 DD-ITx for recipient age/sex, weight, region, IF-cause, retransplant, pretransplant status, ABO compatibility, immunosuppression, and transplant date. Primary endpoints were acute rejection and 1-/5-year patient/graft survival. Most LDs were performed in North America (61%), followed by Asia (29%). The mean recipient age was: 22 years; body mass index: 19kg/m²; and female/male ratio: 1/1.4. Volvulus (N=17) and ischemia (N=17) were the most frequent IF-causes. Fifty-two percent of patients were at home at the time of transplant. One-/5-year patient survival for LD and DD was 74.2/49.8% versus 80.3/48.1%, respectively ( P =0.826). One-/5-year graft survival was 60.3/40.6% versus 69.2/36.1%, respectively ( P =0.956). Acute rejection was diagnosed in 47% of LD versus 51% of DD ( P =0.723). Worldwide, LD-ITx has been rarely performed. This retrospective matched ITR analysis revealed no difference in rejection and in patient/graft survival between LD and DD-ITx.

P11.08: International Registry in Organ Donation and Transplantation (IRODAT) – 2021 Worldwide Data

Introduction: IRODaT is the first registry in this field, which contains statistics of deceased/living donors and transplants. Out of the 111 countries with organ donation or transplantation (D&T) activity, 86 national reporters have submitted data to IRODaT during the last 19 years. Methods: Each participant country inserts their own data to the website and all data are validated. The information registered follows the definition of “The Critical Pathway of Deceased Donation (1)”, ensuring uniformity throughout the registry and aiding correct interpretation of the data by the scientific community. The data could be verified contacting the official reporter when it is needed. The compilation of all this information worldwide can be accessed by the whole community. Results: Currently twenty one countries have summited the database from 2021 at the IRODaT registry. Although organ D&T rates mostly dropped as expected due to the emergency of COVID-19 worldwide, some countries had the highest improvement in deceased donation (DD) compared to 2020 data, such as: Spain (from 37,97 to 40,2 pmp), USA (from 38,03 to 41,88 pmp), Italy (from 21,6 to 22,52 pmp); Czech Republic (from 23,3 to 25,06 pmp), Argentina (from 9,82 to 13,13 pmp) and Iceland (from 13,33 to 29,35 pmp); while Australia, Austria, Denmark and Estonia reported a downward trend with16 from 18 pmp; 20,26 from 23,9 pmp;16,90 from 21,38 pmp and 15,79 from 24,83 pmp and respectively. The increase in the DD activity of Saudi Arabia and United Arab Emirates is significant by 150% and 400% compared to the previous year. Regarding Brazil and Portugal preliminary data, the numbers collected included only the first semester of 2021 and are excluded in the figure 1. Six countries have reported an increase in Donation After Cardiac Death (DCD type III) including Spain, the US and Italy, in which DCD donation represents more than 30% of their total number of deceased donations. Thus far, thirteen countries have reported living donation activity (LD) led by Saudi Arabia (37,4 ppm), the US (19,75 ppm) and Cyprus (11,59 ppm). The number of LD performed was affected significantly since many programs were deferred. Conclusions: In 2021, the challenges hospitals faced, including restrictions, flight reductions and border closures affected national programs worldwide as reflected above. Nevertheless, coordination and transplant teams have minimized the impacts of the pandemic and while health resources were globally disproportionally affected, certain countries managed to increased D&T rates.

423.11: Long-term Compromised Immune Regulation After Rituximab Induction in Blood Group Incompatible Living-Donor Renal Transplantation - 5 Year Results of a Prospective Pilot Study

Background: An increased frequency of severe infectious diseases and BK viremia has been described after ABOi renal transplantation. As rituximab induction may alter immunoregulation in these patients, we analyzed clinically relevant immune parameters in a prospective renal transplant study up to 5 years posttransplant. Materials and Methods: Mononuclear cell subsets (peripheral blood; lymph nodes taken during transplant surgery), intracellular cytokine responses, CD4 helper function and in-vitro B cell responses were assessed pretransplant and up to 5 years posttransplant in 85 renal transplant recipients (living donation: n=25 ABO incompatible (ABOi) and n=30 ABO compatible (ABOc); deceased donation (DD): n=30, all ABO compatible). Results: Severe infectious diseases occurred more often in ABOi than ABOc recipients within 2 years posttransplant (11/24 (46%) versus 6/30 (20%), P=0.042) but not beyond. The incidence of BK viremia was significantly enhanced in rituximab versus non-rituximab treated patients (1 year: 9/29 (31%) versus 4/54 (7%), P=0.009; 5 years: 10/30 (33%) versus 7/53 (13%), P=0.029). After rituximab induction in ABOi recipients, counts of peripheral blood B cell subsets were profoundly downregulated even 3 years posttransplant and reached the level of non-ABOi recipients after 4 years (memory B cells after 5 years). T-dependent and T-independent B cell responses were significantly impaired in ABOi patients up to 2 years posttransplant (P=0.010 and P=0.053, respectively) whereas CD4 helper activity was not compromised. CD4+ T cell counts were significantly lower in ABOi compared to ABOc recipients at 3 and 6 months (P=0.025 and P=0.046, respectively), but showed no differences in the percentage of Tregs. In regional lymph nodes of ABOi patients, we found a significant downregulation of CD20+ but not CD19+ B cells (P<0.0005), of naive B cells (P=0.031) and short lived plasma cells (P<0.0005) at the time of transplantation. Conclusion: An increased frequency of severe infectious diseases and BK viremia in rituximab treated ABOi renal transplant recipients may be explained by significantly downregulated CD4+ T cell counts up to 6 months and a profoundly delayed B cell repopulation, most pronounced with regard to memory B cells, together with compromised B cell responses up to 2 years posttransplant. IL-10, as a key player in chronic BK virus infection, was not upregulated in rituximab-treated ABOi transplant recipients.

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities.

Liver Transplantation in Malaysia: Needs, Obstacles, and Opportunities.

Regional Report on Organ Transplantation in Trinidad and Tobago.

Regional Report on Organ Transplantation in Trinidad and Tobago.

Explant Biopsy and Remuzzi Scoring Outperforms Kidney Donor Profile Index (KDPI) in Selection of Extended Criteria Donor Kidneys for Single Implant

IntroductionGiven the high incidence of End Stage Renal failure (ESRF), Extended Criteria Donors (ECD) are crucial to increase deceased donation (DD) rates. However, allocation of ECD kidneys to waitlisted ESRF patients is challenging due to difficulty in predicting donor quality and post-transplant

Should Deceased Donation be Morally Preferred in Uterine Transplantation Trials?

In recent years much research has been undertaken regarding the feasibility of the human uterine transplant (UTx) as a treatment for absolute uterine factor infertility (AUFI). Should it reach clinical application this procedure would allow such individuals what is often a much‐desired opportunity to become not only social mothers (via adoption or traditional surrogacy arrangements), or genetic and social mothers (through gestational surrogacy) but mothers in a social, genetic and gestational sense. Like many experimental transplantation procedures such as face, hand, corneal and larynx transplants, UTx as a therapeutic option falls firmly into the camp of the quality of life (QOL) transplant, undertaken with the aim, not to save a life, but to enrich one. However, unlike most of these novel procedures – where one would be unlikely to find a willing living donor or an ethics committee that would sanction such a donation – the organs to be transplanted in UTx are potentially available from both living and deceased donors.In this article, in the light of the recent nine‐case research trial in Sweden which used uteri obtained from living donors, and the assertions on the part of a number of other research teams currently preparing trials that they will only be using deceased donors, I explore the question of whether, in the case of UTx, there exist compelling moral reasons to prefer the use of deceased donors despite the benefits that may be associated with the use of organs obtained from the living.

Successful Example of How to Implement and Develop a Deceased Organ Donation System in the Caribbean Region: Five-Year Experience of the SEUSA Program in Trinidad and Tobago

BackgroundThe SEUSA program, the Donation and Transplantation Institute foundation consultancy program, was implemented in Trinidad and Tobago (T&T) in 2010 with the support of the National Organ Transplant Unit (NOTU) and the Ministry of Health of T&T. MethodsThe SEUSA program included (1) diagnosis of the current situation using the ODDS (Organ Donation Diagnostic Surveys); (2) creation of a human resources structure through Transplant Procurement Management (TPM); (3) detection of all brain and cardiac deaths in the hospitals implementing the DAS (Decease Alert System); (4) in-hospital awareness based on the EODS (Essentials in Organ Donation); and (5) external hospital audits. Additionally continued monitoring is performed. ResultsThus far, thanks to implementation of the SEUSA program in Trinidad and Tobago 175, healthcare professionals have been exposed to training programs in the organ donation field. The Living Kidney Program was reinforced and the structure of the Deceased Donation (DD) network was defined. Since 2010, 485 potential organ donors have been detected, and 9 have become actual organ donors; 74 patients have received a kidney transplant (59 from living and 15 from deceased donors). ConclusionsThis project results demonstrate that the application of the SEUSA program is an efficient methodology to develop DD programs that increase and consolidate transplant programs in the Caribbean region.

OR36: IMPACT OF PREEMPTIVE PERIOPERATIVE DESENSITIZATION ON DECEASED DONOR TRANSPLANTATION AND DSA ELIMINATION

Aim Sensitized kidney tranplant (KT) patients have poorer graft survival due to DSA induced chronic rejection. While preoperative desensitization effectively minimizes DSAs, it is not suitable for patients dependent on deceased donation (DD). To improve graft survival among sensitized DDKT patients, we developed a protocol to preemptively desensitize immediately after KT using PP/IVIG or IVIG alone. This report summarizes the impact of both treatments upon clinical outcome and posttransplant DSA. Methods 253 patients were stratified perioperatively by assigning points for PRA, FCXM, DGF and histology. Patients with ⩾3 points received PP/IVIG ( n = 40); 2 points got IVIG ( n = 28); ⩽1 point got standard treatment (ST) ( n = 167). Serums were collected quarterly for 1 year posttransplant and tested for DSA by luminex. Five-year clinical outcomes were collected. Results As expected, PP/IVIG and IVIG patients were more sensitized than ST and had higher PRAs (64 ± 29% vs 53 ± 40% vs. 26 ± 32%, p p p p = ns). Posttransplant DSAs were eliminated among more PP/IVIG than IVIG patients (67% vs. 33%, p p = ns). Outcome metrics were revisited based upon DSA loss or persistence. Rejection frequency was equivalent to ST (5%) among PP/IVIG patients with DSA loss or persistence (10%, p = ns) and IVIG patients with DSA loss (0%, p = ns). In contrast, IVIG patients with persistent DSA had more rejection (20%, p p Conclusions After perioperative desensitization, graft survival among sensitized patients was now equivalent to non-sensitized individuals. PP/IVIG treatment was more effective than IVIG in DSA elimination, rejection prevention and graft survival among patients with persistent DSA.

Public attitudes to financial incentive models for organs: a literature review suggests that it is time to shift the focus from ‘financial incentives’ to ‘reciprocity’

Waiting lists for organs have stimulated interest in the use of financial incentives for organ donation (FIs), but the literature does not contain an adequate overview of studies of public attitudes toward this mode of procurement. We conducted a literature review of international peer-reviewed research published between 2002 and 2012 on how members of the public position themselves toward FIs. We identified and analyzed 23 studies using MEDLINE, PsycINFO, Sociological Abstracts and cross-reference search. The search included whole organs, donation, quantitative and empirical qualitative social scientific studies on, public attitudes (excluding professionals and medical students). The review reveals a broad divergence of public opinions on financial incentives. However, quantitative studies showed a low overall level of acceptance of payment for organs in living donation (LD); only a slightly higher one for deceased donation (DD); and a general preference for alternative forms, such as removal of disincentives or expressions of social reciprocity. Across different national and methodological settings we observed a considerable preference of noncommercial forms. This does not preclude the opportunity to consider various types of acknowledgement of economic value given in return for the organ. This provides reason to shift the focus from incentives to reciprocity.

Outcome of deceased donor renal transplantation in diabetic nephropathy: a single-center experience from a developing country

Type 2 diabetes mellitus (DM) is the commonest cause of end-stage renal disease (ESRD) worldwide. Renal transplantation (RTx) is the best therapeutic modality for such patients. First-degree relatives of patients with type 2 DM have high risk of diabetes/pre-diabetes. Parents are often too old to be suitable donors, and siblings/children/spouse are either not suitable/acceptable or do not come forward for organ donation. This leaves deceased donation (DD) as only suitable donors. Data scarcity on DDRTx outcome in diabetic nephropathy (DN) prompted us to review our experience. This retrospective single-center 10-year study was undertaken to evaluate patient/graft survival, graft function, rejection episodes, and mortality in these patients. Between January 2001 and March 2011, thirty-five DN-ESRD patients underwent DDRTx in our center following cardiac fitness assessment of recipients. All patients received single-dose rabbit-anti-thymocyte globulin for induction and steroids, calcineurin inhibitor, and mycophenolate mofetil/azathioprine for maintenance immunosuppression. Mean recipient age was 49.66 ± 6.76 years, and 25 were men. Mean donor age was 50 ± 16.45 years, 23 were men. Over a mean follow-up of 2.28 ± 2.59 years, patient and graft survival rates were 68.5% and 88.5%, respectively, with mean SCr of 1.9 ± 0.62 mg/dl. Delayed graft function was observed in 34.3% patients, and 25.7% had biopsy-proven acute rejection; 31.5% patients died, mainly because of infections (22.8%), coronary artery disease (2.86%), and cerebrovascular events (5.7%). DDRTx in patients with DN has acceptable graft function and patient/graft survival over 10-year follow-up in our center and, therefore, we believe it should be encouraged.

Do Future Journalists Have a Favorable Attitude Toward Deceased Donation?

Introduction The information provided by future journalists is fundamental for promoting healthcare and their attitude toward organ donation and transplantation (ODT) could affect public opinion. The objective of this study was to analyze the attitude of students of journalism toward ODT and the factors affecting this attitude. Materials and Methods The subjects of this study were students doing a degree in journalism in 2005–2006 (N = 129). A self-administered questionnaire about ODT was completed anonymously. For statistical analysis we used Student t test and the χ 2 test. Results The questionnaire completion rate was 98% (n = 126). Most students (78%; n = 98) would be willing to donate their organs, although 22% (n = 28) would not. Attitude was more favourable among those respondents who knew a transplant recipient (100% vs 71%; P = .002), had a favourable attitude toward donating a family member's organs ( P = .000), and had discussed ODT within the family ( P = .000). Those who had a positive attitude toward living donation had a more favourable attitude toward deceased ODT ( P = .000 for kidney and P = .003 for liver). Most respondents (56%; n = 70) believed that the general information they received about ODT was limited and 9% (n = 11) believed that it was good. Most (83%; n = 104) had never received a talk about the subject, although 90% (n = 113) believed that receiving one would be very interesting. Conclusion Attitude toward ODT is favorable in a high percentage of students of journalism. This is positive if we want these professionals to inform society about the subject. They should be provided with clear and concise information.

Public Attitudes Toward Incentives for Organ Donation: A National Study of Different Racial/Ethnic and Income Groups

Attitudes toward monetary and nonmonetary incentives for living (LD) and deceased donation (DD) among the U.S. general public and different racial/ethnic and income groups have not been systematically studied. We studied attitudes via a telephone questionnaire administered to persons aged 18-75 in the continental United States. Among 845 participants (85% of randomized households), less than one-fifth participants were in favor of incentives for DD (range 7-17%). Most persons were in favor of reimbursement of medical costs (91%), paid leave (84%) and priority on the waiting list (59%) for LD. African Americans and Hispanics were more likely than Whites to be in favor of some incentives for DD. African Americans were more likely than Whites to be in favor of monetary incentives for LD. Whites with incomes less than $20 000 were more likely than Whites with greater incomes to be in favor of reimbursement for deceased donors' funeral expenses or medical expenses. The U.S. public is not generally supportive of incentives for DD, but is supportive of limited incentives for LD. Racial/ethnic minorities are more supportive than Whites of some incentives. Persons with low income may be more accepting of certain monetary incentives.

Vascular complications in living‐related and deceased donation pediatric liver transplantation: Single center's experience from Turkey

The aim of the study was to assess early and long-term incidence of venous complications, in both deceased donation (DD) and living-related (LR) liver transplantation (LT) in a pediatric population. Seventy-five liver transplants performed in 69 (39 boys, 30 girls) children at Ege University Hospital between 1997 and 2004 were prospectively monitored and reviewed. Age, sex, primary diagnosis, graft type, vascular complications and their management were evaluated. All patients received Doppler ultrasonographic examination both during operation and daily for the first three postoperative days and when necessary thereafter. The complications were classified as early and late presented. Thirty-three grafts (47.8%) were from DD and 36 (52.2%) were from LR donors. Recipients of DD were older than LR donors (mean age 10.5 +/- 5.1 and 5.0 +/- 0.7, respectively) (p < 0.05). Vascular complication occurrence was not statistically different between DDLT and LRLT recipients (p = 0.2), and between infants and children (p = 0.9). Overall, stenosis was more common than thrombosis. We observed hepatic artery (HA) thrombosis, in five of 75 (6.7%) transplants within 30 days post-transplant. Portal vein (PV) thrombosis and hepatic vein (HV) thrombosis were detected in six and one patients (8.7% and 1.3%), respectively. Six PV stenosis were identified (8.7%), while HA and HV-VC (vena cava) stenosis occurred in one and six patients (1.4% and 8.7%), respectively. All PV stenosis (6/33, 18.2%) and one PV aneurysm occurred in DDLT recipients while HV-VC stenosis were detected almost equally in LRLT and DDLT recipients (4/36 vs. 2/33). Except one, all PV stenosis were detected as a late complication and no intervention were needed. Stenosis of HV-VC was more common in girls (5/30 vs. 1/39) (p < 0.05) and the incidence was not different in DDLT and LRLT recipients (p = 0.8). In conclusion, overall incidences of thrombosis and stenosis formation after orthotopic liver transplantation (OLT) were 17.4% and 18.8%, respectively in our center. We suggest that in the cases with HA thrombosis manifested intra-operatively or within the early postoperative period, graft salvage was successful. Thrombosis of HA causes significant mortality. Thrombosis of PV was among the causes of mortality and morbidity. Stenosis of HV-VC could be managed by angioplasty and endovascular stenting with no significant effect to mortality.