Donor Procurement Research Articles

Directed Organ Donation After Euthanasia.

Organ donation after euthanasia is performed in Belgium, the Netherlands, Canada and Spain. Directed deceased organ donation is currently possible under strict conditions in a limited number of countries, while it is currently not possible to opt for directed donation following euthanasia. While organ donation after euthanasia is a deceased donation procedure, directed organ donation after euthanasia could be seen as a deceased donation procedure with a living donation consent process. Therefore, directed organ donation after euthanasia is feasible on medical and ethical grounds. Strict safeguards should be in place, including the requirement of a pre-existing familial or personal relationship with the proposed recipient, without any evidence of coercion or financial gain.

University students’ opinion on gamete donor identification regimes

PurposeThis study aims to evaluate the opinion of university students about the identification or nonidentification of gamete donation and the probability of donation according to the different regimes.MethodsThis was a cross-sectional observational study based on an online anonymous survey including questions about sociodemographic data, reasons for considering donations, information about the donation process and legislation, and their opinions about the different regimes and how they would influence donations.ResultsIn total, 1393 valid responses were obtained, with a mean age of 24.0 years (SD = 4.8), most of the respondents being female (68.5%), living in a relationship (56.7%), and without children (88.4%). The main reasons for considering donation would be altruism and monetary compensation. Overall, it was found that participants were poorly informed about the donation procedure and legislation. Students revealed preference for nonidentified donation, and they were less likely to donate in an open identity regime.ConclusionMost university students consider themselves poorly informed about gamete donation, express a preference for nonidentified gamete donation, and would less likely donate on an open identity basis. Thus, an identified regime may be less attractive to potential donors and lead to a decrease in the availability of gamete donors.

N-acetylcysteine and Reduction of Ischemia-reperfusion Injury in Liver Transplantation.

In the current issue of Transplantation, Jia et al perform a systemic review and meta-analysis looking at the utilization of N-acetylcysteine (NAC) in the donor and recipient in liver transplantation.1,2 It has been suggested that NAC may have a role in mitigating ischemia-reperfusion injury that occurs during the various stages of organ donation. The pathophysiology of ischemia-reperfusion injury is mainly due to the oxidative stress and cytotoxicity arising from the imbalance between oxidants and antioxidants. NAC is a rich source of sulfhydryl groups, which are important for replenishing glutathione (GSH) stores. GSH acts as a free radical scavenger to decrease damage caused by the toxic free radicals. GSH is the main endogenous antioxidant, and the liver is the main organ producing GSH under normal conditions.2 The present meta-analysis demonstrates a lower incidence of primary nonfunction, a reduction in posttransplant peak aspartate transaminase and alanine transaminase, and reduced postoperative complications in the NAC treatment groups compared with the control groups. As a long-time proponent of the use of NAC in the transplant setting, the overall results of this meta-analysis are encouraging. At Mayo Clinic Florida, we routinely use a NAC infusion for donation after circulatory death (DCD) liver transplant recipients. Our protocol involves a bolus of 150 mg/kg given over 1 h before reperfusion followed by an infusion of 150 mg/kg given for 72 h. Our current rate of ischemic cholangiopathy is <4%; however, whether NAC provides any direct benefit in the reduction of ischemic cholangiopathy remains unproven.3 More recently, we have also started using NAC in the perfusate when performing abdominal normothermic regional perfusion in DCD donors ([6 g/30 mL] × 3 vials). Negative effects of NAC administration are minimal. Although the meta-analysis demonstrated a slightly increased need for packed red blood cells and cryoprecipitate in NAC treatment groups, the magnitude of difference was <1 unit. This may imply that although a statistically significant difference was seen, such a small difference may not be clinically significant. There are some limitations to the present study that should be mentioned. One of the challenges with combining the data from the different studies in the present analysis is that some of the studies gave NAC to the donors at the time of donor procurement, some gave NAC to the recipients at the time of transplant, and others gave NAC to both the donor and recipient. Dosing and timing of dosing was also very heterogeneous between the different studies. Given this heterogeneity, developing a comprehensive protocol utilizing NAC is problematic. In the subanalysis, the authors did suggest that NAC administration to the recipient appeared to produce better clinical effects than administration to the donor. Another unanswered question based on the present analysis is how the benefits of NAC may vary by donor type? Some of the studies looked at living donors while others looked at donation after brain death donors and others looked at DCD donors. Could there be a more significant effect in marginal liver grafts with a suspected higher degree of ischemia-reperfusion injury or should NAC be utilized in all cases? Finally postoperative complications were treated as a binary variable (yes/no) for the analysis. Given the vastly different implications of complications based on their severity, using a classification system such as Clavien-Dindo would be more meaningful when comparing study groups. Despite the limitations of the present meta-analysis, the results are encouraging and suggest that NAC does have some potentially beneficial effects in reducing ischemia-reperfusion injury when used in the setting of liver transplantation. The adequate safety of NAC, in addition to its low costs, makes it an appealing intervention. Further studies are needed before evidence is strong enough to recommend a specific protocol describing both optimal timing and dosage for administration. Moreover, the donor type that may achieve the greatest benefit remains unknown.

Better Than Ice: Advancing the Technology of Donor Heart Storage With the Paragonix SherpaPak.

Better Than Ice: Advancing the Technology of Donor Heart Storage With the Paragonix SherpaPak.

Temperature Distribution Monitoring on Blood Bank Chamber Using Android Application on Mobile Phone

Blood cold chain is a mandatory requirement of blood donation procedures to protect blood from bacterial contamination and to extend the shelf life of blood. Blood bank as a storage medium for blood bags requires a temperature between 2℃-6℃ on average. However, in general, blood banks only have 1 cold temperature distribution point, which is feared that the spread of cold temperatures in the compartment will be different at each point. For this reason, the researcher intended to design a blood bank temperature distribution monitoring device consisting of 7 measurement points. In this case, temperature sensor readings at each point are displayed wirelessly to smartphone devices using the Blynk platform and are also on a 3.5-inch TFT screen. The measurement data were then stored on the SD card memory so that the level of temperature fluctuations in the blood bank compartment can be analyzed during use. The module was also equipped with an alarm warning on the module and the Blynk application if the temperature is out of the normal temperature range (2℃-6℃). Before being used for measuring temperature distribution, the device made was compared with the standard Fluke DPM4 tester, in which the highest error obtained was 2.08% at T1, 1.58% at T2, -2.73% at T3, 1,61% at T4, -1.07% at T5, -0.06% at T6, and -2.32% at T7. After being compared with standard equipment, the device was used to measure the temperature spread in the Kirsch brand blood bank and the average temperature obtained was 3.56℃ at T1, 3.58℃ at T2, 3.73℃ at T3, 3.57℃ at T4, 3.67℃ at T5, 3.63℃ at T6, and 3.72℃ at T7. Based on the analysis results, the blood bank monitoring device can be used to measure the temperature spread in the blood bank compartment at 7 measurement points. Furthermore, temperature readings can be monitored wirelessly and remotely. It is hoped that this research can further help laboratory personnel at the Blood Transfusion Unit to monitor and evaluate the level of temperature spread in the blood bank compartment and prevent early damage to blood components.

Haemovigilance Programme of India: A brief Review on Musketeer of safe Blood Transfusion in India

Haemovigilance contributes major importance in regard to safe blood transfusions and ensuring patient safety. With coherently scrutinizing adverse events in the transfusion chain, Haemovigilance aids a safer and effective blood donation and transfusion procedures. These days, adverse event tracking, investigation, and analysis create pertinent data for the quality cycle of blood collection facilities, transfusion laboratories, and transfusion institutions. This review article focuses on the requirement of Haemovigilance, the current status of Haemovigilance in India as well as the Haemovigilance Program of India (HvPI) with respect to blood transfusion.

Deceased donor vein extension grafts for right living donor kidney transplantation.

In an effort to maximize living donor kidney utilization, we describe the use of deceased donor vein extension grafts for right-sided living donor kidneys and report our single-center experience using this technique. A retrospective review of kidney transplant recipients (KTR) who received a right living donor kidney with deceased donor vein extension graft. Recipient demographics, postoperative graft function, and surgical complications were reviewed. Living donor nephrectomies were performed laparoscopically. Vein grafts were obtained from recent deceased donor procurements. End-to-end anastomosis of the graft to the renal vein was performed prior to implantation. Thirty-eight KTR received a right kidney transplant with deceased donor extension grafts. The median recipient age and BMI were 53.0 years and 29.3kg/m2 . Total 71% were male. Ninety-five percent of grafts displayed immediate graft function, with two recipients requiring temporary dialysis due to anaphylaxis from induction therapy. Median serum creatinine at two weeks was 1.6mg/dL and at three months was 1.5mg/dL. There were no graft thromboses. Utilization of deceased donor extension grafts for short right renal veins is a simple technique that expands the donor pool for living donor renal transplantation. Our experience resulted in no technical complications and excellent early graft function.

Critical Analysis of China’s Higher Education Cost-sharing Policy under the Background of Universal Higher Education

China's higher education has entered the stage of universal higher education. This has significantly increased the demand for education funding in the higher education sector and has also brought new requirements for higher education cost-sharing systems. This paper analyzed the current situation of China's higher education cost-sharing system under the background of universalization and found that due to insufficient government investment in higher education intuitions, tuition fees have risen, and the cost of higher education shared by students and parents has increased significantly. However, the cost shared by higher education institutions and society remains low. Regarding the problem, this paper suggests that policymakers should consider increasing government spending, charging tuition fees according to family conditions, improving the student loan system, encouraging social donations and standardizing donation procedures, and improving higher education institutions’ ability to raise educational funds, so as to optimize the structure of cost-sharing and meet the needs of higher education expansion.

Leukocyte Reduction Filters Are Reliable and Economic Source for Natural Killer Cell Preparation.

An issue that hinders researchers' access to Natural Killer (NK) cells is their low proportion in peripheral blood leukocytes. This issue is currently addressed by methods involving a series of differentiation and expansions that are time-consuming and expensive. We have investigated whether the used leukocyte reduction filters, a by-product in the blood transfusion practice that currently is considered waste, can be utilized as a source of the NK cells. Following the blood donation of 46 donors based on the Iranian Blood Transfusion Organization's protocols, a sample of peripheral blood of each donor and the leukocyte reduction filter used in their donation procedure have been obtained. The entrapped cells were flushed back from the leukocyte reduction filters. Both groups of samples were analyzed using an automatic hematological analyzer. NK cell isolation was done by the MACS negative selection method. The samples have been comparatively analyzed utilizing flow cytometry data of NK cells' subpopulation compositions, viability, degranulation patterns, and cytotoxic capacity against the K562 cell line. Every major leukocyte population was abundant in the samples extracted from the used leukocyte reduction filters. The NK cells extracted from leukocyte reduction filters did not show any statistically meaningful differences (P<0.5) from peripheral blood samples in terms of subpopulation composition, viability, degranulation potency, and cytotoxic capacity. Used leukocyte reduction filters can be considered an economic, easy to obtain, and robust source of abundant research-grade NK cells.

Ethical Challenges for Organoid Research and Use: Focusing on Targets of Organoid Research, Donation Procedure, and Future Use*

Ethical Challenges for Organoid Research and Use: Focusing on Targets of Organoid Research, Donation Procedure, and Future Use*

OECD workshop consensus report: Ethical considerations with respect to human derived products, specifically human serum, in OECD test guidelines.

The ethical needs and concerns with use and sourcing of human materials, particularly serum, in OECD in vitro test guidelines were explored in a dedicated international workshop held in 2019. The health-related aspects of the donation procedure, including tissue screening, donor health, laboratory work health protection, permission from the donor for commercial use, payment of the donors and the potential for exploitation of low-income populations and data protection of the donors; supply, availability, and competition with clinical needs; traceability of the serum and auditability/GLP needs for the Test Guideline Programme, were examined. Here we provide the recommendations of the workshop with respect to the use of human serum, and potentially other human reagents, specifically with regard to test method development for OECD Test Guideline utility as part of the Mutual Acceptance of Data requirement across all OECD member countries. These include informed donor consent terminology, a checklist of human serum information requirements to be included with the Good Laboratory Practise report, and suitable sources for human serum to ensure waste supplies are used, that can no longer be used for medical purposes, ensuring no competition of supply for essential medical use.

Willingness towards eye donation: A public health necessity in Pakistan

Introduction: According to the WHO, a person is said to be blind when he/she has visual acuity of less than 3/60, and/or a corresponding visual field of less than 10°; for a smaller diameter, in the better eye with the best possible correction. At present, approximately 39 million individuals are bilaterally blind, and another 285 million with severe visual impairment.&#x0D; Objective: To assess the willingness and knowledge of the people regarding eye donation and to evaluate factors associated with eye donation.&#x0D; Methodology: This cross-sectional study was carried out in the outdoor patient department (OPD) of two governments and two private tertiary healthcare hospitals in Rawalpindi and Islamabad. A total of 360 individuals who visited OPD of the tertiary health care hospitals were included. Data were obtained by using an interview-based questionnaire after taking informed consent. Inferential analysis was done by applying the Chi-Square test and binary logistic regression.&#x0D; Results: Out of 360 respondents, the majority were males 201. 276 were willing to donate their eyes. Willingness showed a statistically significant association with occupation. 175 had good knowledge regarding eye donation. Male respondents had 3 times more knowledge regarding eye donation as compared to females. Respondents having an age higher than 30 years had 2 times high knowledge as compared to individuals having an age less than 30 years. &#x0D; Conclusion: The majority of the people showed willingness but had little knowledge regarding eye donation procedures and eye banks in Pakistan.

An Optimized Search Prognosis Tool to Predict 8/8 HLA Allele-Matched Unrelated Donor Procurement

For patients in need of allogeneic transplantation who lack an HLA-identical sibling, an 8/8 HLA allele-matched unrelated donor (URD) is a standard alternative. However, delays in URD procurement can adversely impact patient care. Recipient genotype and search assessment (MSKv1.0)-based tools can predict search prognosis for many, but both tools have lower performance in non-European ancestry patients. Using the MSKv1.0 tool, we analyzed searches from 1530 potential allograft recipients (including 863 who underwent transplantation) with the aim of creating an optimized MSKv2.0 search prognosis tool that can classify a URD search as either Good or Poor with a high level of accuracy while also limiting an ambiguous Fair search prognosis regardless of patient ancestry. By MSKv2.0, the 8/8 URD search prognosis distribution was 57% Good, 21% Fair, and 22% Poor in Europeans and 15% Good, 21% Fair, and 63% Poor in non-Europeans. Importantly, compared to MSKv1.0, the likelihood of Fair categorization was reduced to <25% with comparable Fair rates (P=.847) in both European and non-European groups. Moreover, all patients with an MSKv2.0 Good prognosis had an 8/8 URD identified, and almost all of those who underwent transplantation had an 8/8 URD (Europeans, 99%; non-Europeans, 98%; P=.504). The MSKv2.0 tool also was highly accurate at classifying Poor searches, with <10% identifying an 8/8 URD, and almost all patients who underwent transplantation (Europeans, 95%; non-Europeans, 96%) receiving an alternative donor. Using preliminary search results, MSKv2.0 accurately classifies patients by likelihood of 8/8 URD procurement, greatly facilitating triage to 8/8 URD (Good prognosis) or alternative donor (Poor prognosis) transplantations.

American Society of Transplant Surgeons recommendations on best practices in donation after circulatory death organ procurement.

The American Society of Transplant Surgeons supports efforts to increase the number of organs that are critically needed for patients desperately awaiting transplantation. In the United States, transplantation using organs procured from donation after circulatory death (DCD) donors has continued to increase in number. Despite these increases, substantial variability in the utilization and practices of DCD transplantation still exists. To improve DCD organ utilization, it is important to create a set of best practices for DCD recovery. The following recommendations aim to provide guidance on contemporary issues surrounding DCD organ procurement in the United States. A work group was composed of members of the American Society of Transplant Surgeon Scientific Studies Committee and the Thoracic Organ Transplantation Committee. The following topics were identified by the group either as controversial or lacking standardization: prewithdrawal preparation, definition of donor warm ischemia time, DCD surgical technique, combined thoracic and abdominal procurements, and normothermic regional perfusion. The proposed recommendations were classified on the basis of the grade of available evidence and the strength of the recommendation. This information should be valuable for transplant programs as well as for organ procurement organizations and donor hospitals as they develop robust DCD donor procurement protocols.

Perception of blood donation among employees of healthcare organizations during COVID-19 pandemic: A national multicenter cross-sectional study.

Maintaining a safe and adequate blood supply during a crisis is a major challenge facing blood banks around the world. With the recent global COVID-19 crisis and the enforced "stay at home" lockdown, access to blood donors was limited. Since employees of healthcare facilities may act as potential blood donors, their perception of blood donation and their willingness to donate during the pandemic period is important to be assessed. A national cross-sectional study at six centers in Saudi Arabia was conducted using an online-based questionnaire that was distributed to all healthcare employees in these facilities between June and August 2020. Among the total of 1664 participants, 63.2% (n= 1051) did not donate blood during the last 2 years. However, 53% (n= 882) of participants reported they are likely to donate blood during the COVID-19 crisis. Furthermore, 85% (n= 1424) did not donate blood during the current pandemic, with the biggest worries of getting the COVID-19 infection in the donor center. The main concerns of participants were about adherence to physical distancing requirements and the safety of the donation procedure. The majority of health care participants (88.2%) support implementing a hospital policy for a voluntary blood donation by employees during crises. Recruitment of more blood donors among health care employees is a feasible solution to improve the blood supply during a crisis. This should be based on efforts throughout the year including regular awareness campaigns and effective communication.

Analisis Pengetahuan tentang Donor Darah untuk Kesehatan Kepada Masyarakat di PMI Kota Medan

The death rate due to the unavailability of blood reserves in developing countries is relatively high. In fact, the percentage of blood donors is still low which causes limitations in meeting the increasing demand for blood. This limited number of blood donors can be caused by lack of knowledge about blood donors, wrong assumptions or perceptions about blood donors, or fear of technical blood donation procedures. This study aims to describe knowledge about blood donation, and the importance of blood donation for health. This research uses a descriptive qualitative research approach, namely by using the interview method. The object of this research is 3 PMI members. The results of the study stated knowledge about blood donation, the importance of blood donation for health and the impact of blood donation.&#x0D; Keywords: Knowledge, Benefit, Impact.

Experimental Assessment of Intestinal Damage in Controlled Donation After Circulatory Death for Visceral Transplantation.

There is an urgent need to address the shortage of potential multivisceral grafts in order to reduce the average time in waiting list. Since donation after circulatory death (DCD) has been successfully employed for other solid organs, a thorough evaluation of the use of intestinal grafts from DCD is warranted. Here, we have generated a model of Maastricht III DCD in rodents, focusing on the viability of intestinal and multivisceral grafts at five (DCD5) and twenty (DCD20) minutes of cardiac arrest compared to living and brain death donors. DCD groups exhibited time-dependent damage. DCD20 generated substantial intestinal mucosal injury and decreased number of Goblet cells whereas grafts from DCD5 closely resemble those of brain death and living donors groups in terms intestinal morphology, expression of tight junction proteins and number of Paneth and Globet cells. Upon transplantation, intestines from DCD5 showed increased ischemia/reperfusion damage compared to living donor grafts, however mucosal integrity was recovered 48h after transplantation. No differences in terms of graft rejection, gene expression and absorptive function between DCD5 and living donor were observed at 7 post-transplant days. Collectively, our results highlight DCD as a possible strategy to increase multivisceral donation and transplantation procedures.

Can the Close be Tested from Afar? Dilemmas Regarding Online Interviews with Bone Marrow Donors

The article was written on the basis of the experience of conducting individual interviews using the Internet. The aim of the text is to present reflections on the possibilities, opportunities and dilemmas regarding the threats and limitations of this form of data collection. Interviews were conducted with three actual bone marrow donors and covered their experiences throughout the donation procedure. The remote form was chosen due to the ongoing Covid-19 pandemic and difficulties with setting the date of the meeting. Constructed conclusions are based on the observations and experiences of the researcher and the statements of the Narrators themselves regarding participation in the online interview conducted in this way.

Body Donation Awareness in Eastern Uttar Pradesh: A Cross-sectional Study among Medical Students, Practitioners, and Support Staff

Introduction: Cadavers play a crucial role in facilitating the study of anatomy, as a comprehensive understanding of human anatomy necessitates the dissection of human bodies. Additionally, cadavers are utilised for advanced laboratory work, workshops, and the training of surgical science postgraduates. With the rapid proliferation of medical colleges across the nation and the existing institutions striving to increase their student intake, the supply of unclaimed bodies may no longer be adequate to meet the demands of these institutions. Consequently, the necessity for voluntary body donation becomes increasingly pertinent. Aim: To assess the knowledge, attitude, and awareness regarding body donation among 1st-year MBBS students, healthcare professionals/doctors, and non teaching staff of a teaching institution in Eastern Uttar Pradesh, India. Materials and Methods: This was a cross-sectional study conducted at Varun Arjun Medical College and Rohilkhand Hospital, Banthra, Shahjahanpur, Uttar Pradesh, India. The total number of study participants (n=230) was divided into three groups: 1st-year MBBS students (n=90), healthcare professionals/ doctors (n=70), and non teaching staff (n=70). A self-designed and structured questionnaire containing 15 questions was used in the study. Data were recorded in an Excel sheet and analysed using Statistical Package for Social Sciences (SPSS) Version 26.0 (Chicago, Inc, USA). Results: In the MBBS and Doctors groups, all participants demonstrated familiarity with the study topic, while 95.7% of the non teaching group reported being unacquainted with the concept of body donation. Regarding the purpose of body donation, both MBBS students and Doctors indicated the dual purposes of organ donation/transplantation and medical teaching and research. Male respondents exhibited a notably positive attitude (96.6%) towards both purposes without reservation, while females showed a stronger inclination towards organ donation. When questioned about the procedure for donating the body, the MBBS students and non teaching staff displayed a lack of awareness regarding the process, with 89.5% of doctors being knowledgeable about the donation procedure. Conclusion: Despite the considerable level of awareness regarding body donation, there exists a notable lack of motivation, which could be addressed through effective sensitisation and education initiatives. Enhancing the scenario of insufficient body donations could be accomplished through targeted awareness campaigns utilising both print and electronic media.

Blood Donation Knowledge, Perceptions, and Practices during COVID-19 Pandemic: Questionnaire-Based Study in Saudi Arabia.

The level of good knowledge of the blood donation process and perceptions constituted more than 52.2% and 52.9%, respectively, of the participants. The biggest motivation for the donation process was the awareness campaigns, which amounted to 52.5%, and the biggest obstacle to the blood donation procedure is the lack of health fitness. It has been found that 43.0% of those who completed the questionnaire had donated blood during the COVID-19 pandemic. Though the high level of awareness of the importance of blood donation for COVID-19 patients, as well as the satisfaction with the experience of blood donation for patients, the level of general knowledge remains average.