Recognition Of Donors Research Articles

Serum Hepcidin Is an Early Predictor of Iron Depletion in Non-Anemic Blood Donors

Introduction Iron deficiency is one of the major concerns in repeated whole blood donors. Although taking iron supplementation, frequent whole blood donors sometimes suffer from iron depletion which contributes to adverse impact on donor's health and may reduce the donor blood pool. Laboratory parameters identifying iron depleted status could help early recognize donors at risk of iron deficiency. Hepcidin is a key iron regulator, which blocks ferroportin to inhibit iron absorption and iron release from hepatocytes. In iron depletion, hepcidin down regulates to encourage iron absorption. Previous data reported that serum hepcidin at less than 10 ng/mL was significantly associated with iron deficiency. According to the biological function and physiological response of hepcidin, we hypothesize that hepcidin could be an early predictor of iron deficiency status in non-anemic individuals. Methods This cross-sectional study was conducted at the Blood Bank Center at Chiang Mai University Hospital, Chiang Mai, Thailand in May 2023. After the informed consent was obtained, ninety-seven healthy repeated whole blood donors who had donated blood at least twice in the past year were recruited. The medical records were reviewed. Basic characteristics and laboratories including complete blood count, reticulocyte indices, iron parameters, and serum hepcidin were evaluated. Donors who had serum ferritin level less than 30 and 30-100 ng/mL were categorized as iron deficiency, and low ferritin group, respectively. Those who had ferritin more than 100 ng/mL were the control group. Logistic regression analysis was done to determine the value of serum hepcidin in predicting iron deficiency status in each group. Results The total of 97 repeated whole blood donors were recruited, 48 (49.5%) were women. Mean age was 34.6 ± 10.7 years. There were 8 donors in the iron deficiency group, 38 in the low ferritin group, and 51 donors in the control group. Mean hemoglobin levels were 13.4 ± 1.1, 13.8 ± 1.2, and 14.2 ± 1.2 g/dL in the iron deficiency, low ferritin group and control, respectively, (p = 0.796). White blood cell and platelet count were not different in these groups. Similarly, red cell indices including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and reticulocyte indices showed no difference among groups. Serum hepcidin had a significant difference between the three groups. Median levels of hepcidin were 2.61 (1.37, 3.4) and 12.35 (10.12, 15.57) ng/mL in the iron deficiency and the low ferritin group, respectively, compared to 26.01 (21.36, 39.08) ng/mL in the control group, (p < 0.001). Low serum hepcidin (less than 10 ng/mL) were found in 14 (36.8 %) donors who had ferritin levels less than 100 ng/mL, compared to only 1 (2.4%) donor in the control group, (p < 0.001). In addition, serum hepcidin showed a strong correlation with ferritin levels (r = 0.779). Logistic regression model showed that only female sex (OR: 2.87; 95% CI: 1.26, 6.56) and hepcidin (OR: 0.76; 95% CI: 0.66, 0.86) were significant predictors of repeated donors who were at risk of iron depletion and had the ferritin levels less than 100 ng/mL. Conclusions Frequent blood donors are at risk of iron depletion. Serum hepcidin was a significant predictor of iron depleted status in non-anemic donors. Serum hepcidin also showed a significant correlation with ferritin levels. The downregulation of serum hepcidin was detected prior to the changes of red blood cell indices and reticulocyte responses. Early recognition and identification of donors at risk of iron depletion and prompt iron restoration are the key to ensuring the donor safety and preserving adequate blood donor pool.

Perception of Brazilian medical students toward organ donation.

Brazil ranks second in gross numbers of kidney and liver transplantations, but deceased organ donation is still far below the national demand for organs. Apart from a high family refusal rate, another significant barrier is healthcare workers' inappropriate knowledge concerning organ donation and transplantation. Since most of them have recently graduated from university, this study aimed to evaluate the awareness and attitudes of medical students concerning organ donation. Between August and September 2021, a web-based survey with 10 overlapping questions was sent to medical students from several Brazilian universities after advertisements on social media. A total of 391 (60% female, mean age: 23 [17-41] years) students answered the survey. Most of them (91%) would like to donate organs in case of death, and 75% have already notified their family. The main reasons for not becoming a donor were fear of body manipulation (n=3) or family reaction (n=2) and religious reasons (n=2). When inquired, 54% were unaware of brain death criteria, and half of them claimed to have never discussed the topic in medical classes. Except for Glasgow coma scale (97%), pupillary (72%), and corneal (53%) reflexes, less than 25% knew other reflexes required for brain death diagnosis. Most medical students declared themselves as organ donors, and most informed their families. However, many students have never learned about crucial steps toward organ donation, which may impact their adequate recognition of potential organ donors later in life.

Structural Basis of Specificity for Carboxyl-Terminated Acyl Donors in a Bacterial Acyltransferase.

Macrolactins (MLNs) are a class of important antimacular degeneration and antitumor agents. Malonylated/succinylated MLNs are even more important due to their efficacy in overcoming multi-drug-resistant bacteria. However, which enzyme catalyzes this reaction remains enigmatic. Herein, we deciphered a β-lactamase homologue BmmI to be responsible for this step. BmmI could specifically attach C3-C5 alkyl acid thioesters onto 7-OH of MLN A and also exhibits substrate promiscuity toward acyl acceptors with different scaffolds. The crystal structure of BmmI covalently linked to the succinyl group and systematic mutagenesis highlighted the role of oxyanion holelike geometry in the recognition of carboxyl-terminated acyl donors. The engineering of this geometry expanded its substrate scope, with the R166A/G/Q variants recognizing up to C12 alkyl acid thioester. The structure of BmmI with acyl acceptor MLN A revealed the importance of Arg292 in the recognition of macrolide substrates. Moreover, the mechanism of the BmmI-catalyzed acyltransfer reaction was established, unmasking the deft role of Lys76 in governing acyl donors as well as catalysis. Our studies uncover the delicate mechanism underlying the substrate selectivity of acyltransferases, which would guide rational enzyme engineering for drug development.

Improving recognition of potential tissue donors: a quality improvement project by a hospitalist in training in The Hague, The Netherlands.

The number of tissue donations decreased in The Netherlands over recent years. The aim of this project was to determine the number of missed tissue donors in the Haaglanden Medical Centre and to develop a strategy to improve the number of tissue donors. We retrospectively analyzed patient files of all deceased patients in 2014 for their potential as tissue donors. Our objectives were to determine the number of missed tissue donors and the percentage of correctly identified tissue donors among all physicians and hospitalists in training. In addition, a clinical audit and three focus group interviews were used to determine the level of knowledge about and adherence to local and national protocols. The findings enabled us to suggest national and local improvements to reduce the percentage of missed tissue donors. The number of missed tissue donors was 94 (17.2%) of 548 deceased patients in 2014. The percentage of correctly identified tissue donors was 65.7% among all physicians (Cohen's Kappa coefficient 0.557, p ≤ 0.001) and 57.1% among hospitalists in training (Cohen's Kappa coefficient 0.492, p ≤ 0.001). In 31 patients (32.4%), the reported contra-indication by physicians was not a contra-indication for tissue donation in The Netherlands. There was no statistical difference in correct identification between physicians and hospitalists in training (p = 0.321, Mann-Whitney). The most effective actions to increase the number of tissue donations include to better inform physicians about contra-indications and help them in the recognition of a tissue donor.

Critical care in the Emergency Department: organ donation

Organ transplantation is associated with improved outcomes for some patients with end-stage organ failure; however, the number of patients awaiting a transplant exceeds the available organs. Recently, an extended role...

Selection and outcome of the potential live liver donor.

A thorough donor evaluation in the living donation process is mandatory to ensure a safe outcome in an otherwise healthy individual. The aim of the current study was to evaluate the reasons for not proceeding to donation and the outcome of live liver donors. A prospective study of potential donors who underwent evaluation and proceeded to surgery from 1 April 2012 to 31 January 2015 was conducted. The process of donor selection, its outcome and peri-operative complications were recorded. A total of 460 donors were evaluated in a stepwise manner for 367 potential recipients. Of the 321 (69.7%) donors not proceeding to donation, the reasons were donor-related in 63.6% and recipient-related in the rest. Common donor-related reasons were: donor reluctance (23.5%), negative liver attenuation index (16.2%), anatomic variations (10.3%), inadequate remnant liver volume (9.8%), unacceptable liver biopsy (8.8%), and inadequate graft volume (5.4%). A majority of donors (82.8%) were turned down early in the (steps 1 and 2) evaluation process. Recipient death was the most common recipient-related reason [n=51 (43.6%)] for not proceeding to donation. There was no donor mortality. The overall complication rate was 19.8% and major complication rate (grade 3 or higher) was 4.4%. A stringent stepwise donor evaluation process leads to early recognition of unsuitable donors and a low complication rate.

Guidelines for the assessment and acceptance of potential brain-dead organ donors.

Organ transplantation is the only alternative for many patients with terminal diseases. The increasing disproportion between the high demand for organ transplants and the low rate of transplants actually performed is worrisome. Some of the causes of this disproportion are errors in the identification of potential organ donors and in the determination of contraindications by the attending staff. Therefore, the aim of the present document is to provide guidelines for intensive care multi-professional staffs for the recognition, assessment and acceptance of potential organ donors.

Organ Donation From Deceased Donors: A Proactive Detection Program in Saudi Arabia.

Several challenging obstacles remain to increasing the number of organ donations from deceased patients in a hospital setting. These include medical, administrative, and ethical issues. Possible medical obstacles include the failure of early recognition of possible donors and inadequate care of potential and actual donors. To maximize the use of donated organs, proper care of the donors and expedited donor consent cannot be overemphasized. The care rendered to patients should ensure appropriate perfusion and nutrition of the organs, with meticulous follow-up until organ recovery. For example, patients involved in accidents are presumed to be healthy, but many have no available medical history on file. At the time of organ recovery, unexpected infections or malignancies can be minimized by raising the index of suspicion of the presence of serious conditions in donors, especially in donors with unknown medical history. A careful physical examination and an appropriate and aggressive laboratory investigation may disclose the cause of suspected clinical conditions in these potential donors. Individuals who work in intensive care units are the main group of health care providers directly involved in the process of organ donation. Appointing a donor coordinator in each intensive care unit could improve all aspects of organ donation. Such coordination could harmonize efforts toward the goals mentioned above and surmount the obstacles encountered during deceased-donor organ donation. Here, we describe the preliminary results of the Proactive Detection Program, a collaboration between the Saudi Center for Organ Transplantation (the national organ donation and transplant supervising center) and intensive care units of donating hospitals. With its success in Saudi Arabia, it is hoped that it will be widely adopted in other regions.

헌혈자의 헌혈기록정보의 인식도 및 만족도 연구

본 연구는 헌혈 참여자들의 헌혈에 대한 지식과 인식 및 만족도, 효과적이라고 생각하는 홍보방안에 대해 살펴보고 자발적이고 지속적인 헌혈인구의 확대방안 마련의 기초자료를 얻기 위하여 시도되었다. 자료수집기간은 2012년 3월 9일부터 3월 24일까지 16일간이었고, 자료의 수집방법은 설문조사로 총 700부를 배포하여 636부를 최종 분석 자료로 사용하였다. 수집된 자료는 SPSS 21.0을 이용하여 빈도분석 및 교차분석, t-test, ANOVA를 시행한 결과 첫째, 남성, 20~29세의 범위 연령층에서, 학생, 대졸이상의 집단에서 높은 분포를 보였다. 둘째, 헌혈에 대한 지식과 인식도는 모른다는 내용이 많았으며, 만족도는 헌혈행위에 대한 만족보다는 헌혈과 관련된 서비스 만족도 점수가 더 높게 나타났다. 셋째, 헌혈 홍보에서는 홍보교육이 필요하며 홍보매체와 수단으로는 TV, 거리광고, 전철광고 방법 순의 결과를 보였으며 지속적인 헌혈을 위하여 헌혈에 대한 긍정적인 인식이 필요하다는 결과를 보였다. 그러므로 헌혈인구 확대를 위해서는 헌혈에 대한 지속적인 교육, 홍보를 통하여 대국민 인식변화를 유도하고 헌혈자에 대한 다양한 보상 이벤트제공 등으로 헌혈에 대한 더욱 적극적인 방법을 모색해야 할 것이다. The purpose of this study is to investigate the knowledge and recognition about blood donation and satisfaction, look for ways to promote the idea that effective, was trying to get the plan to provide the basis for the expanding population of voluntary and continuous blood donation. A survey was from May 9, 2012 to May 24, 2012 and total 636 copies were used as final study data. The data collected analyzed with SPSS win 21.0 using descriptive methods, frequency analysis, chi-square test, t-test, ANOVA. The results were as follows. First, the rates of the blood donors were higher in the men, in the age group from 20 to 29, in the students and in the group that received college or higher education. Second, as for the knowledge and recognition of the blood donors on blood donation, many replied they didn't know well about it. Concerning satisfaction level, they gave higher marks to satisfaction with related service than with blood donation itself. Third, the necessity of sustained blood donation promotion and education was pointed out. TV was most preferred, followed by ads on the street and ads on the subway. To expedite an increase in the blood-doner population, prolonged education and promotion are required to change the way that people in general look at blood donation, and a variety of rewards should be provided for blood donors.

A retrospective evaluation of informed consent for tissue donation within a year of the donor's death

By German law organ and tissue donation may only be done if explicit consent is given during lifetime, e.g. by a donor card, or if the family grants informed consent after death in line with the deceased's last will, what is discussed to mean an additional emotional load in the situation of mourning.Every year about 35 musculoskeletal tissue donations and 250 donations of corneoscleral discs (means 125 donors) are performed in the Hamburg Institute of Legal Medicine. Talking to the next of kin plays a key role in the consenting process for donation. We show our guidelines according to the family contact by telephone and present the results of a catamnestic review referring to the donors of one year's period. Methods: One year after procurement had been completed we requested the consenting person to answer a questionnaire and asked for an evaluation of the contact to the institute's coordinator and furthermore the emotional impact of the consenting process. Results: 26 (72.2% of 36 only musculoskeletal donors) and 77 (73.3% of 114 only cornea donors) consenting persons answered and gave a positive feedback in the dimensions of information, support and consent. Discussion: The telephone contact with families of deceased persons out of the Institute of Legal Medicine is perceived to be helpful in an acute stress situation caused by a sudden death and an accepted way to establish the deceaseds’ wishes in respect to donation through the relatives. Conclusion: According to the letter of the German Transplantation Act asking for donation is an obligation for every physician and our data show that this means no additional burden for relatives, if the question is placed appropriately. Forensic institutes play a key role in the recognition of tissue donors and take up the challenge to act as an interface between donors and recipients. But caring for the sufficient supply with tissue transplants needs considerable resources. Therefore additional support is necessary to fulfill this task.

Electrocardiographic abnormalities in Trypanosoma cruzi seropositive and seronegative former blood donors.

BackgroundBlood donor screening leads to large numbers of new diagnoses of Trypanosoma cruzi infection, with most donors in the asymptomatic chronic indeterminate form. Information on electrocardiogram (ECG) findings in infected blood donors is lacking and may help in counseling and recognizing those with more severe disease.ObjectivesTo assess the frequency of ECG abnormalities in T.cruzi seropositive relative to seronegative blood donors, and to recognize ECG abnormalities associated with left ventricular dysfunction.MethodsThe study retrospectively enrolled 499 seropositive blood donors in São Paulo and Montes Claros, Brazil, and 483 seronegative control donors matched by site, gender, age, and year of blood donation. All subjects underwent a health clinical evaluation, ECG, and echocardiogram (Echo). ECG and Echo were reviewed blindly by centralized reading centers. Left ventricular (LV) dysfunction was defined as LV ejection fraction (EF)<0.50%.ResultsRight bundle branch block and left anterior fascicular block, isolated or in association, were more frequently found in seropositive cases (p<0.0001). Both QRS and QTc duration were associated with LVEF values (correlation coefficients −0.159,p<0.0003, and −0.142,p = 0.002) and showed a moderate accuracy in the detection of reduced LVEF (area under the ROC curve: 0.778 and 0.790, both p<0.0001). Several ECG abnormalities were more commonly found in seropositive donors with depressed LVEF, including rhythm disorders (frequent supraventricular ectopic beats, atrial fibrillation or flutter and pacemaker), intraventricular blocks (right bundle branch block and left anterior fascicular block) and ischemic abnormalities (possible old myocardial infarction and major and minor ST abnormalities). ECG was sensitive (92%) for recognition of seropositive donors with depressed LVEF and had a high negative predictive value (99%) for ruling out LV dysfunction.ConclusionsECG abnormalities are more frequent in seropositive than in seronegative blood donors. Several ECG abnormalities may help the recognition of seropositive cases with reduced LVEF who warrant careful follow-up and treatment.

161 Children as Donors: A National Pediatric Intensive Care Study to Assess Procurement of Organs and Tissues

ObjectivesShortage of size-matched organs and of tissues is the key factor limiting transplantation in children. Empirical data on the procurement process in children is sparse. This study aimed to gain...

When Good Intentions Are Not Enough: Obtaining Follow-Up Data in Living Kidney Donors

The Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) has increased the amount of data collected before and after donation and increased the duration of donor follow-up to 2 years, yet there is evidence that reporting is incomplete. We examined the frequency of missing data in the OPTN/UNOS donor follow-up registry and found that reporting rates were low, particularly for donors who may have limited access to health care. We argue that a national donor follow-up registry is essential to ensure transparency in ascertaining long-term health outcomes among all living donors and in providing assessments of quality assurance within transplant programs. We have suggested approaches to strengthen the donor follow-up registry system. These include setting clear and high standards for follow-up reporting, a system of incentives and penalties that would motivate transplant centers to comply with these standards and would encourage donors to follow-up and lifelong follow-up reporting by primary care providers. We argue that the US government must provide funding to support a donor follow-up registry that can allow for meaningful and valid conclusions, in recognition of donors' public service and to maintain trust in the system of living organ donation.

Asymmetric Supramolecular Primary Amine Catalysis in Aqueous Buffer: Connections of Selective Recognition and Asymmetric Catalysis

A new approach of asymmetric supramolecular catalysis has been developed by combining the supramolecular recognition of beta-cyclodextrin (beta-CD) and the superior property of a chiral primary amine catalyst. The resulted beta-CD enamine catalysts could effectively promote asymmetric direct aldol reactions with excellent enantioselectivity in an aqueous buffer solution (pH = 4.80). The identified optimal catalyst CD-1 shows interesting characteristics of supramolecular catalysis with selective recognition of aldol acceptors and donors. A detailed mechanistic investigation on such supramolecular catalysis was conducted with the aid of NMR, fluorescence, circular dichroism, and ESI-MS analysis. It is revealed that the reaction is initialized first by binding substrates into the cyclodextrin cavity via a synergistic action of hydrophobic interaction and noncovalent interaction with the CD-1 side chain. A rate-limiting enamine forming step is then involved which is followed by the product-generating C-C bond formation. A subsequent product release from the cavity completes the catalytic cycle. The possible connections between molecular recognition and asymmetric catalysis as well as their relevance to enamine catalysis in both natural enzymes and organocatalysts are discussed based on rational analysis.

Recognition of acyl donors by lipase CAL‐B in the acylation of 6‐azauridine

CAL-B-catalyzed synthesis of different 5'-O-monoester derivatives of 6-azauridine via a one-step highly regioselective enzymatic acylation route was successfully performed for the first time. The effects of some crucial factors on the enzymatic undec-10-enoylation of 6-azauridine were examined. The optimal reaction medium, molar ratio of 6-azauridine to vinyl undec-10-enoate and reaction temperature were found to be anhydrous acetone, 1:3 and 50 degrees C, under which the reaction rate, the substrate conversion and the regioselectivity were 22.3 mM/h, 99.0% and 99.0%, respectively. In addition, the enzyme recognition of acyl donors was investigated. The results showed that the enzyme activity varied widely with different acyl donors owing to the specific structure of the lipase active site and the acyl donors. 5'-O-Monoesters of 6-azauridine were achieved exclusively with all the acyl donors tested.

Evaluation of appearance transfer and persistence in central face transplantation: A computer simulation analysis

Partial facial allotransplantation is an emerging option in reconstruction of central facial defects, providing function and aesthetic appearance. Ethical debate partly stems from uncertainty surrounding identity aspects of the procedure. There is no objective evidence regarding the effect of donors' transplanted facial structures on appearance change of the recipients and its influence on facial recognition of donors and recipients. Full-face frontal view color photographs of 100 volunteers were taken at a distance of 150 cm with a digital camera (Nikon/DX80). Photographs were taken in front of a blue background, and with a neutral facial expression. Using image-editing software (Adobe-Photoshop-CS3), central facial transplantation was performed between participants. Twenty observers performed a familiar 'facial recognition task', to identify 40 post-transplant composite faces presented individually on the screen at a viewing distance of 60 cm, with an exposure time of 5s. Each composite face comprised of a familiar and an unfamiliar face to the observers. Trials were done with and without external facial features (head contour, hair and ears). Two variables were defined: 'Appearance Transfer' refers to transfer of donor's appearance to the recipient. 'Appearance Persistence' deals with the extent of recipient's appearance change post-transplantation. A t-test was run to determine if the rates of Appearance Transfer differed from Appearance Persistence. Average Appearance Transfer rate (2.6%) was significantly lower than Appearance Persistence rate (66%) (P<0.001), indicating that donor's appearance transfer to the recipient is negligible, whereas recipients will be identified the majority of the time. External facial features were important in facial recognition of recipients, evidenced by a significant rise in Appearance Persistence from 19% in the absence of external features to 66% when those features were present (P<0.01). This study may be helpful in the informed consent process of prospective recipients. It is beneficial for education of donors families and is expected to positively affect their decision to consent for facial tissue donation.

Regioselective acylation of nucleosides and their analogs catalyzed by Pseudomonas cepacia lipase: enzyme substrate recognition

The substrate recognition of Pseudomonas cepacia lipase in the acylation of nucleosides was investigated by means of rational substrate engineering for the first time. P. cepacia lipase displayed excellent 3′-regioselectivities (96 to >99%) in the lauroylation of 2′-deoxynucleosides 1a– 1e, while low to good 3′-regioselectivities (59–89%) in the lauroylation of ribonucleosides 1f– 1j. It might be due to the unfavorable hydrogen bond interaction between 2′-hydroxyl group of 1f– 1j and phenolic hydroxyl group of tyrosine residue present in the alternate hydrophobic pocket of the enzyme, which stabilizes the conformation of 5′-acylation transition state and thus increases the amount of the minor regioisomer. In addition, various ester derivatives of floxuridine were synthesized successfully by the lipase with high conversions (99%) and good to excellent 3′-regioselectivities under mild conditions. The recognition of various acyl donors by the enzyme was examined. The enzymatic recognition of acyl groups was rationalized in terms of the structure of the active site of the lipase, especially the size, shape, and physicochemical properties.

Recognition of potential organ donors: an audit in a university hospital ICU

In Poland, in 2002, the number of organ donors per one million inhabitants was 12.68, and was 8.9% higher than in 2001 (11.64/million). But still many potential organ donors are missed. The objective of this study was to identify the major causes of missed donors in a university hospital (600 beds) with a busy neurosurgery ward.

A highly congested N,N'-dioxide fluorosensor for enantioselective recognition of chiral hydrogen bond donors.

A rigid C2-symmetric 1,8-diacridylnaphthalene N,N'-dioxide fluorosensor has been developed for enantioselective recognition of chiral hydrogen bond donors such as amines and amino acids.

Organ and tissue donation from the emergency department

Despite mandatory request legislation, the lack of available donor organs and tissues continues to limit transplant efforts. The potential contribution from emergency department (ED) patients remains undefined. We reviewed the charts of patients dying in our ED for organs and tissues potentially suitable for transplantation, age, cause of death, and physician documentation of donation inquiry. Of 155 charts reviewed, potential donors were identified for corneas (99), bones (61), heart valves (42), and kidneys (3). Of the 155 charts, 130 (84%) made no mention of donation, and of 37 charts containing a donor request form, 34 (92%) were incorrectly filled out or left blank. Four charts (2.6%) mentioned donation in the narrative section, two (1.3%) documented discussion with family, and one patient was referred to our Organ Procurement Organization, with recovery of one kidney and heart valves. We conclude that physicians rarely document consideration of donation for patients dying in the ED; the number of potential donors far exceeds the number referred or recovered. Future efforts should focus on methods to increase recognition and referral of organ and tissue donors from the ED.