Donation System Research Articles

Protocol and Statistical Analysis Plan for a Comparative Interrupted Time Series Evaluation of the Impact of Deemed Consent for Organ Donation Legislative Reform in Nova Scotia, Canada

The Canadian province of Nova Scotia recently became the first North American jurisdiction to implement deemed consent for deceased organ donation as part of a comprehensive legislative reform of their donation and transplantation system. This study will examine the performance metrics and effectiveness of this policy in comparison with other Canadian provinces via a natural experiment evaluation. We will use a cross-sectional controlled interrupted time series quasi-experimental design. Our primary outcome will be consent for deceased donation as confirmed at the time of eligibility (prior registered intent to donate will be noted but not be considered positive unless affirmed at the time of eligibility). Secondary outcomes will include identification and referral of patients who are potential donors, rates of family override of previously registered intent to donate, and donation and transplantation rates per million population. Data will be collected from potential donor audits in Nova Scotia and 3 control provinces (provinces in Canada without deemed consent policies). Study outcomes will be compared in Nova Scotia relative to control provinces in the 3 y before and 3 y after the implementation of legislative reform. These provinces were selected as having systems resembling those of Nova Scotia but without deemed consent.Using controlled interrupted time series methodology compared with other Canadian provinces with otherwise similar systems, we aim to isolate the impact of the deemed consent aspect of legislative reform in Nova Scotia using a robust natural experiment evaluation design as much as possible. Careful selection of outcome measures will allow donation and transplantation stakeholders to properly evaluate if similar reforms should be considered in their jurisdictions.

Exploring Perspectives of Blockchain Technology and Traditional Centralized Technology in Organ Donation Management: A Comprehensive Review

Background/Objectives: The healthcare sector is rapidly growing, aiming to promote health, provide treatment, and enhance well-being. This paper focuses on the organ donation and transplantation system, a vital aspect of healthcare. It offers a comprehensive review of challenges in global organ donation and transplantation, highlighting issues of fairness and transparency, and compares centralized architecture-based models and blockchain-based decentralized models. Methods: This work reviews 370 publications from 2016 to 2023 on organ donation management systems. Out of these, 85 publications met the inclusion criteria, including 67 journal articles, 2 doctoral theses, and 16 conference papers. About 50.6% of these publications focus on global challenges in the system. Additionally, 12.9% of the publications examine centralized architecture-based models, and 36.5% of the publications explore blockchain-based decentralized models. Results: Concerns about organ trafficking, illicit trade, system distrust, and unethical allocation are highlighted, with a lack of transparency as the primary catalyst in organ donation and transplantation. It has been observed that centralized architecture-based models use technologies such as Python, Java, SQL, and Android Technology but face data storage issues. In contrast, blockchain-based decentralized models, mainly using Ethereum and a subset on Hyperledger Fabric, benefit from decentralized data storage, ensure transparency, and address these concerns efficiently. Conclusions: It has been observed that blockchain technology-based models are the better option for organ donation management systems. Further, suggestions for future directions for researchers in the field of organ donation management systems have been presented.

Peer-to-Peer Human Milk Sharing Through Social Media Groups: The Experiences of Women Donors and Recipients in Hong Kong.

To explore the lived experience of donors and recipients involved in peer-to-peer human milk donation. An exploratory descriptive qualitative study. Semi-structured interviews were conducted between November 2022 and April 2023. A total of 50 women consisting of 34 donors and 16 recipients were recruited using purposive sampling from specific social media groups in Hong Kong that focus on breast milk donation and sharing. Data were analysed based on thematic analysis. Five key themes were identified in this study: Motivation; Milk sharing as a social act; Not a Norm; Recommendation to formal milk banks; and Formal donation as the preferred route. The findings indicate informal milk sharing is seen as an inferior alternative to formal milk donation systems. The establishment of formal milk banks is viewed as a way to address the shortcomings of informal sharing. The findings have implications for the healthcare field, particularly in improving the experiences of those involved in informal milk sharing. The insights gained from the experiences of informal milk sharers can directly inform and enhance the services provided by formal milk banks. Given the growing prevalence of online informal milk sharing, healthcare professionals should enhance their understanding of this practice. However, the practice has remained understudied, particularly in Asian region. This study brings together the experiences of both milk donors and recipients, providing a comprehensive view on the phenomenon. The Standards for Reporting Qualitative Research (SRQR). No patient or public contribution.

How doctors can lead the way in their communities: Co-creation, the Indian community and organ donation registration.

Transplant success rates can increase when organs and tissues are matched within ethnic communities, but how well are the processes around organ donation understood by discrete ethnic communities in Australia? We investigated this in relation to one ethnic group, the Australian-Indian community in Sydney. A culturally appropriate survey and dissemination strategy was co-created with Indian community members through an Advisory Panel. Items were informed by a thematic analysis of cultural beliefs shared through the advisory panel discussions and measured awareness and practices associated with organ donation and transplantation and beliefs about organ donation and registration. Donation information was provided at the end. Two hundred and thirty-eight participants completed the survey. Hinduism along with Tamil and Gujarati were the most frequently identified religious and cultural backgrounds. The processes around organ donation were not well known, and Australian Organ Donor Register registration rates were below the national average. Principal component analysis revealed positive, social, medical trust, concerns, and cardiac and brain death belief factors. Doctors played a key role in generating trust in the donation system, decisions about organ donation were embedded in family and community, and family discussion was related to increased registration. Registered participants reported higher scores on medical trust beliefs, which also predicted family discussion. The information needed to understand the process of organ donation and registration in Australia is not embedded in this community, highlighting the need forprogrammes to be tailored to each culturally diverse community rather than culturally diverse communites in general. Doctors and the advisory panels are pivotal in this process.

Gender Dynamics In Organ Donation And Transplantation: An Analysis Of Donor And Recipient Trends

Organ donation and transplantation represent critical components of modern medicine, offering life-saving solutions for individuals with organ failure. Despite advancements in medical practices, significant gender disparities exist within these processes, where women disproportionately contribute as donors while men are predominantly recipients. This study integrates an in-depth statistical analysis of data from major registries like the United Network for Organ Sharing (UNOS) and the Organ Procurement and Transplantation Network (OPTN), utilizing chi-square tests, logistic regression, multivariate analysis, and stratified sampling to elucidate these trends. By combining quantitative data with socio-cultural theories, this research aims to uncover the multifaceted causes behind these gender-based discrepancies, revealing that social conditioning, altruistic behaviour, and systemic biases in medical practices play crucial roles. The results indicate statistically significant correlations between gender and donor/recipient status, suggesting that both traditional gender roles and healthcare biases need to be addressed to create a more equitable organ donation system. The study concludes by proposing policy reforms and advocacy strategies to foster gender neutrality in organ transplantation, ultimately promoting a fairer healthcare paradigm.

Analysis of Attitudes Towards Opt-Out Organ Donation Consent: A Cross-Sectional Study Among Saudi Arabian Residents

ObjectiveThe study aims to investigate public opinion on opt-out organ donation registration in Saudi Arabia, addressing a gap identified in existing research that reveals varied attitudes and intentions among the population, as indicated by studies in Qatar and Saudi Arabia. MethodsThis study employed a secondary analysis approach, utilizing data from a cross-sectional survey conducted online among 1397 residents of Saudi Arabia. The survey utilized a GoogleTM form questionnaire adapted from a previous study in Qatar. The questionnaire comprised three sections, gathering socio-demographic information, assessing general awareness about organ donation, and exploring participants' agreement with opt-out consent and beliefs related to organ donation using the Theory of Planned Behaviour (TPB) model. ResultsAmong the participants, 44.4% supported opt-out consent, with 25.7% females and 39.1% Saudi citizens. Females and diploma/graduation-level education were significantly associated with opt-out support (p<0.001, p=0.012, respectively). 98.06% of opt-out supporters were familiar with organ donation. 93.05% agreed to promote organ donation, 98.38% believed registration saves lives, and 81.91% were willing if family had no objections. 86.75% were ready with more information, and 85.78% if informed about their religion's perspective. 92.25% believed living and posthumous donation positively impact life after death. Concerns included inadequate care (33.44%) and bodily disfigurement (28.43%) postmortem. Majority felt healthy (45.56%) and appropriate in age for donation (57.67%). Among opt-out supporters, 20.84% expressed interest, 8.4% conveyed disinterest, while 36.34% remained undecided regarding organ donation registration. ConclusionThe study reveals a considerable openness among Saudis toward adopting an opt-out organ donation system, suggesting a potential avenue for increased organ donation rates. While acknowledging cultural nuances, particularly familial influences, targeted interventions are vital to overcome specific barriers and ensure the successful implementation of an opt-out policy.

Smart Blockchain Networks: Revolutionizing Donation Tracking in the Web 3.0

A donation-tracking system leveraging smart contracts and blockchain technology holds transformative potential for reshaping the landscape of charitable giving, especially within the context of Web 3.0. This paper explores how smart contracts and blockchain can be used to create a transparent and secure ledger for tracking charitable donations. We highlight the limitations of traditional donation systems and how a blockchain-based system can help overcome these challenges. The functionality of smart contracts in donation tracking, offering advantages such as automation, reduced transaction fees, and enhanced accountability, is elucidated. The decentralized and tamper-proof nature of blockchain technology is emphasized for increased transparency and fraud prevention. While elucidating the benefits, we also address challenges in implementing such a system, including the need for technical expertise and security considerations. By fostering trust and accountability, a donation-tracking system in Web 3.0, empowered by smart blockchain networks, aims to catalyze a profound positive impact in the realm of philanthropy.

Why did England change its law on deceased organ donation in 2019? The dynamic interplay between evidence and values.

In the three years since the law on adult deceased organ donation consent in England changed to include an opt-out system, there has been no discernible change to donation rates. The lack of a positive impact on donation rates was predicted by many of those who took part in debates before and during the passage of the Bill through Parliament. This invites the question as to why England moved to an opt-out system for organ donation despite equivocal evidence of likely benefit and opposition from expert health professional organisations. To address this question qualitative analyses of Parliamentary debates on organ donation was undertaken. This revealed a shift from a dominant position, which gave primacy to the evidence of likely effects, towards a more normative position where a deemed consent option was viewed as the 'correct thing to do' and the limited and conflicting evidence viewed in a positive light. By 2017, following Wales's move to an opt-out system, together with continued lobbying for similar changes for England by professional and patient groups, alongside sustained public popularity for organ donation, the balance of opinion had shifted towards a system where deemed consent would become the default position for most English adults.

405.5: The need for rethinking about kidney donation systems.

405.5: The need for rethinking about kidney donation systems.

A 25-year scoping review of the organ donation system in Malaysia: past, present, and future.

Organ donation and transplantation are integral components of modern medicine. This scoping review thoroughly explores the historical evolution, current status, and future prospects of organ donation and transplantation in Malaysia. Historically, Malaysia faced significant challenges in establishing a robust organ transplantation system, with various factors hindering organ donation efforts. Currently, Malaysia continues to struggle with stagnant donation rates despite collaborative efforts from various sectors. There is an urgent need to amend the 50-year-old Human Tissue Act to strengthen the legal framework for organ donation and address ethical concerns. Looking to the future, Malaysia could adopt a soft opt-out system and prioritize advancements in organ preservation techniques by exploring new sources of organs through the donation after circulatory death program. Continued efforts are necessary to enhance education programs for professionals and the public, dispelling myths about organ donation and effectively educating on the concepts of brain death. Malaysia strives to create a more accessible future for organ transplantation, aligning with the Sustainable Development Goals to reduce the burden of organ failure and improve the population's health and well-being.

Trends in organ donation in England, Scotland and Wales in the context of the COVID-19 pandemic and 'opt-out' legislation.

In May 2020, England implemented soft 'opt-out' or 'deemed consent' for deceased donation with the intention of raising consent rates. However, this coincided with the COVID-19 pandemic, making it difficult to assess the early impact of the law change. Wales and Scotland changed their organ donation legislation to implement soft opt-out systems in 2015 and 2021 respectively. This study provides a descriptive analysis of changes in consent and transplant rates for deceased organ donation in England, Scotland and Wales. Logistic regression and descriptive trend analysis were employed to assess the probability of a patient who died in critical care becoming a donor, and to report consent rates using data, respectively, from the Intensive Care National Audit and Research Centre (ICNARC) in England from 1 April 2014 to 30 September 2021, and from the Potential Donor Audit for England, Scotland and Wales from April 2010 to June 2023. The number of eligible donors in April-June 2020 were 56.5%, 59.3% and 57.6% lower in England, Scotland and Wales relative to April-June 2019 (pre-pandemic). By April-June 2023, the number of eligible donors had recovered to 87.4%, 64.2% and 110.3%, respectively, of their levels in 2019. The consent rate in England, Scotland and Wales reduced from 68.3%, 63.0% and 63.6% in April-June 2019 to 63.2%, 60.5% and 56.3% in April-June 2023. While the UK organ donation system shows signs of recovery from the COVID-19 pandemic, the number of eligible potential donors and consent rates remain below their pre-pandemic levels.

BOMS: blockchain-enabled organ matching system

This work proposes a Blockchain-enabled Organ Matching System (BOMS) designed to manage the process of matching, storing, and sharing information. Biological factors are incorporated into matching and the cross-matching process is implemented into the smart contracts. Privacy is guaranteed by using patient-associated blockchain addresses, without transmitting or using patient personal records in the matching process. The matching algorithm implemented as a smart contract is verifiable by any party. Clinical records, process updates, and matching results are also stored on the blockchain, providing tamper-resistance of recipient’s records and the recipients’ waiting queue. The system also is capable of handling cases in which there is a donor without an immediate compatible recipient. The system is implemented on the Ethereum blockchain and several scenarios were tested. The performance of the proposed system is compared to other existing organ donation systems, and ours outperformed any existing organ matching system built on blockchain. BOMS is tested to ascertain its compatibility with public, private, and consortium blockchain networks, checks for security vulnerabilities and cross-matching efficiency. The implementation codes are available online.

Blockchain-based Management for Organ Donation and Transplantation

Organ donation and transplantation systems now face a variety of requirements and obstacles in terms of registration, donor-recipient matching, organ removal, organ delivery, and transplantation, all of which are hampered by legal, clinical, ethical, and technical restrictions. As a result, a comprehensive organ donation and transplantation system is essential to provide a fair and efficient procedure that improves patient experience and confidence. In this work, we present a private Ethereum blockchain-based system for managing organ donation and transplantation in a completely decentralised, secure, traceable, auditable, private, and trustworthy manner. We create smart contracts and offer six algorithms, along with information on their implementation, testing, and validation. We assess the performance of the suggested solution by conducting privacy, security, and confidentiality assessments and comparing it to current solutions.

Attitude of Jordanians towards a new enactment for an opt-out organ donation system: a cross-sectional study

BackgroundOrgan donation entails saving or transforming lives through the provision of organs, either from living donors or deceased individuals. In Jordan, low donation rates are attributed to religious misconceptions, limited...

Unmet need for heart transplantation in Africa.

Heart transplantation is a critical treatment option for end-stage heart failure patients, offering a lifeline for those with severe cardiac conditions. However, in Africa, the unmet need for heart transplantation is a significant issue that poses challenges to the healthcare system and patient outcomes. Africa faces multiple barriers to heart transplantation, including limited infrastructure, a shortage of skilled healthcare professionals, a lack of funding, and inadequate organ donation systems. These challenges result in a considerable gap between the demand for heart transplants and the available resources to meet this need. As a result, many patients in Africa do not have access to life-saving heart transplantation procedures, leading to high mortality rates among those awaiting transplants. Addressing the unmet need for heart transplantation in Africa requires a multifaceted approach. The authors recommend that Africa as a continent build up a heart transplantation workforce involving a multidisciplinary team that consists of transplant surgeons, transplant physicians, nurses, anesthetists, pharmacists, etc. Heart transplant education and training programs should be well-constructed to ensure the delivery of safe and effective transplantation services. International collaborations have proven to be effective and should be encouraged between African institutions and transplant centers worldwide to facilitate knowledge transfer. Foreign and local organizations should promote public awareness about organ donation to address the myths about heart transplantation and promote heart donation. With these, African countries can improve access to heart transplantation, enhance patient outcomes, save lives in the region, and ultimately reduce the mortality rate in Africa.

Liver transplantation for alcohol-associated liver disease.

Alcohol-associated liver disease (ALD) is a major cause of morbidity and mortality worldwide, and a leading indication for liver transplantation (LT) in many countries, including the United States. However, LT for ALD is a complex and evolving field with ethical, social, and medical challenges. Thus, it requires a multidisciplinary approach and individualized decision-making. Short-term and long-term patient and graft survival of patients undergoing LT for ALD are comparable to other indications, but there is a continued need to develop better tools to identify patients who may benefit from LT, improve the pretransplant and posttransplant management of ALD, and evaluate the impact of LT for ALD on the organ donation and transplantation systems. In this review, we summarize the current evidence on LT for ALD, from alcohol-associated hepatitis to decompensated alcohol-associated cirrhosis. We discuss the indications, criteria, outcomes, and controversies of LT for these conditions and highlight the knowledge gaps and research priorities in this field.

Consciousness of the vital role of transplantology among citizens of Polish small towns

Transplantology in Poland has faced challenges in recent years, marked by a decline in organ donation rates. From 2016 to 2020, the organ donation ratio decreased from 14 to 10 donors per million inhabitants. Although a slight increase to 11.8 was observed in 2022, there remains a shortage in organ procurement. This study investigates society’s knowledge and attitudes towards organ donation, focusing on small towns where literature on transplantology is limited. A survey was conducted among 100 patients in Ryglice and Zalasowa, southeastern Poland. Analysis of demographic data revealed correlations between gender, education level, and certain aspects of transplantology knowledge. Women with higher education exhibited greater awareness and willingness to become living donors. However, the study found no correlation between age groups and transplantology knowledge. Despite technological advancements in transplantology, the study emphasizes the importance of health education, particularly in rural areas, to address the knowledge gap and foster a culture of organ donation. Strategies to increase awareness, especially among younger generations, and improve legislative measures are proposed. The study also highlights the potential of digital platforms for information dissemination and suggests statistical extrapolation to estimate the potential donor pool in rural areas. Overall, addressing these challenges is crucial for building a robust organ donation system and improving public health in Poland. Keywords: Tissue and Organ Procurement Living Donors, Poland, Health Education, Public Health.

Investigation into Enhancing the Motivation and Distribution System for Organ Donation in China

Investigation into Enhancing the Motivation and Distribution System for Organ Donation in China

Modern problems of plasma donation services: global experience in solving them

As an analysis of foreign literature on donation has shown, the global market for therapy with drugs from human plasma is growing, which leads to the need for large volumes. With significant geographic imbalances in the global plasma supply and the dependence of most countries on plasma supplies from the United States, the most vulnerable are low- and middle-income countries, where the challenge of meeting the demand for plasma products requires improvements to regional plasma donation systems. An effective tool for the development of plasma collection services is compliance with the standards of plasma donation services, the development of voluntary free plasma donation, and the optimization of donor recruitment and retention processes.

Paths to improve voluntary blood donation in mixed public/private blood donation systems such as in Lebanon?

BackgroundThe World Health Organization advocates for the achievement of 100% voluntary non-remunerated blood donation (VNRD) globally by the year 2020. However, until today, little was known in Lebanon regarding its actual rate or influencing factors, particularly donor motivations and behaviors. Therefore, the aim of this study was to assess the knowledge, attitudes, and practices of blood donors in Lebanon. The ultimate goals were to retain first-time donors, encourage them to become regular ones, and facilitate the transition from replacement donation to VNRD. Materials and MethodsA multi-centric cross-sectional study was carried across the five governorates in Lebanon. A self-administered and structured questionnaire was used in this survey. Results were presented in terms of odds ratios, with statistical significance defined at a P value of 0.05 and a 95% confidence interval. Additionally, a benchmarking analysis of the situation of blood donation in Lebanon was also conducted, identifying several areas for improvement. ResultsA total of 620 blood donors participated in this study, with 21.3% being first-time donors and 78.7% repeat donors. While the latter were primarily motivated by self-esteem, solidarity or returning a favor (89%, 77.9% and 78.1%), the main obstacle for becoming regular donors was a lack of initiative (34.6%). Female donors (9.9% of the total) exhibited better knowledge (OR = 2.20, p = 0.011) and were more inclined to donate voluntarily (OR = 1.52, p = 0.048). Conversely, male donors were more likely to be repeat donors, often through replacement donation (OR = 2.95, p = 0.001). ConclusionThere is a significant disparity between the low rate of voluntary donation in Lebanon (22.2%) and the relatively high proportion of donors with adequate knowledge of the donation process (60.5%). Therefore, urgent action by public authorities, based on the evidence based strategies outlined in this article, is crucial to enhancing the voluntary donation rate in Lebanon.