Organ Procurement System Research Articles

What is visible is fixable: Visual dashboards for multi-domain assessment of organ procurement organization performance

With stakeholder focus on the United States organ procurement system, there is a need for tools that permit comparative assessment of organ procurement providers. We developed a public-facing dashboard for organ procurement organizations (OPOs), using data from multiple sources, to create an online, readily accessible visualization of OPO practice conditions and performance for the period 2010-2020. With this tool, OPOs can be compared on the CMS metric of donors procured per 100 donation-consistent deaths, as well as donation after circulatory death procurement, procurement of older and minority patient populations, procurement in smaller hospitals, and procurement of patients without a significant drug history. Patterns of higher performance were identified, and 74% of differences in overall donor procurement rates could be explained using model variables. Procurement differences were affected to a greater and more reproducible degree by OPO performance among Black and non-White patient populations, as well as in smaller hospitals, than by donation service area characteristics. Dashboards such as ours support OPOs and stakeholders in quality improvement actions, through leveraging benchmarked performance data among organ procurement clinical providers.

413.12: Summarizing the Characteristics of the Recent Progress of Organ Donation and Transplantation in China by Using GODT Data

Introduction: Although COVID-19 pandemic has caused a significant impact worldwide, organ donation & transplantation (OD & OT) practice continuous in most of the countries. Since China launched the pilot program of voluntary deceased OD in 2010, the national organ donation & procurement system has been developing towards standardization. In this study, features of the global & national trends in OD & OT during the COVID-19 pandemic were summarized. Method: A retrospective study using data from the global observatory on donation and transplantation (GODT) was conducted. We analyzed the collected data to obtain the results and conclusions. Results: The summed-up characteristics covered different aspects and could be outlined as the followings: 1) The number of global OT has been increasing until the outbreak of COVID-19 pandemic in 2020. There were 129,681 OT performed worldwide in 2020, a decrease of 17.6% comparing to that of 2019. The percentage of China’s annual OT to the global OT number rose from 7.9% among in 2015 (10,057 cases) to 13.8% in 2020 (17,949 cases). 2) In China, joint-efforts have been made to achieve self-sufficiency of OT on the national level. The total number of OD exceed 5,000 in 2020, accounting for 14.5% of the global deceased OD. The China OD & OT program works orderly with implementation of prevention control policy under the pandemic. 3) DBD remains as the major source for OT worldwide while the number of DCD has been increasing in the recent year. With the lasting promotion of clinical practice in brain death diagnosis, the percentage of DBD in China has increased over the past five years. 4) The percentage of global living donor (LD) transplants has decreased year-on-year. With the implementation of deceased OD program in different Asian countries, living donation does not comprise the majority of organ source for OT in Asia. 5) The percentages of liver, kidney and lung transplantation in China were on the rise compared to the global total and the liver transplantation accounted for the highest proportion. 6) China’s OT activity ranks second in the world, but the PMP of deceased OD & OT is low, indicating rooms for improvement. 7) Innovative transplant approaches were explored worldwide to meet the increasing transplant demands. Efforts have been made in China to promote innovation for transplantation, examples can be seen, such as the fact that China completed ischemia-free liver/kidney/heart transplantation, and successfully performed the world’s first double-lung transplant with COVID-19 patient in 2020. Conclusion: Summary of current features in OD & OT in China and worldwide were analyzed in this study. The degree of OT program development varies across the world but all making efforts to meet the ever-changing demands for transplants. Chinese reform on OD & OT marks it one of the countries contributing to the increase of OD & OT activities worldwide but still has room for improvement in operational efficiency.

ESTABLISHING A MARKET FOR HUMAN ORGANS* IN SOUTH AFRICA PART 1: A PROPOSAL**

In the current system of organ procurement in South Africa, demand for transplantable organs outstrips supply by far. A change in legislation governing donation of organs is desperately needed as too many patients die unnecessarily waiting for an organ. A possible solution is to reward the donor financially. Authors in other countries have also expressed the need for changes in their countries’legislation in order to legalise the sale of human organs for transplant in an effort to save more lives. The proposed way of regulating the trade in organs is through “futures contracts”. In order to propose a market for human organs in South Africa, it is necessary to take note of these proposals. A problem highlighted is the question whether property rights in human organs exist. Although not legislated in South Africa, it will be shown that there are property rights in human body parts. Finally, a contract of sale for selling kidneys from living donors and a futures contract for the sale of transplantable organs from a deceased donor will be proposed after analysing arguments against the commercialisation of human organs. In Part 2 the shortcomings in South African legislation, specifically regarding organ transplants will be discussed. Solutions will be suggested in accordance with the four pillars of bioethics.

ESTABLISHING A MARKET FOR HUMAN ORGANS* IN SOUTH AFRICA PART 2: SHORTCOMINGS IN LEGISLATION AND THE CURRENT SYSTEM OF ORGAN PROCUREMENT**

The present shortage of transplantable organs in South Africa may be attributed to inadequate legislation and the current system of organ procurement. The Human Tissue Act 65 of 1983, in the interim phase, still prohibits the sale of organs for transplantation. Chapter 8 of the new National Health Act 61 of 2003 will take over this function once it is promulgated. Although the new Act allows the reimbursement of costs incurred in the donation of an organ, it may still not be sufficient to motivate more donors to donate organs in an effort to alleviate the organ shortage. The purpose of this article is to illustrate that the sale of organs and a change in thecurrent system of organ procurement may be a solution. It is also submitted that, should legislation be changed to legalise organ sales, it will be neither an encroachment on the basic principles of medical ethics nor a violation of fundamental rights.

Equity or Equality? Which Approach Brings More Satisfaction in a Kidney-Exchange Chain?

In United States (U.S.), government-funded organizations, such as NLDAC, reimburse travel and subsistence expenses incurred during living-organ donation process. However, in Iran, there is a non-governmental organization called Iranian Kidney Foundation (IKF) that funds the direct and indirect costs of donors through charitable donations and contributions from participants in the exchange program. In this article, for countries outside the U.S. that currently use an equality approach, we propose a potential new compensation-apportionment approach (equitable approach) for kidney-exchange chains and compare it with the currently available system (equality approach) in terms of the apportionment of compensation in a kidney-exchange chain to cover the expenses incurred by the initiating living donor of the chain in the act of donation. To this end, we propose a mechanism to apportion compensation among all participating pairs based on the equity approach by utilizing a prediction model to calculate the probability of graft survival in each transplant operation. These probabilities are then used to define the utility of any transplantation, considering the quality of each pair’s donated and received kidney in the chain. Afterward, the corresponding cost is apportioned by a mechanism based on the normalized differences between the utility of donated and received kidneys for each incompatible pair of the chain. In summary, we demonstrate that by utilizing the equitable approach, there is more fairness and equity in the allocation of resources in organ-procurement systems, which results in more satisfaction among incompatible pairs. Additional future prospective studies are needed to assess this proposed equitable approach for kidney-exchange chains in countries outside the U.S., such as Iran, that currently use an equality approach.

Impact of Obesity on Heart Transplantation Outcomes.

BackgroundPatients with obesity and advanced heart failure face unique challenges on the path to heart transplantation. There are limited data on waitlist and transplantation outcomes in this population. We aimed to evaluate the impact of obesity on heart transplantation outcomes, and to investigate the effects of the new organ procurement and transplantation network allocation system in this population.Methods and ResultsThis cohort study of adult patients listed for heart transplant used the United Network for Organ Sharing database from January 2006 to June 2020. Patients were stratified by body mass index (BMI) (18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and 40–55 kg/m2). Recipient characteristics and donor characteristics were analyzed. Outcomes analyzed included transplantation, waitlist death, and posttransplant death. BMI 18.5 to 24.9 kg/m2 was used as the reference compared with progressive BMI categories. There were 46 645 patients listed for transplantation. Patients in higher BMI categories were less likely to be transplanted. The lowest likelihood of transplantation was in the highest BMI category, 40 to 55 kg/m2 (hazard ratio [HR], 0.19 [0.05–0.76]; P=0.02). Patients within the 2 highest BMI categories had higher risk of posttransplantation death (HR, 1.29; P<0.001 and HR, 1.65; P<0.001, respectively). Left ventricular assist devices among patients in obese BMI categories decreased after the allocation system change (P<0.001, all). After the change, patients with obesity were more likely to undergo transplantation (BMI 30–35 kg/m2: HR, 1.31 [1.18–1.46], P<0.001; BMI 35–55 kg/m2: HR, 1.29 [1.06–1.58]; P=0.01).ConclusionsThere was an inverse relationship between BMI and likelihood of heart transplantation. Higher BMI was associated with increased risk of posttransplant mortality. Patients with obesity were more likely to undergo transplantation under the revised allocation system.

Application of theory of planned behavior on organ donation behavior: A systematic review.

Organ donation saves lives and improves the quality of life. There is a shortage of organ donors worldwide. Behavior theories, such as the theory of planned behavior (TPB), help identify the antecedents of organ donation behavior and design effective interventions. The TPB suggests that intention is driven by constructs: attitude, subjective norm, perceived behavioral control (PBC), and intention. TPB can help improve organ donation behavior. This study aimed to analyze TPB-based interventions on Organ donation. Relevant studies were identified searching electronic databases, i.e., PubMed, Scopus, Science Direct, and Google Scholar from January 1, 2000 to February 30, 2020. None MeSH terms in title or abstract were searched, including: "theory of planned behavior*" and "Tissue donation" or "Tissue procurement" or "Organ procurement system" or "Organ procurement" or "Organ donation." Two authors independently reviewed the full texts and extracted all critical data from the included studies. Seventeen studies were assessed as having a reasonable methodology design. Studies show that TPB-based interventions can improve organ donation. Among TPB's constructs, PBC is the moderator and the determinant of organ donation behavior which its determination is different in different cultures. Attitude, subjective norms, moral norms, and anticipated regret should be considered in related interventions plus PBC. Increasing knowledge can facilitate organ donation behavior. Removing related cultural issues, removing fear due to misunderstanding of Brain death, improving trust, and improving moral values have effects on the behavior of organ donating.

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

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

Predictors of organ donation-related cognitions and intentions in China: communication variables and cultural values

ABSTRACT China is in the process of establishing a more regulated organ procurement and distribution system. Previous media reports stated that misperceptions toward organ donation and value-related beliefs (e.g., helping others) were two important reasons that prevented or facilitated donor registration in China. Based on a sample of 472 Chinese non-registered donors, the present analysis found that compared with subjective norms, self-efficacy, and anticipated guilt, misperceptions toward organ donation were a weak predictor of donor registration intentions, whereas value-related beliefs did not predict donor registration intentions. In addition, collectivistic values were negatively related to misperceptions and positively related to value-related beliefs and subjective norms. Lastly, organ donation-related media use and interpersonal discussion predicted subjective norms, self-efficacy, and anticipated guilt. Overall, results indicate that for internalized beliefs (e.g., misperceptions and value-related beliefs), media and interpersonal discussion of organ donation may exert less influence.

Stem cell donor HLA typing improves CPRA in kidney allocation.

The Organ Procurement and Transplantation Network (OPTN) Kidney Allocation System provides a priority to sensitized candidates based on the calculated panel reactive antibody (CPRA) value. The human leukocyte antigen (HLA) haplotype reference panel used for calculation of the CPRA by the United Network for Organ Sharing (UNOS), the OPTN contractor, has limitations. We derived a novel panel from the National Marrow Donor Program HLA haplotype data set and compared the accuracy of CPRA values generated with this panel (NMDP-CPRA) to those generated from the UNOS panel (UNOS-CPRA), using predicted and actual deceased donor kidney offers for a cohort of 24282 candidates. The overall accuracy for kidney offers was similar using NMDP-CPRA and UNOS-CPRA. Accuracy was slightly higher for NMDP-CPRA than UNOS-CPRA for candidates in several highly sensitized CPRA categories, with deviations in linkage disequilibrium for Caucasians and the smaller size of the UNOS panel as contributing factors. HLA data derived from stem cell donors yields CPRA values that are comparable to those derived from deceased kidney donors while improving upon several problems with the current reference panel. Consideration should be given to using stem cell donors as the reference panel for calculation of CPRA to improve equity in kidney transplant allocation.

A critical look at the U.S. deceased‐donor organ procurement and utilization system

AbstractThe U.S. system for procuring and utilizing deceased‐donor organs for transplantation has been studied and written about in many articles. The purpose of this paper is to examine the interactions between the elements that comprise this system, and point out improvement opportunities that may be affected through operations research/management techniques. The authors demonstrate the need for developing data‐driven and analytic tools. In fact, data is used to generate hypotheses and support claims throughout the paper. The paper also points out the need to fully leverage data that is available to researchers, and to seek data that is currently not deposited in a centralized archive.

Join the Lone Kidney Club: incentivising live organ donation

Given the dramatic shortage of transplantable organs, demand cannot be met by established and envisioned organ procurement policies targeting postmortem donation. Live organ donation (LOD) is a medically attractive option,...

Analysis of official deceased organ donation data casts doubt on the credibility of China\u2019s organ transplant reform

BackgroundSince 2010 the People’s Republic of China has been engaged in an effort to reform its system of organ transplantation by developing a voluntary organ donation and allocation infrastructure. This has required a shift in the procurement of organs sourced from China’s prison and security apparatus to hospital-based voluntary donors declared dead by neurological and/or circulatory criteria. Chinese officials announced that from January 1, 2015, hospital-based donors would be the sole source of organs. This paper examines the availability, transparency, integrity, and consistency of China’s official transplant data.MethodsForensic statistical methods were used to examine key deceased organ donation datasets from 2010 to 2018. Two central-level datasets — published by the China Organ Transplant Response System (COTRS) and the Red Cross Society of China — are tested for evidence of manipulation, including conformance to simple mathematical formulae, arbitrary internal ratios, the presence of anomalous data artefacts, and cross-consistency. Provincial-level data in five regions are tested for coherence, consistency, and plausibility, and individual hospital data in those provinces are examined for consistency with provincial-level data.ResultsCOTRS data conforms almost precisely to a mathematical formula (which first appeared to be a general quadratic, but with further confirmatory data was discovered to be a simpler one-parameter quadratic) while Central Red Cross data mirrors it, albeit imperfectly. The analysis of both datasets suggests human-directed data manufacture and manipulation. Contradictory, implausible, or anomalous data artefacts were found in five provincial datasets, suggesting that these data may have been manipulated to enforce conformity with central quotas. A number of the distinctive features of China’s current organ procurement and allocation system are discussed, including apparent misclassification of nonvoluntary donors as voluntary.ConclusionA variety of evidence points to what the authors believe can only be plausibly explained by systematic falsification and manipulation of official organ transplant datasets in China. Some apparently nonvoluntary donors also appear to be misclassified as voluntary. This takes place alongside genuine voluntary organ transplant activity, which is often incentivized by large cash payments. These findings are relevant for international interactions with China’s organ transplantation system.

Respect for autonomy in systems of postmortem organ procurement: A comment.

In 2015 Robert Veatch published the second edition of his Transplantation ethics, this time together with Lainie Ross. The chapters on postmortem organ procurement distinguish between 'giving' and 'taking' systems, and argue that 'taking' systems may promise a greater yield of organs for transplantation, but inevitably violate a requirement of respect for the deceased's autonomy. That argument has been very influential, and is also representative of a way of thinking that is widespread in the literature and in public debate. In this paper I contend that it is conceptually flawed in a number of important respects. These concern the understanding of both the concept of 'consent' and the requirement of respect for autonomy, the role of the relatives in any procurement system, and the factors that actually determine the extent to which a system respects autonomy, under any interpretation of that requirement.

The Gift-of-Life and Family Authority: A Family-Based Consent Approach to Organ Donation and Procurement in China.

China is developing an ethical and sustainable organ donation and procurement system based on voluntary citizen donation. The gift-of-life metaphor has begun to dominate public discussion and education about organ donation. However, ethical and legal problems remain concerning this "gift-of-life" discourse: In what sense are donated organs a "gift-of-life"? What constitutes the ultimate worth of such a gift? On whose authority should organs as a "gift-of-life" be donated? There are no universal answers to these questions; instead, responses must be compatible with local cultural values. This paper argues that from a Confucian point of view, organs should be viewed as a gift from the donor's family, and that final dispositional authority should also rest with the donor's family. The worth of such a "gift" rests on the virtue of ren, the origin of which is family love. Ultimately, I will argue that a family-based consent model for deceased organ donation is not merely justified, but morally required in the Chinese cultural context.

Medical Students' Attitude Toward Organ Donation: Understanding Reasons for Refusal in Order to Increase Transplantation Rates

ObjectivesTo assess, among medical students, the willingness to donate their own organs or those of a family member, and to establish reasons for refusal. Materials and MethodsDuring the 2016 academic year, an anonymous survey was conducted among University of Buenos Aires School of Medicine second-year students. ResultsOf the total 1012 respondents, 81.92% would agree to donate and 18.08% would not. Thirty two percent would not authorize donation of a family member's organ. Almost all (94.1%) students reported they had little information about organ donation. Reasons for refusal included: fears about the possibility of not being really dead when considered for organ ablation (36.4%); lack of confidence in (25.8%) or lack of information about the organ procurement and transplantation system (14.6%); no interest in organ donation (9.3%); and religious reasons (6%). Brain death was considered irreversible by 59.7% of donors and by only 51% of non-donors (P = .036). Contact with a transplanted person was more frequent in the donor group (30.9% vs 21.3%, P = .01). More donors were found among the group who discussed the subject with their families than among the group who did not (69.1% vs 62.9%, P = .053). ConclusionsA considerable percentage of medical school students would not be willing to donate their own or a family member's organs. Main reasons are mistrust of the system, lack of information about donation programs, and poor understanding of the brain death concept. Contact with an organ recipient and discussing the subject in the family both favored donation.

Attitude of the Citizens of Havana, Cuba, Toward Organ Donation: A Multivariate Analysis of the Psychosocial Factors Affecting Attitude

IntroductionBecause personal decisions affect the availability of organs for transplants, awareness about organ donations among the general population is fundamental. ObjectiveTo analyze attitudes toward organ donation among the citizens of Havana, Cuba. MethodsThe sample population was the residents of the city of Havana, Cuba. The inclusion criterion was being older than 15 years; the sample was obtained randomly and stratified by age and sex. Attitude was assessed using a validated questionnaire on psychosocial aspects of organ donation and transplant (PCID-DTO-Ríos). A random selection of people to be surveyed was carried out. ResultsA sample of 920 respondents was included in the study. Attitude toward cadaveric donation was favorable in 68% of respondents, while 14% were against and 18% were undecided. Several variables were associated with having a more favorable attitude. In the multivariate analysis, the following variables continue to feature as independent variables (P < .05): 1. level of studies; 2. knowledge of the concept of brain death; 3. attitude toward organ donation of a relative; 4. having discussed the issue of organ donation and transplantation with one's family; 5. the attitude of the couple toward organ donation and transplantation; 6. the religion of the respondent; 7. knowing the opinion of one's religion toward organ transplantation; 8. fear of manipulation of the body after death; and 9. acceptance of burial as a treatment of the body after the death. ConclusionsThe attitude toward cadaveric organ donation among the residents of Havana is favorable and similar to that of the citizens of Spain. Improving the organ procurement system will increase donation rates given the population's awareness of the issue.

Opting out never looked so good

In this second article in a series about the ethics of kidney care, David Curran and Peter Ellis will present the arguments for and against an opt-out system of organ procurement. In this first piece, Curran takes a look at positive aspects of presumed consent, reflecting on issues such as donors' rights, shifting attitudes to organ donation and the potential decline of difficult discussions about transplantation.

A CONSTITUTIONAL DEMOCRACY SHOULD PROVIDE FOR THE LEGALISATION OF ORGAN TRADING

The choice before us is not between buying or not buying organs.1 This is happening regardless of the law. The choice is whether transplant operations and the sale of organs will be regulated or not.’2 It is in light of this statement that I propose a legalised system of organ trading. Desperate people will turn to the black market regardless of the law. If organ trading could be regulated, we can protect all parties involved and ensure that they get the benefit they deserve.3 A very important factor of this way of procuring organs is that it will curb the organ shortage organ shortage. The waiting period for an organ transplant in South Africa is 5-11 years. Approximately 50% of people die while being on a waiting list for an organ transplant.4 While there is such a dire need for organs, research has shown that only 0.2% of South Africans are organ donors.5 Something must be done to motivate more people to become organ donors. While the need for organs grows daily, the black market is flourishing. As none of the organ procurement systems in other countries are successful enough to provide the need for organs, our only viable option might be to implement a payment system. When closely regulated, the system of organ trading can be an enormous success.

Financial aspects of organ procurement from deceased donors in the USA-Relevance to xenotransplantation.

When clinical xenotransplantation is introduced, the costs associated with acquisition of a genetically engineered pig organ are as yet unknown. How will these costs compare with those currently associated with the acquisition of deceased human organs? An understanding of the financial aspects of deceased organ and tissue procurement in the USA is therefore worthwhile. We have therefore attempted to review certain economic aspects of non-profit and for-profit organizations that provide cadaveric organs and/or tissues for purposes of transplantation into patients with end-stage organ failure, cellular deficiencies, or in need of reconstructive procedures. We briefly consider the laws, organizations, and business practices that govern the acquisition, processing, and/or distribution of cadaveric organs and tissues, and the economic implications of industry practices. In particular, we explore and highlight what we perceive as a lack of transparency and oversight with regard to financial practices, and we question whether donor families would be entirely happy with the business environment that has developed from their altruistic donations. Until xenotransplantation becomes established clinically, which will negate the need for any system of organ procurement and allocation, we suggest that those involved in organ and cell transplantation, as well as those who participate in reconstructive surgery, should take responsibility to ensure that the financial practices associated with procurement are transparent, and overseen/regulated by a responsible authority. We suggest the major transplant societies should take a lead in this respect. The ability to acquire a genetically engineered pig organ whenever required through a simple commercial transaction (as in the acquisition of a life-saving drug) will be greatly to the patient's benefit.