Ethics and Organ Donation After Cardiac Arrest.

Determine the incidence and predictors of missed organ donation opportunities. Population-based, prospective cohort study. All adult ICU and PICU (medical, surgical, neurologic, and cardiovascular) and emergency departments (EDs) in a Canadian province with a population of 5 million. Consecutive patients that died with devastating brain injury, regardless of etiology, and were mechanically ventilated in the last 12 hours of life over a period of 42 months. None. Patients were defined as eligible potential donors if they were diagnosed with death by neurologic criteria (DNC), probable DNC (neurologic examination consistent, but without full assessment), or had death by circulatory criteria (DCC) within 2 hours of withdrawal of life-sustaining measures (WLSMs). Missed donation opportunities were defined as occurring when there was no evidence in the medical record that the family of an eligible potential donor was approached regarding donation. Multivariable logistic regression was performed to identify predictors of missed opportunities. There were 3481 patients and 1072 eligible potential organ donors, including 481 with confirmed DNC, 154 with probable DNC, and 437 with DCC within 2 hours of WLSM. There were 172 (16%) missed organ donation opportunities. In multivariable analysis, risk factors included older age (odds ratio [OR] per decade, 1.1 [1.0-1.3]), death in an ED rather than ICU (OR, 5.4 [3.0-10.0]), death in a regional rather than urban hospital (OR, 2.8 [1.7-4.6]), and DCC rather than DNC (6.7 [4.4-10.1]). Missed opportunities were less common when the most responsible physician was a donation specialist (OR, 0.3 [0.2-0.5]). Missed cases categorized as probable DNC were proportionally more common in EDs (45%) than in ICUs (21%; p = 0.0005). Missed organ donation opportunities occur with regularity, especially in EDs and regional hospitals, and among older patients and potential DCC donors. Donation physicians are likely to have a positive impact in reducing missed opportunities.

Inflammation in deceased kidney donors in the pre-organ retrieval period and the association with transplant outcomes: A systematic review.

Exciplex systems based on deuterated organic semiconducting molecules provide a promising strategy to enhance the performance of organic light-emitting diodes (OLEDs). Although the enhancement of OLED performance by utilizing a...

Objective: This study aims to assess demographic and clinical characteristics of the donor and recipient in kidney transplantation. Materials and Methods: The population was composed of kidney transplant recipients and donors who applied to an organ transplant centre in Turkey. A total of 71 people were reached. The researcher prepared the questionnaire used in the study. The form included information on whether or not the participant was a recipient or donor, living or cadaveric, some socio-demographic characteristics, whether or not the participant was treated with immunosuppressive therapy before transplantation, whether or not the participant was undergoing dialysis, and follow-up findings after transplantation (Blood Urea Nitrogen (BUN) /creatinine, eGFR, chronic kidney disease stage, haemoglobin/ white blood cell/platelet). Results: The mean age of the participants was 37.42± 15.41. 50.7% of the participants were recipients, and 49.3% of them were donors. A great majority (82.9%) of those who were organ donors were married (p=0.007) when looking at “marital status”, one of the variables that made a difference. A great majority of the participants (91.7%) were transplant recipients who did not smoke (p=0.000). A moderate positive correlation was found between BUN values and creatinine values in patients before transplantation. Conclusions: The results of this study are compatible with the literature in terms of both demographic and clinical characteristics of the donor and recipient

Although the goal of extracorporeal cardiopulmonary resuscitation (ECPR) remains survival with meaningful neurologic recovery, secondary contribution to organ donation is increasingly recognized. We identified standardized outcome metrics for quality improvement and reporting and explored the feasibility of developing an ECPR Cumulative Impact Index. Fourteen international ECPR experts completed a modified Delphi process to achieve these aims. Qualitative analysis of free-text responses further informed framework development. Consensus was not reached on a unified scoring index. However, participants endorsed several reporting domains with greater than 75% agreement, including cerebral performance categorization and modified Rankin score with organ donation as outcomes, and specific metric tracking pertaining to organ donation. Similarly, there was greater than 75% agreement not to stratify organ donation into neurological versus circulatory determination of death. Qualitative analysis explored five themes: death without donation, non-neurologically intact survival, organ donation benefit, score implementation, and ethical principles. Particular emphasis was placed on avoiding incentivization of cannulation solely for organ donation and understanding that the lived patient and family experience cannot be so simply summarized through numeric quantification. Ultimately, the panel agreed that while a unified ECPR beneficence score remains elusive, consensus-based outcome metrics offer a practical and ethically grounded framework for program evaluation.

Venous thromboembolism (VTE) is a known complication in critically ill patients, yet its prevalence in deceased organ donors and impact on organ recipients remain poorly characterized. Standardized guidelines for donor VTE assessment and management are lacking. In this prospective observational study of brain-dead donors at a regional organ recovery center (October 1, 2021-August 1, 2023), all donors underwent duplex ultrasonography and CT pulmonary angiography to screen for deep vein thrombosis (DVT) and pulmonary embolism (PE). Donors with VTE received prompt therapeutic anticoagulation. Organ recovery data and recipient 1-year survival data were obtained from the Scientific Registry of Transplant Recipients (SRTR). Additionally, we surveyed US organ procurement organizations (OPOs) regarding VTE practices. Among 215 donors, 73 (34%) had VTE: 28% with DVT and 14% with PE. All VTE-positive donors received prompt anticoagulation and no bleeding complications were observed. Organ recovery rates and 1-year recipient survival did not differ by donor VTE status. Among 96 survey respondents from 41 of 56 U.S. OPOs, there was substantial variation in VTE practices, only 2% accurately estimated prevalence, and most respondents (83%) supported development of standardized guidelines. VTE is common but underrecognized in brain-dead donors. In this observational cohort, prompt diagnosis and short-term management of donor VTE were feasible and were not associated with reduced organ utilization or early recipient outcomes, although the study was not designed to establish treatment efficacy.

The global shortage of organs and tissues highlights the need to strengthen and monitor the quality of deceased donor programs. Evaluating each stage of this process using quality-sensitive indicators is essential to ensure transparency, efficiency, safety, and effectiveness. However, there is still no consensus on which indicators best reflect the quality of organ and tissue donation processes, highlighting the need to map and analyze existing evidence. The aim of this study was to map and analyze international literature on indicators for monitoring the quality of the process of deceased organ and tissue donation for transplantation. This review will be conducted following the methodology proposed by the JBI and guidelines for scope reviews. The databases, portals, and directories to be searched included MEDLINE (via PubMed), CINAHL (EBSCO), Embase (Elsevier), Scopus (Elsevier), Web of Science (Clarivate Analytics), Business Source Complete (EBSCO), VHL Virtual Health Library; gray literature will be sought on Google Scholar, OpenGrey (GreyNet), CAPES Theses and Dissertations, Global ETD Search (formerly the Union Catalog), Open Access Theses and Dissertations, and websites of organ and tissue donation and transplant organizations. Studies in any language and published after 1980 will be considered for inclusion. A wide range of study designs will be included, encompassing quantitative, qualitative, and mixed-methods research, as well as relevant gray literature on organ and tissue donation and transplantation. Two reviewers will screen the studies, paying attention to the eligibility criteria. The data will be extracted by means of specific variables and presented in categories according to the evaluative triad structure, process, and result, and by the pillars of quality proposed by Avedis Donabedian in the form of diagrams, tables, charts, and narrative synthesis. The evidence on quality indicators for organ and tissue donation processes is conceptually diverse. This scoping review will provide an overview of existing studies, identify gaps in current knowledge, and guide future research on the development and validation of quality indicators. Open Science Framework osf.io/ymuvj/.

Technical insights and implications of thoracolumbar spine and neural tissue harvesting in recently deceased organ donors: a direct anterior approach integrated into multi-organ procurement protocols.

While many Antibody Drug Conjugates (ADCs) are investigated in solid tumors, their target expression and heterogeneity is poorly documented in metastatic breast cancer. Here, we perform RNA sequencing to investigate expression of 72 ADC targets in 909 samples from 30 female patients from our post-mortem tissue donation program UPTIDER (NCT04531696). We report that the highest median expression in metastases is seen for FN1, MUC1, LAMP1, HER3 and SLC39A6. TROP2 and HER2 have the 9th and 27th highest expression. We observe reduced expression in metastases as compared to primary untreated tumors for 15 targets but observe only limited differences in expression between metastases of different subtypes. We show that TROP2, VTCN1, NECTIN4, HER2 and HER3 are interesting targets as they have higher mRNA expression in tumor as compared to normal tissues. This is confirmed at the protein level by explorative immunohistochemistry. Correlations between targets can help guide design of bispecific ADCs. Taken together, the results of this study can help inform the design and prioritization of drugs for the treatment of patients with metastatic breast cancer.

The paper critically examines Benyamin’s medico-thriller novel, Body and Blood (2020) to expose the malpractice of organ trafficking in India. Initially published in Malayalam as Sareera Shastram (2017), and translated into English by Swarup B.R., the novel offers a realistic account of the illegal harvesting and trade of human organs under the camouflage of organ donation to the needy population. The story revolves around vulnerable youngsters and the polemics of their exposure to deliberately brandished accidents. These accidents subsequently follow a nebulous series of reiterative actions that comprise pharmaceutically injected coma in the injured youths, non-permissive extraction of healthy organs for unlicensed trade to accomplish megalomaniac aspirations of religious mafias, and eventually leading to inevitable deaths of innocent victims. Using interdisciplinary methodology, the article contributes to the eye-opening revelation about the new-age churches and their pretentious strategies to attract the young to operate the heinous medical crime of organ trafficking in the nation-state.

This paper develops a theoretical model to show how changes in the default system of organ donor registration, along with a Priority Rule, affect society's cadaveric organ donation rate. The developed model is on the lines of Kessler and Roth (2012) and seeks to inspect the hypotheses put forward by Li etal (2013), solely based on their laboratory experiment. The model shows that some of these results can change under specific assumptions regarding the population of potential donors. Among the hypotheses examined in this paper, special emphasis has been given to hypothesis 4, which evaluates whether a nation benefits more from the introduction of the priority rule compared to a change in the default system of organ donation to presumed consent, when the baseline system is explicit consent without the priority rule. The findings suggest that the outcome of such an analysis, in an economy like the United States, will critically depend on how one chooses to quantify the monetary value of Quality Adjusted Life Years (QALYs) gained from organ transplantation and the transaction cost of donor registration. The paper highlights that in the year 2016, the US would have benefited relatively more, in terms of donor registrations for deceased kidney donation, from a change in the default system of organ donation to presumed consent rather than an introduction of the priority rule. This result holds as long as the monetary value of a QALY gained from Deceased Kidney Transplantation is less than $2,068,717.04, at 2016-level prices. The robustness of this result has been confirmed through Monte Carlo Uncertainty Analysis, with statistical significance at the 99 % level.

In Vietnam, the Law on donation, collection, transplantation of human tissues and donation and collection of corpses was issued in 2006. This issue has also been regulated in the 2005 and 2015 Civil Code. However, the enforcement of the law on organ donation still faces many challenges. This problem is not only in Vietnam but also in worldwide. In this article, the authors analyze the practical problems that countries around the world are facing when enforcing the law on organ donation. From there, it is related to the current situation of Vietnamese law and withdraw lessons that can be drawn to overcome these limitations and challenges in the future.

As a core concept in philosophy and critical theory, subjectivity holds fundamental importance in that it constitutes the cornerstone of an individual’s self-awareness, moral status, and existential significance. It also serves as the intrinsic basis for their entitlement to dignity and rights. With the development of cutting-edge technologies such as genetic engineering, biotechnology, and cognitive science, the issue of subjectivity has become a key topic in academic discussions within the posthuman context. <i>Never Let Me Go</i>,<i> </i>a novel by the Japanese-British author Kazuo Ishiguro, centers on a group of clones, vividly depicting their life trajectories and the tragic fate as organ donors for humans. From the perspective of the clone protagonist Kathy, the novel showcases the process in which the clone community resists against their given fate of sacrifice and strives to pursue and construct their own subjectivity. Based on Rosi Braidotti’s theory of posthuman subjectivity, this paper analyzes how the clones strive to escape from their fate as sacrifice caused by their assigned alienated identities and instrumentalized bodies, generate the pure life “Zoe” by means of deterritorializing nomadic resistance and establishing connections with other forms of life, and thereby demonstrate their posthuman nomadic subjectivity. By depicting the clones’ pursuit of their own subjectivity, Ishiguro in this novel expresses his contemplation on the tragic fate of the clones and the ethical problems caused by cloning technology. 主体性作为哲学与文化批判理论的核心概念之一，其重要性在于它是个体之自我认知和道德地位及其存在意义的根本基石，也是个体享有生命尊严与权利的内在依据。随着基因技术、生物技术、认知科学等前沿科技的发展，在后人类语境下，主体性问题再次成为学界讨论的重要话题。日裔英国作家石黑一雄创作的长篇小说《别让我走》以克隆人群体为叙事核心，深刻描绘了其生活轨迹及作为人类器官捐献者的悲惨宿命。小说透过克隆人主人公凯茜的视角，展示了克隆人群体抵抗被给定的牺牲者命运，努力追寻和建构自身主体性的过程。本文基于布拉伊多蒂的后人类主体性理论，分析小说中克隆人试图摆脱其被给定的异化身份和工具化身体所导向的牺牲者命运，并通过解辖域化的游牧抵抗以及与其他生命形式的关联而生成纯粹生命“佐伊”，从而呈现出其后人类游牧主体性。通过描写克隆人群体对自身主体性的追寻，石黑一雄在该作中表达了对克隆人的悲剧命运以及克隆技术所引发的科技伦理问题的思考。

This study presents a forward-leaning approach to constructing hybrid organic–inorganic nanomaterials through a photoelectrocatalytic pathway tailored for sustainable energy generation and selective CO₂ conversion. The work integrates light-driven charge activation with surface-engineered catalytic interfaces, allowing the material to operate under mild conditions while maintaining high stability. By combining organic donor groups with inorganic semiconductor frameworks, the system ensures efficient charge mobility, stronger adsorption of CO₂, and controlled intermediate formation. This synergy enables faster reaction kinetics and enhances product selectivity without relying on harsh chemical inputs. Experimental results show that the hybrid structures exhibit notable improvements in photocurrent density, quantum efficiency, and carbon-based product yield when compared with conventional single-phase catalysts. The material’s architecture also supports extended operational durability, mitigating surface deactivation and maintaining consistent performance across repeated cycles. Mechanistic analysis indicates that the coexistence of organic functionalities and inorganic lattice sites opens new reaction channels, creating a balanced environment for electron transfer and catalytic turnover. This approach demonstrates a practical and scalable route toward low-energy CO₂ transformation technologies, offering a blueprint for advancing renewable-driven chemical production. The findings underscore the potential of photoelectrocatalytic hybrid materials as versatile platforms capable of bridging energy conversion and carbon-management applications. The study ultimately lays a clear foundation for next-generation catalysts engineered to operate at the crossroads of sustainability, efficiency, and molecular precision.

Increasing donor consent rates in countries with low post-mortem donation rates such as Türkiye is paramount. This study explores the experiences of donor relatives in Türkiye who approved post mortem organ donation after brain death, aiming to identify emotional, cognitive, and ethical factors influencing their decisions and post-decision experiences, to inform strategies for increasing consent rates in developing countries. This qualitative study involved semi-structured interviews with eight donor relatives who consented to organ donation, and data were analysed using thematic analysis. Two main fields were identified: (1) Factors influencing the donation decision, with themes: (a) decision-related factors, (b) health system factors, and (c) individual factors; and (2) post-decision experiences, with themes: (a) satisfaction with the decision, (b) curiosity about the recipient, (c) meaning of donation, and (d) creating donation awareness. Empathic motivations, previously stated wishes, the attitude of healthcare professionals, and understanding brain death influence the decisions of donors' relatives. Trust in healthcare professionals helps reduce ethical uncertainty, contributing to a more confident and informed decision-making process. The study found that concerns during the decision-making process and uncertainties such as 'What will happen next?' were replaced by spiritual satisfaction and contentment after the decision. The research results provide evidence-based insights into the organ donation decision-making process and offer recommendations for improving public perception and increasing consent rates.

Volumetric muscle loss (VML) is characterized as the loss of muscle tissue that exceeds the muscle's self-repair mechanism, resulting in incomplete restoration of muscle mass and function. Existing treatment modalities, including muscle grafts or autologous muscle transfers, are limited by constraints such as tissue availability and donor site morbidity. Moreover, the inadequate recovery of muscle may lead to fibrosis within the VML site, impeding the process of muscle regeneration and resulting in permanent deficits. Emerging therapeutics, such as hydrogels, show promise in addressing the limitations of current therapeutics and have the potential to significantly reduce fibrosis and facilitate the restoration of muscle form and function following VML injury and repair. This study evaluated the therapeutic potential of repairing a 30% VML injury in the rat tibialis anterior muscle with engineered skeletal muscle units (SMUs), alone, and in combination with a hyaluronic acid-based hydrogel (HyA-HG). Following 1- or 3-months post-implantation, muscle structure and function were assessed. The results indicated that the incorporation of HyA-HG in combination with our SMUs resulted in improvements in force production for VML injuries repaired for 1 month. However, over extended recovery periods (3 months), sustained superior improvements in muscle function with the combination therapy were not observed compared with the repair with just an SMU. Moreover, histological analyses revealed that muscle treated with SMUs and HyA-HG exhibited a greater cross-sectional area and force production in the early stages of recovery (1-month post-surgery) compared with untreated VML sites or those treated with HyA-HG only. However, after 3 months, muscle mass and force production in all experimental groups reached comparable levels, suggesting a transient benefit of the combination therapy. Our findings highlight the potential of HyA-HG and SMU combination therapy to enhance early functional recovery following VML.

Unlike some critics of the dead donor rule, I do not defend consequentialism or deny the personhood of any potential organ donor. Instead, I argue that the principles of ethics and action theory that support the dead donor rule also prohibit widely accepted procedures, including kidney and partial liver transplants from living donors, fetal surgeries that permanently damage the uterus, sequential or domino liver transplants and lethal palliation. If physicians sometimes may cause death as a result of relieving a patient's pain, then they sometimes may cause death as a result of fulfilling the patient's desire to donate a vital organ.

Liver transplantation (LT) remains the definitive treatment for end-stage liver disease, but it continues to face two major challenges: ischemia-reperfusion injury (IRI), which compromises graft function, and a critical shortage of suitable donor organs. To address the latter, the use of marginal grafts from extended criteria donors (ECD) and donation after circulatory death (DCD) has increased, although these organs are more susceptible to IRI. This review aims to evaluate the current landscape of machine perfusion (MP) technologies-hypothermic, subnormothermic, and normothermic-and their role in improving graft preservation, function, and utilization in LT. MP has emerged as a promising alternative to static cold storage (SCS), offering the potential to assess graft viability and reduce IRI. Hypothermic machine perfusion (HMP), particularly when oxygenated (HOPE), shows protective effects on the biliary system and may reduce ischemic injury, though data on improved graft survival remain limited. Subnormothermic perfusion is associated with enhanced ATP restoration and reduced cold-induced injury in preclinical models but lacks robust clinical validation. Normothermic machine perfusion (NMP) allows real-time functional assessment and supports active metabolism, with clinical trials demonstrating reduced early allograft dysfunction and increased use of marginal grafts. Recent studies suggest that combining techniques, such as HOPE followed by NMP, may offer synergistic benefits, although optimal protocols remain under investigation. Machine perfusion technologies represent a significant advancement in liver transplantation by improving preservation strategies and enabling the use of suboptimal grafts. While NMP appears most promising for functional assessment and extended preservation, HOPE shows particular value in end-ischemic reconditioning. Although MP is not yet a complete replacement for SCS, its potential to improve outcomes and expand the donor pool is increasingly supported by emerging clinical evidence. Further large-scale, randomized trials are essential to determine best practices and establish MP as a standard component of LT protocols.

Inequities for sexual- and gender-minoritized (SGM) populations in organ and tissue donation and transplantation (OTDT) have been identified. We aimed to understand the awareness and attitudes of community members who are SGM regarding current SGM-relevant policies, policy gaps, and policy alternatives in Canadian OTDT systems. We conducted an online, cross-sectional, Canada-wide survey of members of the Two-Spirit, gay, bisexual, transgender, queer, intersex and more (2SGBTQI+) communities (June-September 2024). Questionnaire development adhered to current survey science recommendations. We present descriptive data as counts and proportions. We analyzed responses from a convenience sample of 2,276 participants from across Canada. Most participants self-identified as White cisgender gay men. Prior to questionnaire completion, only 17% (257/1,497) of participants were aware that men who have sex with men are considered "increased infectious risk donors" in OTDT and cannot donate tissues, and 20% (302/1,512) were aware that they may only donate organs if the benefit to the recipient is deemed to outweigh the risk. Of the respondents, 18% (270/1,535) did not realize that potential donors are screened on the basis of sex assigned at birth as opposed to self-identified gender identity. On average, 23% (1,406/6,084) of participants perceived these policies as nondiscriminatory. Of the respondents, 60% (1,865/3,115) supported gender-neutral, behavior-focused donor risk assessments that were data-driven. Most participants reported a willingness to donate organs (79%; 1,237/2,276) and tissues (72%; 1,123/2,276) after death. People in Canada who self-identify as 2SGBTQI+ perceived current OTDT policies to be discriminatory and in need of equitable revision. Evidence-based behavioral and gender-neutral donor risk criteria were preferred over identity-based criteria. The majority of survey participants who identify as SGM were willing to donate organs and tissues despite current system inequities. Health Canada should revise current donor risk assessment criteria to ensure they are data-driven and optimize access and safety to OTDT in Canada.