Life-saving Organ Transplants Research Articles

Providing red blood cells to facilitate organ transplant via normothermic perfusion techniques: A single-center experience.

Normothermic regional perfusion (NRP) and normothermic machine perfusion (NMP) are organ procurement and transport techniques that can improve organ quality, facilitate longer transport, and reduce postoperative complications, increasing organ availability and improving outcomes. NRP and NMP often require allogeneic red blood cells (RBCs). Our academic transfusion service began providing RBCs to support NRP and NMP for adult heart transplant (HT), orthotopic liver transplant (OLT), and multiorgan transplant (MOT) in August 2020. This single-center, retrospective study describes the implementation process and analyzes the characteristics of RBC support during the first 3 years of the perfusion programs. Timing and quantity of units issued and used, organ recipient demographics, and transplant outcomes were obtained from transfusion service and electronic medical records. From 2020 to 2023, the transfusion service received 233 requests to support NRP and NMP perfusion cases. Of these, 105 cases resulted in RBC use, and units were returned or discarded in 112 cases. A total of 131 patients received perfusion-facilitated transplants (92 HT, 27 OLT, and 12 MOT). The majority of perfusion-facilitated HTs utilized NRP (81/92, 88%), whereas most perfusion-facilitated OLTs utilized NMP (21/27, 78%). Across all 233 requests, a total of 381 RBC units were used to facilitate 131 transplants, averaging 2.91 units/transplant. Provision of RBCs for NRP and NMP techniques represents a novel method for transfusion services to support and facilitate life-saving organ transplants with only modest product use, about three RBC units per organ transplant in this single-center study.

Opening a Donor Management Center.

In the United States alone, more than 100,000 people are waiting for a lifesaving organ transplant. In response to the growing need for viable organs to transplant, donor management centers have opened to provide care to brain-dead organ donors prior to the organ procurement operation. This article describes donor management center operations, details the opening of one such unit, and describes the results and lessons learned. More research is needed on the impact of nursing care on the specialized organ donor population.

BRIDGING DIVIDES: SWAP AND DOMINO ORGAN TRANSPLANTATION ACROSS SOCIOCULTURAL AND POLITICAL FRONTIERS

Swap and domino organ transplantation represents a groundbreaking approach to address organ shortages by facilitating organ exchanges among incompatible donor-recipient pairs or utilizing organs from deceased donors to trigger multiple transplant chains. This paper explores the socio-cultural and political implications of swap and domino organ transplantation, transcending traditional boundaries and challenging existing norms in the field of organ donation and transplantation. Through a multidisciplinary lens, it examines the ethical considerations, legal frameworks, and societal attitudes surrounding swap and domino transplantation, highlighting both the opportunities and challenges inherent in this innovative approach. By fostering collaboration and cooperation across sociocultural and political divides, swap and domino transplantation offers a promising pathway to expand access to life-saving organ transplants and promote global health equity.

Public Attitudes and Beliefs About Organ Donation: Development and Validation of a New Instrument.

Background and Purpose: The number of patients in need of lifesaving organ transplants continues to exceed the number of available. One of the most critical factors influencing peoples' practices and rates of organ donation is their attitude and beliefs. This study aimed to develop and validate an instrument that evaluates peoples' attitudes and beliefs about organ donation. Methods: A cross-sectional methodological study was used to guide the development of a questionnaire after reviewing the literature. Results: The initial items (n = 45) were evaluated by 15 nonexperts pilot to verify face validity; then, content validity was established by three experts, and exploratory factorial analysis established construct validity. Afterward, internal consistency was checked using Cronbach's α analysis. Eventually, 31 items were included in the questionnaire, comprising four subscales. Conclusion: According to the results, we found that the "Public Attitudes and Beliefs about Organ Donation" questionnaire has adequate validity and reliability to assess peoples' attitudes and beliefs about organ donation.

Graft Failure after Uterus Transplantation in 16 Recipients: A Review

Uterus transplantation (UTx) is now an alternative to surrogacy and adoption for women with uterine factor infertility to have children; however, there are still unresolved clinical and technical issues. One of these is that the graft failure rate after transplantation is somewhat higher than that of other life-saving organ transplants, which is a critical concern. Herein, we summarize the details of 16 graft failures after UTx with living or deceased donors using the published literature in order to learn from these negative outcomes. To date, the main causes of graft failure are vascular factors (arterial and/or venous thrombosis, atherosclerosis, and poor perfusion). Many recipients with thrombosis develop graft failure within one month of surgery. Therefore, it is necessary to devise a safe and stable surgical technique with higher success rates for further development in the UTx field.

Social Media and Organ Donation: Pros and Cons.

Shortage of organ donors is the most important obstacle standing in the way of lifesaving organ transplantation in a myriad of patients suffering from end-stage organ failure. It is vital that the transplant societies and associated appropriate authorities develop strategies to overcome the unmet needs for organ donation. The power of prominent social media (SoMe) platforms such as Facebook, Twitter, and Instagram, which reach millions of people, can increase awareness, provide education, and may ameliorate the pessimism toward organ donation among the general population. Additionally, public solicitation of organs may be helpful for waitlisted candidates for organ transplantation, who cannot find a suitable donor among near relations. However, the use of SoMe for organ donation has several ethical issues. This review attempts to highlight the advantages and limitations of using social media in the context of organ donation for transplantation. Some suggestions on the best utilization of social media platforms for organ donation while balancing ethical considerations have been highlighted here.

A Minireview of Microfluidic Scaffold Materials in Tissue Engineering.

In 2020, nearly 107,000 people in the U.S needed a lifesaving organ transplant, but due to a limited number of donors, only ∼35% of them have actually received it. Thus, successful bio-manufacturing of artificial tissues and organs is central to satisfying the ever-growing demand for transplants. However, despite decades of tremendous investments in regenerative medicine research and development conventional scaffold technologies have failed to yield viable tissues and organs. Luckily, microfluidic scaffolds hold the promise of overcoming the major challenges associated with generating complex 3D cultures: 1) cell death due to poor metabolite distribution/clearing of waste in thick cultures; 2) sacrificial analysis due to inability to sample the culture non-invasively; 3) product variability due to lack of control over the cell action post-seeding, and 4) adoption barriers associated with having to learn a different culturing protocol for each new product. Namely, their active pore networks provide the ability to perform automated fluid and cell manipulations (e.g., seeding, feeding, probing, clearing waste, delivering drugs, etc.) at targeted locations in-situ. However, challenges remain in developing a biomaterial that would have the appropriate characteristics for such scaffolds. Specifically, it should ideally be: 1) biocompatible—to support cell attachment and growth, 2) biodegradable—to give way to newly formed tissue, 3) flexible—to create microfluidic valves, 4) photo-crosslinkable—to manufacture using light-based 3D printing and 5) transparent—for optical microscopy validation. To that end, this minireview summarizes the latest progress of the biomaterial design, and of the corresponding fabrication method development, for making the microfluidic scaffolds.

The Dark Side of Chasing the Perfect Donor. Is it Time for Us to Change Cardiac Transplant Program Performance Metrics?

The Dark Side of Chasing the Perfect Donor. Is it Time for Us to Change Cardiac Transplant Program Performance Metrics?

Equal Access to Organ Transplantation for People with Disabilities.

People with disabilities are often denied equal access to organ transplantation despite long-standing federal nondiscrimination mandates. Under the Americans with Disabilities Act and the Rehabilitation Act, people cannot be excluded from consideration for organ transplantation because of disability itself, or because of stereotypes or assumptions about the value or quality of life with a disability. Instead, decisions concerning whether an individual is a candidate for organ transplantation should be based on an individualized assessment of the patient and on objective medical evidence. Recent legal developments underscore these basic guarantees and signal a new focus on the policies, practices, and attitudes that continue to compromise equal access to life-saving organ transplants for people with disabilities.

Design of a patient-centered decision support tool when selecting an organ transplant center.

Patients in the US in need of a life-saving organ transplant must complete a long process of medical decisions, and a first step is to identify a transplant center to complete an evaluation. This study describes a patient-centered process of testing and refinement of a new website (www.transplantcentersearch.org) that was developed to provide data to patients who are seeking a transplant center. Mixed methods, including online surveys and structured usability testing, were conducted to inform changes in an iterative process. Survey data from 684 participants indicated the effects of different icon styles on user decisions. Qualitative feedback from 38 usability testing participants informed improvements to the website interface. The mixed methods approach was feasible and well suited to the need to address multiple development steps of a patient-facing tool. The combined methods allowed for large survey sample sizes and also allowed interaction with a functioning website and in-depth qualitative discussions. The approach is applicable for a broad range of target user groups who are faced with challenging decisions and a need for information tailored to individual users. The survey and usability testing concluded with a functioning website that is positively received by users and meets the objective to support patient decisions when seeking an organ transplant.

An overview of and a proposed reform for the organ procurement: System of the United States

Abstract. Over 107,000 Americans are currently awaiting a lifesaving organ transplant. The vast shortage of organs for transplant in the United States is commonly known, but few are aware that the capacity exists for an additional 28,000 organs to be procured each year. These viable organs are not procured because of the limitations of the market and governance structure of the organizations primarily responsible for organ procurement across the United States, Organ Procurement Organizations (OPOs). In this paper, the author provides an overview of the current organ procurement system and its flaws, debates the newly revised organ procurement regulations to come into effect in 2022, and offers a sweeping, market-based reform proposal for the organ procurement system. Keywords. Organ procurement, Organ procurement organizations (OPOs). JEL. I10, I11, I18 .

Reduced Supply in the Organ Donor Market and How 3D Printing Can Address This Shortage: A Critical Inquiry into the Collateral Effects of Driverless Cars

Driverless cars, such as those currently operated by Uber and others as well as those being researched and developed by major and niche automobile manufacturers, are expected to dramatically reduce the number of highway fatalities in the coming years. While no one will fault any technology that safely and effectively protects and saves lives, many individuals with an array of medical conditions rely on organ donors to provide the liver, kidney, or other organs required to facilitate a life-saving organ transplant. Consequently, one collateral effect of the introduction of driverless car technology will be a reduction in the market supply of healthy organs for transplantation. In this paper, a venture capital lawyer, a medical researcher, and a bioengineer will establish the expected size of this reduction in supply, the associated harm resulting from this reduction, and discuss two promising technological solutions—bioprosthetics and 3D bioprinting of tissues and organs. In the case of both technologies, the authors will discuss the challenges and opportunities presented for institutional investors (private equity, venture capital, angel funds) and medical researchers in tackling the potential reduction in organ donations.

Three-dimensional printing of extracellular matrix (ECM)-mimicking scaffolds: A critical review of the current ECM materials.

The loss of tissues and organs through injury and disease has stimulated the development of therapeutics that have the potential to regenerate and replace the affected tissue. Such therapeutics have the benefit of reducing the reliance and demand for life-saving organ transplants. Of the several regenerative strategies, 3D printing has emerged as the forerunner in regenerative attempts due to the fact that biologically and anatomically correct 3D structures can be fabricated according to the specified need. Despite the progress in this field, improvement is still limited by the difficulty in fabricating scaffolds that adequately mimic the native cellular microenvironment. In response, despite the complexities of the native extracellular matrix (ECM), the inclusion of ECM components into bioinks has emerged as a cutting-edge research area in terms of providing possible ECM-mimicking abilities of the 3D printed constructs. Furthermore, the development of ECM-mimicking scaffolds can potentially assist in improving personalized patient treatments. This review provides a critical analysis of selected naturally occurring ECM components as well as synthetic self-assembling peptides in their ability to provide the required ECM microenvironment for tissue regeneration. The success and possible short comings of each material, as well as the specific characteristics of each bioink, are evaluated.

School and sports participation post-transplant.

Pediatric recipients of life-saving organ transplants are living longer, with improved graft and overall survivals. After successful transplant, children are encouraged to return to "normal life," with school attendance and participation in age-appropriate physical activities. This transition may cause stress to the recipients, parents, teachers, and other participating caregivers and staff. Planning for school reentry and assuring education for and open lines of communication with the school staff can help alleviate some of this discomfort and ease the process for the patient and the family. Cardiovascular disease has emerged as the leading cause of death in survivors of pediatric transplantation and is contributed to by modifiable risk factors such as obesity, hypertension, and the MS. Physical activity is a proven tool in decreasing surrogate markers of this risk. Sports participation is an important way to promote an enjoyment of physical activity that can ideally persist into adulthood, but conflicting advice and opinions exist regarding type and participation in physical activity. Moreover, specific recommendations are likely not applicable to all recipients, as certain degrees of rehabilitation may be needed depending on degree and length of illness. In general, a program of rehabilitation and increased physical activity has been shown to be safe and effective for most pediatric transplant recipients. Focusing on optimizing the "normal" childhood activities of going to school and participating in sports can improve the physical, social, cognitive, and mental health outcomes of this population after transplant and should be prioritized.

Donor and transplant candidate selection for solid organ transplantation during the COVID-19 pandemic.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus responsible for a worldwide pandemic has forced drastic changes in medical practice in an alarmingly short period of time. Caregivers must modify their strategies as well as optimize the utilization of resources to ensure public and patient safety. For organ transplantation, in particular, the loss of lifesaving organs for transplantation could lead to increased waitlist mortality. The priority is to select uninfected donors to transplant uninfected recipients while maintaining safety for health care systems in the backdrop of a virulent pandemic. We do not yet have a standard approach to evaluating donors and recipients with possible SARS-CoV-2 infection. Our current communication shares a protocol for donor and transplant recipient selection during the coronavirus disease 2019 (COVID-19) pandemic to continue lifesaving solid organ transplantation for heart, lung, liver, and kidney recipients. The initial results using this protocol are presented here and meant to encourage dialogue between providers, offering ideas to improve safety in solid organ transplantation with limited health care resources. This protocol was created utilizing the guidelines of various organizations and from the clinical experience of the authors and will continue to evolve as more is understood about SARS-CoV-2 and how it affects organ donors and transplant recipients.

Enabling allogeneic therapies: CIRM-funded strategies for immune tolerance and immune evasion.

A major goal for the field of regenerative medicine is to enable the safe and durable engraftment of allogeneic tissues and organs. In contrast to autologous therapies, allogeneic therapies can be produced for many patients, thus reducing costs and increasing availability. However, the need to overcome strong immune system barriers to engraftment poses a significant biological challenge to widespread adoption of allogeneic therapies. While the use of powerful immunosuppressant drugs has enabled the engraftment of lifesaving organ transplants, these drugs have serious side effects and often the organ is eventually rejected by the recipient immune system. Two conceptually different strategies have emerged to enable durable engraftment of allogeneic therapies in the absence of immune suppression. One strategy is to induce immune tolerance of the transplant, either by creating “mixed chimerism” in the hematopoietic system, or by retraining the immune system using modified thymic epithelial cells. The second strategy is to evade the immune system altogether, either by engineering the donor tissue to be “invisible” to the immune system, or by sequestering the donor tissue in an immune impermeable barrier. We give examples of research funded by the California Institute for Regenerative Medicine (CIRM) in each of these areas, ranging from early discovery‐stage work through clinical trials. The advancements that are being made in this area hold promise that many more patients will be able to benefit from regenerative medicine therapies in the future.

Moving the Margins: Updates on the Renaissance in Machine Perfusion for Organ Transplantation

Escalating end-organ disease coupled with stagnant donor pools has begotten global organ shortages. Ex vivo organ perfusion, used briefly in the early days of clinical transplant and then sidelined for decades by static cold storage, has resurged to address this organ paucity. Given the recent prolific application of machine perfusion as a platform for assessment, preservation, and treatment of marginal grafts, this review summarizes salient results from the past 2–3 years in kidney, liver, lung, heart, pancreas, vascularized composite allograft, and xenograft transplantation. Clinical trials have established the ability of ex vivo perfusion to make previously declined thoracic and abdominal organs transplantable without sacrificing short- or long-term function and survival. In addition to extended assessment and superior preservation, machine perfusion enables targeted delivery of cutting-edge gene and immunomodulatory therapies. At the leading edge, ex vivo perfusion has recently led to breakthroughs in xenotransplantation, enabled ischemia-free liver transplants, and been incorporated into out-of-hospital organ resuscitation centers. Ex vivo machine perfusion is transitioning from being dormant to indispensable in clinical organ transplantation. Providing a platform for extended assessment, superior preservation, and targeted therapy, ex vivo organ perfusion can make marginal, previously declined organs a part of the donor pool. Pioneering pre-clinical studies continue to provide guidance on how to optimize and leverage this invaluable system for further expansion of lifesaving organ transplantation.

Early identification and referral of organ donors in five private hospitals: A survey to determine the knowledge and views of critical care professional nurses pre and post a PowerPoint training intervention.

Internationally, the declining number of organ donors does not meet the rising demand for life-saving solid organ transplant operations. Critical care professional nurses play an important role in the identification of organ donors. A deeper understanding is needed of the missed opportunities of identification and referral of potential organ donors to organ transplant co-ordinators in the critical care environment. To describe the knowledge and views of critical care professional nurses (CCPNs) in South Africa concerning the early identification and referral of organ donors, and to describe the short-term effect of implementing a PowerPoint training intervention on nurses' knowledge in this domain. A mixed method, experimental, exploratory, descriptive study design was followed. Critical care professional nurses in seven intensive care units at five private hospitals completed a data collection instrument comprising 11 quantitative and three qualitative questions, before and after completing a PowerPoint training intervention. The post test was done directly after the training intervention due to the environment of nursing shift work. A total of 173 (79%) CCPNs participated, from a population of 218. The median (interquartile range) score for all participants increased from 60% (48 - 76) prior to the PowerPoint training intervention, to 96% (88 - 96) after the intervention (p<0.0001). Three main themes emerged from the qualitative questions: stress experienced by the CCPNs during the organ donor process (62%); inadequate collaboration between doctors and nurses (34%); and the need for a policy (9%) to guide the donor referral process. CCPNs' knowledge regarding the early identification and referral of potential organ donors increased significantly following a targeted PowerPoint training intervention. The identified themes suggest that CCPNs require support in order to effectively communicate with the donor's family and medical staff. The findings of this study will contribute to the increase in organ donor referrals. Increased education of critical care professional nurses and doctors on effective communication, and the early identification and referral of organ donors, will expectedly help to resolve the critical barriers in the organ donor process.

The ethics of testing and research of manufactured organs on brain-dead/recently deceased subjects

Over 115 000 people are waiting for life-saving organ transplants, of whom a small fraction will receive transplants and many others will die while waiting. Existing efforts to expand the...

P055 To be a DSA or not to be a DSA, we need to know!

Aim The accuracy of HLA antibody testing is very important for entering UNOS Unacceptable donor antigens, evaluating organ offers by virtual and prospective crossmatch, and evaluating donor specific antibodies (DSAs) pre and post transplant. It is known that Single Antigen Beads (SAB) often have problems with false positive reactions, when the manufacturing process results in 3–5% denatured HLA determinants on every bead, exposing cryptic, non HLA antigens. This case study demonstrates that SAB false positive HLA antibodies can often be ruled out or verified by using additional tests and analyses, including FlowPRA Screen and LSPRA (phenotype bead) assays and epitope and donor HLA allele analysis, which will reduce the risk of denying lifesaving organ transplants based on false positive HLA antibodies. Methods Deceased donor pronased mononuclear cells from blood, were Flow crossmatched against three sera from a 64% CPRA patient. The results were T cell Negative on all three sera, B cell low positive on one of the sera. By SAB the sera had three potential weak DSAs (B62/2,100 MFI, DRB3*02:02/1,000 MFI, DPB1*01:01/A1*01:03/2,500 MFI, and DPB1*01:01/A1*02:01/1,000 MFI), LSPRA assay, crossmatch results, and epitope and donor alleles analysis, were used to rule out or confirm the potential DSAs. Results The three potential DSAs were ruled out, see the table below. The B cell Low Positive in serum 1 did not make sense, the potential DSAs were stronger in serum 3, the reactivity was nonspecific, which had been observed before. Download high-res image (204KB) Download full-size image Conclusions It is unacceptable that alone, the SAB assay false positive DSAs will deny patients lifesaving organ transplants, when there are tests and analysis methods which can often detect and rule out these antibodies. The SAB assay is a very important test, but unless other testing platforms, like Phenotype beads and FlowPRA screen, are used to identify the false positive antibodies, the SAB assay will lose organ offers for our patients or trigger unnecessary DSA treatments post transplant. S.S. Geier: 2. Consultant; Company/Organization; LABSNE Clinical Consulting Director. 7. Other (Identify); Company/Organization; UNOS Histocompatibility Committee and MPSC ad.