Organ Procurement Process Research Articles

Thoracoabdominal normothermic regional perfusion: Is it ethical?

Thoracoabdominal normothermic regional perfusion (TA-NRP), a new method of controlled donation after circulatory death, seems to provide more and better organs for patients on organ transplant waiting lists compared to standard controlled donation after circulatory death. Despite its benefits, the ethical permissibility of TA-NRP is currently a highly debated issue. The recent statement published by the American College of Physicians (ACP) highlights the reasons for these debates. Critics' main concern is that TA-NRP violates the Dead Donor Rule. This paper presents an ethical analysis of the objections raised by the ACP against TA-NRP and argues that TA-NRP is not only morally permissible but also morally required where it is financially and technically feasible. To support this conclusion, the concepts of 'resuscitation,' 'intention,' 'irreversibility,' 'permanence,' 'impossibility,' and 'respect' in the context of TA-NRP are explored. Additionally, the ethical permissibility of this procedure is evaluated through the lenses of Utilitarianism, Kantianism, the core principles of bioethics, and the Doctrine of Double Effect. This ethical analysis demonstrates why the ACP's objection lacks a solid moral foundation and conflates moral and legal considerations. This paper also argues that extra measures are needed to ensure the moral permissibility of TA-NRP, emphasizing the importance of informed consent, additional brain blood flow and activity monitoring, and a contingency plan to abort the organ procurement process if a sign of morally relevant brain activity is detected.

Nurse contributions in corneal capture in the context of public health: reflections for practice

Cornea harvesting is a fundamental process for performing transplants, one of the main strategies for restoring vision to patients with irreversible eye diseases. In Brazil, the Unified Health System (SUS) is responsible for coordinating this service, and nurses play a crucial role in organizing and conducting this process. This article aims to describe and analyze the role of nurses in the public cornea harvesting service, highlighting their skills, challenges faced and the importance of specific training to guarantee the quality and ethics of the procedure. Based on a literature review and analysis of the legal regulations that govern the organ donation and procurement process in Brazil, this study seeks to contribute to the recognition of the importance of nurses in the success of this service. Besides, the study emphasizes the need for continuous training of these professionals so that they can act in a sensitive and technical way in welcoming family members, respecting the moment of mourning and ethical and legal standards, essential for the effectiveness and humanization of the process of capturing information. corneas.

American Society of Transplant Surgeons Normothermic Regional Perfusion Standards: Abdominal.

Normothermic regional perfusion (NRP) has emerged as a vital technique in organ procurement, particularly in donation after circulatory death (DCD) cases, offering the potential to optimize organ utilization and improve posttransplant outcomes. Recognizing its significance, the American Society of Transplant Surgeons (ASTS) convened a work group to develop standardized recommendations for abdominal NRP in the United States. The workgroup, comprising experts in NRP, DCD, and transplantation, formulated recommendations through a collaborative process involving revisions and approvals by relevant committees and the ASTS council. Four key areas were identified for standardization: Preprocedure communication, NRP procedure, Terminology and documentation, and Mentorship/credentialing. The recommendations encompass a range of considerations, including preprocedure communication protocols to facilitate informed decision-making by transplant centers and organ procurement organizations, procedural guidelines for NRP teams, uniform terminology to clarify the NRP process, and standards for mentorship and credentialing of NRP practitioners. Specific recommendations address logistical concerns, procedural nuances, documentation requirements, and the importance of ongoing quality assurance. The standardized recommendations for abdominal NRP presented in this article aim to ensure consistency, safety, and efficacy in the organ procurement process. By establishing clear protocols and guidelines, the ASTS seeks to enhance organ utilization, honor donor wishes, and uphold public trust in the donation process. Implementation of these recommendations can contribute to the advancement of NRP practices and improve outcomes for transplant recipients.

Clinical approach to donor-derived infection in solid organ transplant recipients.

Donor-derived infection is an uncommon but potentially devastating complication of solid organ transplantation (SOT). Accurate and timely identification of unexpected infectious disease transmission events has implications not only for the recipient(s) experiencing infection, but also other recipients of organs or tissues from the same donor who may require additional testing or risk mitigation, as well as the broader organ transplant regulatory framework. This narrative review synthesizes data from published reports of symptomatic unexpected donor-derived infections in SOT recipients to provide clinicians with a systematic approach to the evaluation of undifferentiated illnesses that may be of donor origin. Key reasons to consider donor-derived infection include certain microbiologically proven infections in the recipient, especially early after transplant, characteristics of the donor or their management that suggest potential exposure to or infection with specific pathogens prior to organ procurement, and select clinical syndromes that occur in the post-transplant period. Syndromes for which expedited consideration and evaluation of donor-derived infection may be warranted include central nervous system infection, graft or perigraft complications developing in the absence of typical risk factors, and unexplained critical illness/sepsis syndrome in the early post-transplant period. When embarking on an investigation of a suspected donor-derived infection, clinicians should apply knowledge of the entire continuum of the organ procurement and transplant process to ensure unbiased and comprehensive data collection that will facilitate appropriate adjudication of these uncommon but high-consequence events.

The Effects of 15 Golden Key Points to Increase the Family Consent Rate in Iran.

In nations where organ donation is governed by the opt-in policy, the most crucial stage in the organ procurement process is the family approach and gaining the approval of families of decedents with brain death. In times of grief and sorrow, the ability of health care workers to communicate and have donation conversations is vital to the decision-making process of families and the subsequent consent rate. In this study, we investigated the effects of teaching important points to coordinators in the family approach and gaining consent of families for organ donation. A new training program for Iranian coordinators was designed to increase the skills and knowledge of interviewers and increase the self-confidence of the coordinators. In the training program, 15 golden key points to have when meeting with families of brain dead decedents regarding organ donation consent were presented and discussed with participants. Three coordinating groups participated in this training program. The satisfaction rate of the families was assessed at comparable intervals (12 months for group 1, 6 months for group 2, and 3 months for group 3) before and after the training session to assess the continuity of the training impact. We used the Wilcoxon signed rank test for comparisons. The family consent rate was significantly different for all participants, before and after the 15 golden key points were presented, increasing from 50% to 62.5% (P = .037). In addition, participant sex (P = .051), previous training (P = .090), education (P = .068), and cooperation time (P = .008) had significant effects on family consent rate. Our training approach can increase the performance of coordinators in achieving family satisfaction.

Improvement Gaps to Deal with the Shortage of Lungs for Transplant From a Middle Income Country's Perspective.

Our study aimed to identify the potential causes for the low lung procurement rate in Argentina and to develop strategies to the actual problems in donor management focused on lung retrieval. We performed a crosssectional study in which we analyzed data obtained from digital self-reported surveys conducted on professionals participating in the organ procurement process in Argentina. The surveys included questions on donor management, selection criteria, and resource availability involving increasing lung procurement. Among professionals surveyed, 23.7% did not use advanced hemodynamic monitoring in their donor maintenance and limited their use to central venous pressure. Only 35.8% of participants considered maintaining central venous pressure <10 mm Hg during donor maintenance. With regard to donors with severe deterioration of the ejection fraction, 47.4% of participants would not use restrictive fluid, and only 23.2% would use an advanced monitoring of the hemodynamic status to guide fluid management. Only 27.8% of participants routinely would use steroids to improve lung function in donors. With regard to mechanical ventilation, 80.4% of participants used protective ventilation, but only 4.10% used it adequately. Recruitment maneuvers were routinely used by only 3.1% of those surveyed. With regard to expanded selection criteria (age >55 years, smoking habit of >20 packs/year, positive upper airway cultures, unspecific infiltrates in radiography, and >72 hours of mechanical ventilation), 92.8% of surveyed participants would discount patients with some of these expanded selection criteria without considering offering the lungs for donation. Opportunities for improvement may involve training physicians involved in the donor maintenance process and reviewing the donor selection criteria used to increase adherence to expanded selection criteria.

It Is Time for the Ethical and Religious Directives to Allow an Objection to Brain Death Testing

The Ethical and Religious Directives (ERDs) do not currently address brain death (BD) or medical, professional, and conscience objections. Accordingly, Catholic practitioners, patients, and their families are continually caught in the controversies and confusion surrounding BD and the organ procurement process. Therefore, this essay petitions the US bishops to include a new directive in the next edition of the ERDs that (1) recognizes the moral uncertainty and dubious medical practice surrounding BD and (2) allows families and surrogates and practitioners to object—based on conscience, on medical or professional grounds, and via informed refusal— to the BD tests or (at least) the BD organ procurement process. This essay provides justification for such a directive, proposes potential language, and explores how it could look in practice.

Anesthetic Considerations of Organ Procurement After Brain and Cardiac Death: A Narrative Review.

Organ donation procedures have become more frequent in the US as the need for transplants is increasing. Defining the anesthesiologist's role in organ donations after brain and cardiac death is important, as is understanding its ethics and practical physiologic and perioperative implications. Despite this, there are few papers specifically addressing the anesthetic management of organ donors. This review summarizes the preoperative, intraoperative, and postmortem considerations for the anesthesiologist involved in organ donation after either brain or cardiac death.A search of the published literature was performed using PubMed, Excerpta Medica dataBASE (EMBASE), and Google Scholar in March of 2022 for articles addressing anesthetic considerations of organ procurement surgeries after brain and cardiac death. This review demonstrates that anesthesiologists play a significant role in the organ procurement process. Their role in the perioperative management of the donor may affect the outcomes of organ transplantation. The gap between the number of organs harvested and the number of patients awaiting organ transplantation remains high despite continued efforts to increase the number of available organs. Perioperative management of organ donors aims at counteracting the associated unique physiologic derangements and targets optimization of oxygenation of the organs intended for procurement. Optimizing care after death can help ensure the viability of organs and the best outcomes for recipients. As organ donation after cardiac death (DCD) becomes more frequent in the US, anesthesiologists should be aware of the DCD classifications of donors and emerging novel perfusion techniques.

Opinion of surveyed nurses on transplantation and reasons for negative public attitudes toward organ donation.

Organ transplantation saves thousands of lives every year. Despite growing awareness of transplantation, the issue of obtaining organs for transplantation has been controversial for years. Hundreds of people are waiting in lines all the time for transplantation, for whom it is the only hope for a cure. One extremely important factor contributing to the low number of transplants is the low number of organ donations from deceased donors. Nurses are considered key facilitators of the organ procurement and transplantation process. Their knowledge of and attitudes toward organ donation can influence public opinion, as well as the decisions of their families to donate the organs of the deceased. The purpose of our study was to determine the opinions of surveyed nurses about transplantation and the reasons for negative public attitudes toward organ donation. The survey included 793 nurses employed in surgical wards across Poland with varying levels of job seniority. The survey was conducted between September and October 2022. The research tool was a survey questionnaire, consisting of three parts: socio-demographic data, questions assessing the respondents' knowledge of behavior about transplantation, and a non-standardized tool to measure respondents' emotional and motivational attitudes toward transplantation. Participation in the survey was anonymous and voluntary. The statistical analysis for independence of variables used the χ 2 test. On the other hand, coefficients based on the Phi and Cramer's V test, as well as Kruskal Wallis non-parametric tests for assessing differences (for more than 2 samples) were used to determine the strength of the relationship. During these analyses, in addition to standard statistical significance, the corresponding "p" values were calculated using the Monte Carlo method. According to the nurses surveyed, transplantation is a life-saving procedure. A significant proportion of the nurses (85.6%) believe that there are too few donors in Poland. According to 41.8% of the respondents, this is due to the fear of misdiagnosis of death, for 23.4% it is incompatible with their worldview or religion and 31.8% believe it is due to the belief in the inviolability of the human body after death. The survey showed that, in the nurses' opinion, the reason for objections to organ transplantation is the deficit in public's knowledge of cell, tissue and organ donation from both living and dead donors. Therefore it is extremely important to conduct educational campaigns in this regard.

Critical pathway for deceased donors: An analysis in three regions of Colombia

Introduction. The critical pathway for deceased donation offers a methodical framework for guiding the donation process. It not only serves to assess performance but also to identify areas of potential improvement. Therefore, the identification and selection of potential organ donors (POD) is a key process. This study aims to describe the critical pathway for deceased donation in a cohort of POD in three regions (CRT1, CRT2, and CRT5) of Colombia. Methods. We retrospectively reviewed data of POD assessed from January 2022 to December 2022. General characteristics of POD, diagnosis, contraindication causes, and organ procurement were described. Analysis was conducted using the Chi-squared test for categorical variables and the Mann-Whitney test for quantitative variables. Results. Within the cohort of 1451 assessed POD, 441 (30.3%) were diagnosed with brain death. Among potential donors after brain death, 198 (44.9%) were eligible donors (medically suitable). Of these, 157 donors (79.3%) became actual donors (undergoing operative incision for organ recovery), with 147 (96.3%) having at least one organ recovered (actual donors with organ recovery). Ultimately, 411 utilized organs were utilized. Additionally, there were observed differences in the characteristics of donors from different regions. Conclusion. This study reports the critical pathway for deceased donation in a cohort of POD in three regions of Colombia. This provides useful information and helps to gain insight and understanding into the process of organ donation and organ procurement in order to take actions that could improve the donation rates.

Early prediction model of brain death in out-of-hospital cardiac arrest patients: a single-center retrospective and internal validation analysis

BackgroundA shortage of donor organs amid high demand for transplantable organs is a worldwide problem, and an increase in organ donation would be welcomed by the global healthcare system. Patients with brain death (BD) are potential organ donors, and early prediction of patients with BD may facilitate the process of organ procurement. Therefore, we developed a model for the early prediction of BD in patients who survived the initial phase of out-of-hospital cardiac arrest (OHCA).MethodsWe retrospectively analyzed data of patients aged < 80 years who experienced OHCA with a return of spontaneous circulation (ROSC) and were admitted to our hospital between 2006 and 2018. We categorized patients into either a non-BD or BD group. Demographic and laboratory data on ED admission were used for stepwise logistic regression analysis. Prediction scores of BD after OHCA were based on β-coefficients of prognostic factors identified in the multivariable logistic model.ResultsOverall, 419 OHCA patients with ROSC were admitted to our hospital during the study period. Seventy-seven patients showed BD (18.3%). Age and etiology of OHCA were significantly different between the groups. Logistic regression analysis confirmed that age, low-flow time, pH, and etiology were independent predictors of BD. The area under the receiver operating characteristic curve for this model was 0.831 (95% confidence interval, 0.786–0.876).ConclusionsWe developed and internally validated a new prediction model for BD after OHCA, which could aid in the early identification of potential organ donors for early donor organ procurement.

Developing and verifying an artificial twin of the organ procurement and transplant process: A systems approach

ABSTRACT The practice of deceased-donor solid-organ transplantation is unique among clinical therapies because it substantially benefits recipients, The allocation process is a complex System-of-Systems (SoS) with multiple stakeholders, components, rules, and policies. While we model and simulate such SoS, they are challenging to verify and validate thoroughly due to a large number of use cases and the sensitivity to initial conditions. Furthermore, subject matter experts within communities of practice do not trust such models because they are difficult to explain. This paper proposes a trust-centric approach to validation focusing on experimentally exploring the simulation’s behavior space and demonstrating its utility to a community of experts. We describe a three-step validation process to show how modelling and simulation professionals can foster trust in simulations of a complex SoS. We apply the framework to verify and validate a simulation model of the Kidney–Pancreas (KP) allocation process within the United States.

A Novel National Program to Maximize Utilization of Heart and Lung Allografts from Donors After Brain Death (DBD) and Donors After Circulatory Death (DCD) for Transplantation

<h3>Purpose</h3> Build a national network of dedicated cardiothoracic surgical procurement and Organ Care System (OCS™) ex-vivo perfusion clinical experts to: Maximize cardiothoracic donor organ utilization for transplantation; overcome logistical and infrastructural burden of distant organ procurements and national allocation; standardize clinical quality of care of ex-vivo perfusion management of cardiothoracic allografts; and establish a better work-life balance for transplant teams across the U.S. <h3>Methods</h3> Leveraging the OCS, the only FDA approved portable perfusion technology for heart and lung transplantation, to build a national infrastructure to enable a turn-key service. This program comprehensively covers: donor screening, donor surgical procurement, OCS perfusion management and transportation of allografts from donor hospitals to any transplant program in the U.S. <h3>Results</h3> The National OCS Program (NOP) was initiated in 2021 for lung transplantation using the OCS Lung technology in 9 major regions across the U.S. Early experience is very encouraging and demonstrated the capabilities of NOP to significantly expand thoracic organ retrieval distance. Enabling cross-country thoracic organ sharing to benefit more patients awaiting transplants while unburdening transplant programs resources. The map below demonstrates actual NOP lung transplants. NOP is now expanding to include OCS Heart and provide similar service to heart transplant programs across the U.S. <h3>Conclusion</h3> The process of cardiothoracic donor organ procurement and related logistics are challenging and unscalable to meet the growing national demand for increased donor organ utilization for lung and heart transplantation. NOP was designed to create a collaborative partnership between industry, OPOs and transplant programs to provide solutions to overcome the existing challenges and transform the field of cardiothoracic transplantation in the U.S.

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.

Percutaneous liver biopsy before organ removal-Impact on organ allocation and costs in liver transplantation

HintergrundDer Stellenwert und die Sicherheit einer perkutanen Leberbiopsie (PLB) bei hirntoten Spendern vor Organentnahme sowie der Einfluss der PLB auf die Organallokation und die Kosten im Rahmen der Lebertransplantation (LT) in der Eurotransplant-Region (ET), werden weiterhin diskutiert.Material und MethodenEine perkutane Leberbiopsie vor Organentnahme erfolgte bei 36 hirntoten Spendern. Die Komplikationsrate, Spendercharakteristika, Ultraschallbefunde, die makroskopische Einschätzung und die histologischen Ergebnisse der PLB wurden analysiert. Zusätzlich wurde eine landesweite Umfrage unter 11 Lebertransplantationsexperten durchgeführt. Der Bedarf einer PLB und ihre Auswirkungen auf den Prozess der Organallokation wurden evaluiert. Mögliche Kosteneinsparungen wurden für verschiedene Szenarien auf der Grundlage von Kostendaten der Deutschen Stiftung Organtransplantation berechnet.ErgebnisseEs wurden keine Komplikationen durch die PLB beobachtet. Die Umfrage ergab, dass das Ergebnis der PLB einen erheblichen Einfluss auf die Allokation von Spenderorganen hat, insbesondere bei solchen mit „extended donor criteria (EDC)“. Die Kostenberechnung ergab ein enormes Kosteneinsparungspotenzial durch eine optimierte Allokation und die Vermeidung unnötiger Organentnahmen.SchlussfolgerungDie PLB ist ein sicheres Verfahren und besitzt ein enormes Potenzial für die Optimierung der Organallokation vor Organentnahme durch eine Reduzierung der kalten Ischämiezeit, Vermeidung unnötiger Verwerfungen von Spenderorganen sowie Kosteneinsparungen. Die klinische Relevanz und der Einfluss der PLB auf die Organallokation konnte durch unsere Daten herausgestellt werden.

International Operating Room Nurses' Challenges in Providing Person-Centered Care During Organ Procurement Surgery

PurposeInternational operating room (OR) nurses assisting in organ procurement surgery believe that it is their responsibility to provide continued and comprehensive person-centered care to donors through their surgical journeys. This study explored the challenges these nurses encountered in providing person-centered care during surgical care stages of organ procurement surgery in Australia. DesignThe phenomenological approach by van Manen was used to portray 18 OR nurses' organ procurement experiences. MethodsSemistructured interview data were transcribed verbatim. FindingsInternational OR nurses encountered challenges in providing person-centered care during organ procurement surgery, which were described in different surgical care stages. They faced emotional challenges in handling family grief and clinical challenges in interacting with other health professionals. These challenges could cause personal distress and affect their professional practice. ConclusionsRecognizing and managing these challenges is essential for supporting staff and providing quality person-centered care to deceased donors and their families during the organ procurement process.

SUN-292 KNOWLEDGE AND ATTITUDE TOWARDS ORGAN DONATION AMONG PERUVIAN MEDICAL RESIDENTS

Health care professionals are important and critical link in the organ procurement process and therefore, their knowledge and attitudes are essential factors in the promotion of an environment that has a positive influence on organ donation rates. Objective: To assess the knowledge and attitude towards organ donation among medical residents. A cross sectional study was conducted among medical residents (n=90) on March 2018 at a public tertiary care hospital, Lima-Peru. The survey contents consisted of the organ's general characteristics, education status, religion, general information about donation and trasplantation and the attitude toward the donation and trasplantation. The survey was validated (Spearman=0.67, α Combach=0.812). Used SATA 12, level of significance was 5%. The mean age were 29.2 years ± 4.2. More than half of the respondents had the correct knowledge about organ donation (58%). Nearly half of the respondents have an ID Donation (52.8%) very willing to donation (82.2%), refuse to donate (17.8%) are not willing to donate due to religious and cultural reasons, similar to latinoamerican studies. More than 80% of the study participants in our study accepted that they would donate their organs, similar to mexican and colombian studies, but different some spanish and german studies. They found information in medical school (44.4%) and hospital information (31.1%), others sources of information such as social networks and internet (56%), in our country this the first study that evaluated this tecnological aspects in this population. There are relationship among clinical and surgery residents and knowledge about organ donation and procedence (p<0.05). No statistically significant differences were found among years of residents, gender and cultural aspects. The present study demonstrated favorable attitude among medical residents towards organ donation despite their limitations/gaps in knowledge about the same. Need to implemented courses and workshops about on organ donation and transplantation in the medical residents curriculum in order to improve knowledge of medical students.

Incidência de protocolos de morte encefálica, captações e fatores que influenciam o processo de doação de órgãos em um Complexo Hospitalar Regional

Objetivo: Apontar fatores que segundo os profissionais de saúde envolvidos no cuidar do potencial doador, podem influenciar no processo de captações de órgãos. Além de apresentar dados de incidência de Protocolos de Morte Encefálica, de captações de órgãos ocorridos nos anos de 2017 e 2018 do Complexo Hospitalar Regional de Cacoal (COHREC). Métodos: Pesquisa transversal, de caráter descritivo, com abordagem quantitativa e qualitativa. O levantamento de dados ocorreu por meio de um questionário aplicado aos profissionais atuantes há mais de seis meses na sala vermelha e nas Unidades de Terapia Intensiva (UTI) do COHREC. Resultados: Foi possível constatar que os principais fatores que os profissionais citaram foram a não observação ou não participação de alguma captação de órgão, a falta de profissionais, a falta de capacitação dos profissionais, a falta de equipamentos e a falta de estrutura. Conclusão: Deve-se buscar a qualificação multiprofissional, não só para diagnóstico e manutenção do potencial doador, mas para desenvolvimento de habilidades relacionadas à comunicação entre os profissionais, a comunicação para com os familiares e proporcionar ao profissional apoio psicológico e condições dignas de trabalho.

The Role of the Family in Deceased Organ Procurement: A Guide for Clinicians and Policymakers.

Families play an essential role in deceased organ procurement. As the person cannot directly communicate his or her wishes regarding donation, the family is often the only source of information regarding consent or refusal. We provide a systematic description and analysis of the different roles the family can play, and actions the family can take, in the organ procurement process across different jurisdictions and consent systems. First, families can inform or update healthcare professionals about a person's donation wishes. Second, families can authorize organ procurement in the absence of deceased's preferences and the default is not to remove organs, and oppose donation where there is no evidence of preference but the default is to presume consent; in both cases, the decision could be based on their own wishes or what they think the deceased would have wanted. Finally, families can overrule the known wishes of the deceased, which can mean preventing donation, or permitting donation when the deceased refused it. We propose a schema of 4 levels on which to map these possible family roles: no role, witness, surrogate, and full decisional authority. We conclude by mapping different jurisdictions onto this schema to provide a more comprehensive understanding of the consent system for organ donation and some important nuances about the role of families. This classificatory model aims to account for the majority of the world's consent systems. It provides conceptual and methodological guidance that can be useful to researchers, professionals, and policymakers involved in organ procurement.

Proposal of a management and standardization protocol for organ procurement in Chile

Organ donation rates for transplantation are low in Chile and there is a paucity of a technical-structured-normalized procurement process. To design a protocol to standardize the organ procurement process based on the Chilean reality. After a first phase of bibliographic reviews and analyzing de Chilean legislative and normative frame, a proposal was elaborated in collaboration with five expert coordinators. In the second phase, two Delphi rounds with the local coordinators of the organ procurement centers were carried out. Their responses were analyzed and the stages and criteria to standardize the organ procurement process were determined. The expert defined organ procurement process, validated by local coordinators, comprised nine stages and 36 criteria. The expert opinion coincidence was high and significant (Cronbach's alpha > 0.8, p < 0.01). The protocol describing the procurement process, constructed and validated by experts, will allow to standardize a clinical protocol contributing to a successful national organ procurement.