Organ Procurement Procedures Research Articles

Evaluation of Methods to Obtain Peripheral Blood Mononuclear Cells From Deceased Donors for Tolerance-Induction Protocols.

Regulatory cell therapies have shown promise in tolerance-induction protocols in living donor organ transplantation. These protocols should be pursued in deceased donor transplantation. Donor peripheral mononuclear cells (PBMCs) are an optimal source of donor antigens for the induction of donor-specific regulatory cells. During the development of a regulatory cell tolerance-induction protocol with organs from deceased donors, we compared 3 methods of obtaining PBMCs from deceased donors focusing on cell yield, viability, and contamination of unwanted cell types. PBMC procurement methods: 1. During organ procurement at the time of cold perfusion, blood was collected from the vena cava and placed into a 10-liter blood collection bag, and thereafter transported to Karolinska University Hospital, where leukapheresis was performed (BCL). 2. Blood was collected via the vena cava into blood donation bags before cold perfusion. The bags underwent buffy coat separation and thereafter automated leukocyte isolation system (BCS). 3. To collect PBMCs, leukapheresis was performed via a central dialysis catheter on deceased donors in the intensive care unit (ICU) prior to the organ procurement procedure (LEU).All 3 methods to obtain PBMC from deceased donors were safe and did not affect the procurement of organs. BCL contained around 50% of NK cells in lymphocytes population. LEU had a highest yield of donor PBMC among 3 groups. LEU had the lower amount of granulocyte contamination, compared to BCS and BCL. Based on these results, we choose LEU as the preferred method to obtain donor PBMC in the development of our tolerance-induction protocol.

Operating Theater Nurses' Main Concerns During Organ Procurement Procedures: AGrounded Theory Study.

The purpose of this study was to explore the experiences of perioperative nurses in Sweden (ie, operating theater nurses) associated with caring for a donor patient during organ procurement procedures. We sought to determine the nurses' main concerns and how they dealt with them. Using constructivist grounded theory methodology, our participant sample included 10 nurses, one of whom self-identified as male. The average age of the participants was 51.8years (range=38 to 63years). After interviewing the participants and coding their responses, we developed the core category of optimum organ procurement. The generated grounded theory comprises four main categories: brace oneself, facilitate, procurement, and completion. Commitment is the force that binds the perioperative nurse to a course of action. This theory may help guide a team-based approach to prepare nurses to care for donor patients with dignity and respect during procurement procedures.

Prioritizing direct heart procurement in organ donors after circulatory death does not jeopardize lung transplant outcomes.

Controlled donation after circulatory death (cDCD) has become a standard in liver, kidney, and lung transplantation (LTx). Based on recent innovations in exvivo heart preservation, heart transplant centers have started to accept cDCD heart allografts. Because the heart has very limited tolerance to warm ischemia, changes to the cDCD organ procurement procedures are needed. These changes entail delayed ventilation and prolonged warm ischemia for the lungs. Whether this negatively impacts lung allograft function is unclear. A retrospective analysis of cDCD lungs transplanted between 2012 and February 2022 at the Medical University of Vienna was performed. The heart+lung group consisted of cases in which the heart was procured by a cardiac team for subsequent normothermic exvivo perfusion. A control group (lung group) was formed by cases where only the lungs were explanted. In heart+lung group cases, the heart procurement team placed cannulas after circulatory death and a hands-off time, collected donor blood for exvivo perfusion, and performed rapid organ perfusion with Custodiol solution, after which the heart was explanted. Up to this point, the lung procurement team did not interfere. No concurrent lung ventilation or pulmonary artery perfusion was performed. After the cardiac procurement team left the table, ventilation was initiated, and lung perfusion was performed directly through both stumps of the pulmonary arteries using 2 large-bore Foley catheters. This study analyzed procedural explant times, postoperative outcomes, primary graft dysfunction (PGD), duration of mechanical ventilation, length of intensive care unit (ICU) stay, and early survival after LTx. A total of 56 cDCD lungs were transplanted during the study period. In 7 cases (12.5%), the heart was also procured (heart+lung group); in 49 cases (87.5%), only the lungs were explanted (lung group). Basic donor parameters were comparable in the 2 groups. The median times from circulatory arrest to lung perfusion (24minutes vs 13.5minutes; P=.002) and from skin incision to lung perfusion (14minutes vs 5minutes; P=.005) were significantly longer for the heart+lung procedures. However, this did not affect post-transplantation PGD grade at 0hours (P=.851), 24hours (P=.856), 48hours (P=.929), and 72hours (P=.874). At 72hours after transplantation, none of the lungs in the heart+lung group but 1 lung (2.2%) in lung group was in PGD 3. The median duration of mechanical ventilation (50hours vs 41hours; P=.801), length of ICU stay (8days vs 6days; P=.951), and total length of hospital stay (27days vs 25days; P=.814) were also comparable in the 2 groups. In-hospital mortality occurred in only 1 patient of the lung group (2.2%). Although prioritized cDCD heart explantation is associated with delayed ventilation and significantly longer warm ischemic time to the lungs, post-LTx outcomes within the first year are unchanged. Prioritizing heart perfusion and explantation in the setting of cDCD procurement can be considered acceptable.

245.2: Evaluation of Methods to Obtain Peripheral Blood Mononuclear Cells From Deceased Donors Adjacent to Organ Procurement for Tolerance-Induction Protocols

Regulatory cell therapies have shown promise in tolerance-induction protocols in living donor organ transplantation. These protocols should be pursed in deceased-donor transplantation. Donor peripheral mononuclear cells (PBMCs) are an optimal source of donor antigens for the induction of donor-specific regulatory cells that are more effective than antigen non-specific regulatory cells. During the development of a regulatory cell tolerance induction protocol with organs from deceased donors, we compared three methods of obtaining PBMCs from deceased donors focusing on: cell yield, viability, and contamination of unwanted cell types. PBMC procurement methods: During organ procurement at the time of cold perfusion, blood was collected from the vena cava and placed into a 10-liter blood collection bag, and thereafter transported to Karolinska University Hospital, where leukapheresis was performed (BCL) n=7. Blood was collected via the vena cava into blood donation bags before cold perfusion. The bags underwent buffy coat separation and thereafter automated leukocyte isolation using SEPAX (BCS) n=2.To collect PBMCs, leukapheresis was performed via a central dialysis catheter on deceased donors in the ICU prior to the organ procurement procedure (LEU) n=9. Our results show that all methods were safe in relation to the intended organ procurement procedure. LEU is a feasible method to obtain PBMC from deceased donors. LEU tend to have higher yield of donor PBMC/kg compared to BCS and BCL and acceptable level of granulocyte contamination compared to BCS. Further investigations including the quality of the cell products that was manufactured with PBMCs from these methods will be needed to determine which approach is the most suitable for tolerance induction protocols.

Cases Abusing Brain Death Definition in Organ Procurement in China.

Organ donation after brain death has been practiced in China since 2003 in the absence of brain death legislation. Similar to international standards, China's brain death diagnostic criteria include coma, absence of brainstem reflexes, and the lack of spontaneous respiration. The Chinese criteria require that the lack of spontaneous respiration must be verified with an apnea test by disconnecting the ventilator for 8min to provoke spontaneous respiration. However, we have found publications in Chinese medical journals, in which the donors were declared to be brain dead, yet without an apnea test. The organ procurement procedures started with initiating "intratracheal intubation for mechanical ventilation after brain death," indicating that a brain death diagnosis was not performed. The purpose of the intubation was not to resuscitate the patient but rather was directly related to facilitating the explantation of organs. Moreover, it was unmistakably stated in two of these publications that the cardiac arrest was induced in these patients without brain death determination by cold St. Thomas cardioplegic solution or other cold myocardial protection solutions. This means that the condition of these donors neither met the criteria of brain death nor that of cardiac death. In other words, the "donor organs" may well have been procured in these cases from living human beings. Thus, brain death definition is abused in China by some individuals for organ harvesting, and a systematic investigation is needed to clarify the situation of organ donation after brain death in China.

Development and Application of a Semi quantitative Scoring Method for Ultrastructural Assessment of Acute Stress in Pancreatic Islets.

Background.Pancreas and islet transplantation outcomes are negatively impacted by injury to the endocrine cells from acute stress during donor death, organ procurement, processing, and transplant procedures. Here, we report a novel electron microscopy scoring system, the Newcastle Pancreas Endocrine Stress Score (NPESS).Methods.NPESS was adapted and expanded from our previously validated method for scoring pancreatic exocrine acinar cells, yielding a 4-point scale (0–3) classifying ultrastructural pathology in endocrine cell nuclei, mitochondria, endoplasmic reticulum, cytoplasmic vacuolization, and secretory granule depletion, with a maximum additive score of 15. We applied NPESS in a cohort of deceased organ donors after brainstem (DBD) and circulatory (DCD) death with a wide range of cold ischemic times (3.6–35.9 h) including 3 donors with type 1 and 3 with type 2 diabetes to assess islets in situ (n = 30) in addition to pancreata (n = 3) pre- and postislet isolation.Results.In DBD pancreata, NPESS correlated with cold ischemic time (head: r = 0.55; P = 0.02) and mirrored exocrine score (r = 0.48; P = 0.01). When stratified by endocrine phenotype, cells with granules of heterogeneous morphology had higher scores than α, β, and δ cells (P < 0.0001). Cells of mixed endocrine-exocrine morphology were observed in association with increased NPESS (P = 0.02). Islet isolation was associated with improved NPESS (in situ: 8.39 ± 0.77 [Mean ± SD]; postisolation: 5.44 ± 0.31; P = 0.04).Conclusions.NPESS provides a robust method for semiquantitative scoring of subcellular ultrastructural changes in human pancreatic endocrine cells in situ and following islet isolation with utility for unbiased evaluation of acute stress in organ transplantation research.

A need for emotional, personal and professional support: Operation room nurses’ experience participating in organ procurement surgical procedures. A qualitative study

Participating in organ procurement procedures cause emotional stress and risk of long-lasting health problems. These experiences are rarely discussed in plenary, and research specifically aimed at operating room nurses is limited. The aim of this study was to describe how operating room nurses experience participating in organ procurement surgical procedures. A qualitative, descriptive and exploratory design was chosen. The sample consisted of 14 operating room nurses, recruited from The National Transplant Centre, Norway. Data collection was conducted using individual, in-depth interviews. Qualitative inductive manifest content analysis was used. The study is reported according to QUOREC. Four main categories constitute the findings: operating room nurses have experienced emotional and personal impact; they try to handle these emotions using coping strategies; the experiences have promoted professional development; the importance of colleagues, including an open unit culture, is emphasized. Other studies support these findings regarding the impact this surgical procedure has on operating room nurses. This study also emphasizes their need for personal and professional support. Both individual and structural actions are suggested to generate this kind of support. The study may provide a deeper understanding of how participating in the organ procurement process affects those who are involved, and how to facilitate support to them as leader.

Using metaphor method to interpret and understand meanings of international operating room nurses' experiences in organ procurement surgery

To demonstrate how metaphor method can be employed in health care research, through a rainbow metaphor to conceptualise lived experiences, and represent a sense of verisimilitude, in a phenomenological study of international nurses' experiences of organ procurement procedures. International operating room nurses are likely to form unique attitudes towards multi-organ procurement. Phenomenology is used to focus on discovering human experiences and the meanings of certain phenomena. Phenomenological writing can mediate people's reflections and actions, measure people's thoughtfulness and help people to see and show lived experiences from their lifeworlds. Metaphor was used to interpret meanings of international operating room nurses' experiences in organ procurement surgery. The meanings were identified through a phenomenological approach informed by the work of van Manen. A metaphor method was used to interpret and understand the lived experiences of eighteen international OR nurses recruited from nine different countries. Thematic data analysis was used to portray their lived experiences in organ procurement procedure. Using a rainbow as metaphor, a vivid picture was portrayed reflecting international OR nurses' experiences and organ procurement journey in Australia as challenging, with mixed feelings. According to the relationship between certain colours and emotions, four essential themes evolved into the concept of a four-colour rainbow to signify the meanings of international OR nurses' experiences in organ procurement procedures. The essential themes represented by these four colours were as follows: Orange-"The surreality of experiencing death," Red-"Personal and professional challenges," Green-"Becoming stronger" and Purple-"My beliefs, my wishes." Interpreting the meanings of their organ procurement experiences using metaphor method provided valuable insights about what personal and professional challenges these nurses faced, how they coped and managed their challenges, what support and care they required from others, and suggestions for future practice. Operating room nurses in practice needed a range of workplace supports and the rainbow metaphor provides a suitable approach for reflection and understanding of their experiences in organ procurement, with a focus on international, newly graduated and less experienced nurses. Practice improvement is a likely outcome when nurses have a better understanding of their experiences and the experiences of others in their team and this will assist in identifying their knowledge and professional support needs. The method demonstrates how metaphor can be applied to understand clinical nursing situations.

Transplantation of a Kidney With Duplicated Ureter Harvested From a Donor With Vascular Anomaly in the Form of Double Inferior Vena Cava: A Case Report

During the organ procurement procedure, a surgeon encounters anatomic anomalies not very often but also not uncommonly. These changes may put the success of the transplant into question. Despite the thorough diagnosis of the potential donor, these anomalies are often diagnosed during organ donation. In our paper we present a case of kidney transplantation with duplicated ureter. The organ was collected from a donor with duplicated inferior vena cava. After transplantation, the kidney functioned immediately. Taking into consideration the well-being of the recipient, organs with anatomic abnormalities should be carefully considered for transplantation. This is especially important when there is a constant shortage of organs for transplantation.

Lived experiences of international operating room nurses in organ procurement surgery: A phenomenological study.

International operating room nurses come from different regions of the world with diverse social and cultural backgrounds, religions, personal beliefs, and education. They are likely to form unique attitudes toward multi-organ procurement that potentially might affect their opinions and clinical practices. The aim of this phenomenological study was to explore the lived experiences of international operating room nurses participating in deceased organ procurement procedures in Australia. Semistructured interviews were conducted with 18 international operating room nurses. van Manen's phenomenological data analysis method was adopted to uncover and interpret meanings from these nurses' descriptions. Four essential themes emerged and evolved to signify the meanings of participants' experiences in organ procurement procedures: the surreality of death, personal and professional challenges, becoming stronger, and personal beliefs and wishes. The present study highlights the importance of cultural awareness in dealing with death, organ procurement, and interprofessional collaboration in the multi-cultural perioperative context. It is essential to provide clinical education and support around culture and practice transition for international operating room nurses to increase and maintain their professional confidence, career satisfaction, health, and well-being during organ procurement surgery.

Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: results from a French survey

BackgroundThis study aimed at describing usual anesthetic practices for brain-dead donors (BDD) during an organ procurement (OP) procedure and to assess the knowledge and self-confidence of French anesthesiologists with this practice.MethodsAn electronic and anonymous survey with closed-questions about anesthetic management of BDD was distributed to French anesthesiologists via the mailing list of the French Society of Anesthesiology and Intensive Care Medicine.ResultsFour hundred fifty-eight responses were analyzed. Respondents were mainly attending physicians with more than 10 years of clinical experience. 78% of them declared being cognizant of guidelines regarding management of BDD. Advanced hemodynamic monitoring and endocrine substitution were rarely considered by respondents (31 and 35% of respondents, respectively). 98% of the respondents used crystalloids for fluid resuscitation. During the procedure, use of neuromuscular blockers, opioids and sedative agents were considered by respectively 84, 61 and 27% of the respondents. A very high level of agreement (10 [8–10], on a ten-points Likert-style scale) was reported concerning the expected impact of intraoperative anesthetic management on the primary function of grafts.ConclusionsDeclared anesthetic practice appeared in accordance with guidelines concerning organ donor management in the ICU. Further studies are needed to evaluate the specific impact of intraoperative management during this procedure and thus the need for specific anesthetic guidelines.

Surgical quality in organ procurement during day and night: an analysis of quality forms

ObjectivesTo analyse a potential association between surgical quality and time of day.DesignA retrospective analysis of complete sets of quality forms filled out by the procuring and accepting surgeon on organs...

Alternative Way for Organ Donation in Societies With Traditional Beliefs and Well Organized System of Emergency Medical Care

Substantial improvements in neurological and neurosurgical care in Russia in the last years led to imminent but expected decrease in organ donation rate. This trend inflicted the need to actively search for new ways to expand donor pool and resulted into emergence of two priority areas. First is based on the liberalization of brain death diagnostic criteria. Second one highlights the application of methods of artificial circulation. Brain death criteria liberalization will inevitably cause alterations in conventional relationship between doctor and patient. Adoption of artificial circulation approach induces the necessity to constructively rethink its role in saving person’s life or, in case of failure, saving organs of deceased person for transplant. Resuscitation procedure algorithm, death record protocol for a patient with non-beating heart, but on artificial circulatory support as well as organ procurement procedure from such donor – all these represents complex non-medical, but socio-humanitarian, philosophical and theological issues. From 2009 till now our transplant team performed 35 procedures of extracorporeal membrane oxygenation in potential organ donors with 60 minutes after irreversible cardiac arrest followed by successful transplantation. Study design, perfusion protocols, procurement and transplant procedures were approved by the Scientific Board and the Ethics Committee of the Saint Petersburg State Research Institute for Emergency (Decision 7/0615/09) and authorized for clinical application by the Federal Advisory Service of the Ministry of Health of the Russian Federation (Resolution N2010/299). All donation and perfusion procedures were approved by local Ethics Committees and Institutional Review Board [1]. Our initial experience clearly demonstrates that new technical knowledge concerning artificial circulatory support in isolated human organs and organ systems all put together with integral knowledge about human (philosophical, theological, anthropological and medical) could lead to a breakthrough in the field of organ donation that does not violate the traditional views of society. Reference: 1. Reznik ON, Skvortsov AE, Reznik AO, Ananyev AN, Tutin AP, Kuzmin DO, et al. (2013) Uncontrolled Donors with Controlled Reperfusion after Sixty Minutes of Asystole: A Novel Reliable Resource for Kidney Transplantation. PLoS ONE 8(5): e64209. https://doi.org/10.1371/journal.pone.0064209.

Noneligible Donors as a Strategy to Decrease the Organ Shortage.

Organ procurement organization (OPO) performance is generally evaluated by the number of organ procurement procedures divided by the number of eligible deaths (donation after brain death [DBD] donors aged <70 years), whereas the number of noneligible deaths (including donation after cardiac death donors and DBD donors aged >70 years) is not tracked. The present study aimed to investigate the variability in the proportion of noneligible liver donors by the 58 donor service areas (DSAs). Patients undergoing liver transplant (LT) between 2011 and 2015 were obtained from the United Network for Organ Sharing Standard Transplant Analysis and Research file. LTs from noneligible and eligible donors were compared. The proportion of noneligible liver donors by DSA varied significantly, ranging from 0% to 19.6% of total liver grafts used. In transplant programs, the proportion of noneligible liver donors used ranged from 0% to 35.3%. On linear regression there was no correlation between match Model for End-Stage Liver Disease score for programs in a given DSA and proportion of noneligible donors used from the corresponding DSA (p = 0.14). Noneligible donors remain an underutilized resource in many OPOs. Policy changes to begin tracking noneligible donors and learning from OPOs that have high noneligible donor usage are potential strategies to increase awareness and pursuit of these organs.

Perioperative nurses' attitudes towards organ procurement: a systematic review.

To explore and evaluate perioperative nurses' experience of organ procurement. Organ procurement is part of the organ donation process, and is typically performed in the perioperative setting. This experience may contribute to perioperative nurses' feelings of distress and negative attitudes towards organ donation. Systematic review of the literature. Primary research studies, published in the English language between 1990-2014 were identified, screened and appraised using Joanna Briggs Institute appraisal tools. Data extraction and analysis followed. The quality assessment resulted in seven qualitative and three quantitative research studies. The main findings were: (1) Perioperative nurses reported feeling emotionally distressed, challenged, lonely and physically drained throughout the entire organ procurement procedure. (2) Perioperative nurses reported finding their own unique self-coping strategies and ways of eliciting support. (3) Perioperative nurses had positive and negative attitudes towards organ donation. Perioperative nurses reported feelings of sadness, feeling challenged and physically drained through the entire organ procurement procedure, which were influenced by differing factors in the preoperative, intraoperative and postoperative stages. It is acknowledged that personal coping strategies and support are important to help perioperative nurses improve their psychological well-being, and their experiences and attitudes towards organ procurement and donation. The meaningfulness of these findings for practice policy and research is described. Perioperative nurses play a vital role in the organ procurement procedure and require ongoing support to ensure their psychological welfare, in particular, newly qualified or inexperienced nurses' participating in organ procurement.

Transplant Medicine in China: Need for Transparency and International Scrutiny Remains.

Previous publications have described unethical organ procurement procedures in the People's Republic of China. International awareness and condemnation contributed to the announcement abolishing the procurement of organs from executed prisoners starting from January 2015. Eighteen months after the announcement, and aligned with the upcoming International Congress of the Transplantation Society in Hong Kong, this paper revisits the topic and discusses whether the declared reform has indeed been implemented. China has neither addressed nor included in the reform a pledge to end the procurement of organs from prisoners of conscience, nor has the government initiated any legislative amendments. Recent reports have discussed an implausible discrepancy of officially reported steady annual transplant numbers and a steep expansion of the transplant infrastructure in China. This paper expresses the viewpoint that, in the current context, it is not possible to verify the veracity of the announced changes, and it thus remains premature to include China as an ethical partner in the international transplant community. Until we have independent and objective evidence of a complete cessation of unethical organ procurement from prisoners, the medical community has a professional responsibility to maintain the academic embargo on Chinese transplant professionals.

Ischemia-reperfusion injury in kidney transplantation.

Ischemia-reperfusion injury to the kidney is a complex pathophysiological process that has importance during transplantation as it affects graft function and survival. It starts with the physiological changes associated with the death of the donor, including the direct effects of hypoxia and metabolic stress. The injury continues through the organ procurement and preservation procedures. Upon reperfusion, the organ is then further damaged by a reactive inflammatory process which had been primed during the earlier injuries. Clinically, the damage from microvascular dysfunction and cytotoxic agents contributed by the immunologic response results in impaired graft function or graft loss. Recent advances in understanding the specific pathways involved in this injury have helped identify novel therapies. Nevertheless, ischemia-reperfusion injury continues to be a daunting problem even as these treatment strategies are being evaluated for clinical use.

End-of-Life and Brain Death in Acute Coma and Disorders of Consciousness

Consulting neurologists are often asked to evaluate patients in acute nontraumatic coma. The authors review prognostication of functional outcomes, determining brain death, and managing end-of-life care. Prognostication of outcome after cardiac arrest in comatose patients is a frequently encountered scenario with high-stakes implications. However, current guidelines are limited by a failure to address the use of therapeutic hypothermia and thus may lead to overly pessimistic outcome prediction. Pupillary light responses and corneal reflexes remain highly predictive clinical signs of a poor prognosis. Motor responses have a high false-positive rate for predicting a poor outcome, especially in patients treated with therapeutic hypothermia. Ancillary testing with electroencephalography, somatosensory evoked potentials, serum neuron-specific enolase, and neuroimaging is often useful in predicting outcomes. Brain death is a clinical condition of irreversible coma of known cause with absent brainstem reflexes and apnea. An understanding of the value of confirmatory testing and the potential for confounding factors is essential in making a correct diagnosis. As coma carries a high mortality rate, neurologists must be capable of guiding goals of care, discussing end-of-life issues, and understanding organ-procurement procedures.

PS17 - 83. Could pancreatic islets derived from pancreases from NHB-III donors be used as autonomous single islet grafts?

Isolation of pancreatic islets is worldwide performed on organs that are obtained from heartbeating (HB) organ procurement procedures. Distinctively, in The Netherlands and in Belgium a strong tradition has developed in the acquisition of high quality pancreas from (Non-HeartBeating type-III) NHB-III donors. In this study, the feasibility of using pancreatic islets from high quality NHB-III donors autonomously is investigated.

Regulation of Organ Transplantation in China

IN RECENT YEARS, THE CHINESE GOVERNMENT HAS MADE great progress in regulating organ transplant operations. Since 2007, the Chinese Ministry of Health has strictly enforced the authentication program for approval of hospitals to perform organ transplantation. Of the more than 600 hospitals that had performed organ transplantations before regulation began, only 163 hospitals now have authentication to perform organ transplantation. Of these, 123 hospitals are approved to perform kidney transplantation, 80 for liver transplantation, 38 for heart transplantation, and 27 for lung transplantation. Quality surveillance and management of transplantations have improved substantially. Hospitals that conduct illegal transplant operations or mismanage organ transplantations are punished with financial penalties or administrative sanctions. For example, 10 hospitals were ordered to improve their transplant program, 7 hospitals had their qualification for transplantation suspended for 3 to 6 months, and 1 was denied qualification. The China Liver Transplant Registry and the Chinese Scientific Registry of Kidney Transplantation were launched in 2008. All transplant-qualified hospitals must record detailed information for each patient. In 2010, the China Heart Transplant Registry and China Lung Transplant Registry began, indicating that management of transplantation in China had entered the information era. The Chinese government has strictly followed the guiding principles of the World Health Organization for organ transplantation and prohibits organ trade. Owing to the scarcity of donor organs, sentenced convicts have become the main organ source for transplantation, drawing much concern and criticism from the international community. In response to whether the organ of a convict sentenced to death would be permitted for transplantation by the Chinese Health Supervision Department, the spokesman for the Chinese Ministry of Health indicated on September 8, 2009, “We don’t set distinct restriction on transplantation of organs from convicts, but the government does stringently regulate organ procurement procedures, and the donor must consent to the use of his or her organs for transplantation.” Living relative donor transplantation has gradually increased according to the Regulation of Human Organ Transplantation, which relieves the pressure placed on organ sources to some extent. However, as one wave of controversy has subsided, another has arisen as organ agents have reemerged because of the profitability of illegal organ trading, which has not only been greatly disruptive to transplant medicine but has also resulted in a negative perception of China’s national image. In December 2009, the Chinese Ministry of Health promulgated the Principles of Regulating Living Donor Transplantation, which limits the clinical application of living donor transplantation and strictly opposes underground organ trading among living donors. Hospitals are required to strengthen their procedures for validating the donor’s identity and must strictly evaluate the indication and selection of living donor transplants. Meanwhile, the Regulation of Human Organ Transplantation is under revision by the State Council so that transplantation programs will be more closely regulated. How can the problem of organ shortage be solved? Donation after brain death or donation after cardiac death (DCD) is available in some countries. Without legislation for brain death in China, the public will only accept the concept of death as cardiac death, with cessation of respiration. To reduce dependence on executed prisoners as a source of organs, in August 2009, the Chinese Red Cross Society and Chinese Ministry of Health announced the start of a system for organ donation and tested this system in 11 provinces and cities. However, of the more than 200 individuals who volunteered to donate their organs, only 63 were able to do so by the end of