Organ Donation Research Articles

Seasonal Patterns of Living Kidney Donation in the United States From 1995 to 2019.

The number of living kidney donors in the United States has declined since 2005, with variations based on the donor-recipient relationship. The reasons for this decline are unclear, and strategies to mitigate declined donations remain elusive. We examined the change in donor number monthly (within-year) versus annually (between-years) to inform potentially modifiable factors for future interventions. In this registry-based cohort analysis of 141759 living kidney donors between 1995 and 2019, we used linear mixed-effects models for donor number per month and year to analyze between-year and within-year variation in donation. We used Poisson regression to quantify the change in the number of donors per season before and after 2005, stratified by donor-recipient relationship and zip-code household income tertile. We observed a consistent summer surge in donations during June, July, and August. This surge was statistically significant for related donors (incidence rate ratio [IRR] range: 1.12-1.33) and unrelated donors (IRR range: 1.06-1.16) across donor income tertiles. Our findings indicate lower rates of living kidney donation in non-summer months across income tertiles. Interventions are needed to address barriers to donation in non-summer seasons and facilitate donations throughout the year. Since the Organ Donor Leave Law provides a solid foundation for supporting year-round donation, extending the law's provisions beyond federal employees may mitigate identified seasonal barriers.

How Do Financial Obstacles Affect Decision-Making Among Potential Living Organ Donors?

Introduction: Living donation increases the organ supply, but associated non-medical expenses can disincentivize donation. Programs aimed at increasing living donation need to better understand how financial obstacles, including lost wages, impact the decision to pursue donation. Methods/Approach: Forty-eight interviews were conducted and analyzed using a grounded theory approach. Findings: Three key themes were identified that influenced decision-making: emotional attachment, temporal flexibility, and job security. These themes emerged when dividing interview participants into 3 groups: close relationship donors, broader network donors, and non-directed donors, representing donation to a family member or friend, a specific person they do not know well or at all, or a non-specified individual, respectively. Most close relationship donors wanted to donate regardless of personal financial cost, based on emotional attachment to the recipient. Wage reimbursement did not typically affect their decision-making but could reduce stress. Since non-directed donors did not donate to a specific individual, they could wait to achieve financial stability before donating, if needed. While wage reimbursement might create more proximate stability, non-directed donors had the flexibility to postpone donations until they could independently achieve financial stability. Lacking emotional attachment and temporal flexibility, broader network donors were particularly active decision-makers and most influenced by wage reimbursement. Across all groups, donors with job security were more resolute about donating. Conclusion: The findings underscore the importance of lost wage reimbursement to facilitate donation and reduce stress, and policies to protect donor job security.

403.2: Project donor: A national intervention to improve the health of living organ donors.

403.2: Project donor: A national intervention to improve the health of living organ donors.

P.469: Psychometrics of Flodén attitudes toward organ donor advocacy instrument in Turkish: A scale adaptation study among intensive care unit nurses.

P.469: Psychometrics of Flodén attitudes toward organ donor advocacy instrument in Turkish: A scale adaptation study among intensive care unit nurses.

P.133: Identification of risk of malaria and selective post-transplant testing of deceased organ donors in the UK.

P.133: Identification of risk of malaria and selective post-transplant testing of deceased organ donors in the UK.

412.2: Favourable outcomes of recipients of SARS-CoV-2 RNA positive donor organs support their safe utilisation in the post-pandemic era.

412.2: Favourable outcomes of recipients of SARS-CoV-2 RNA positive donor organs support their safe utilisation in the post-pandemic era.

The Interconnection Between the Liver and Other Organs: Insights for Hepatic Long–Term Normothermic Machine Perfusion

ABSTRACTNormothermic machine perfusion (NMP) is emerging as a promising technique for organ preservation, evaluation, and scientific research, offering the potential to enhance the viability and function of donor organs. To fully harness the benefits of NMP, sustained long–term NMP (LNMP) at 36°C for periods exceeding 24 h is required. However, the development of stable LNMP devices is hindered by our limited understanding of ex vivo liver physiology. This review synthesizes insights from clinical and experimental studies to highlight the knowledge gaps associated with the impact of the absence of various organs or systems on isolated livers during ex vivo perfusion. Additionally, it discusses liver injuries and adverse events documented in published liver LNMP studies, elucidating their underlying mechanisms. By analyzing these findings, the paper proposes a series of recommendations to establish a more stable LNMP platform, aiming to optimize the outcomes of liver preservation and expand the applications of NMP in clinical practice and research.

P.088: Basic study of brain death donor organ transplant.

P.088: Basic study of brain death donor organ transplant.

The Effect of Education on the Knowledge Level, Awareness and Attitudes of Physiotherapy Students’ Towards Organ Donation and Transplantation

The current educational curriculum does not provide physiotherapists with adequate knowledge and skills regarding tissue and organ donation and transplantation. This study aims to investigate whether educational interventions on organ donation and transplantation lead to significant changes in physiotherapy students' knowledge, awareness, and attitudes. The study involved 96 students from the Department of Physiotherapy and Rehabilitation at a state university, with a mean age of 19.61±1.43 years. Data were gathered through face-to-face interviews and evaluated using a socio-demographic information form, the Organ-Tissue Donation and Transplantation Knowledge Scale, and the Organ Donation Attitude Scale. After administering a pre-test, a 60-minute educational session was conducted, followed by a post-test. Statistical analysis revealed significant differences in the Organ Donation Knowledge Scale before and after the educational intervention (p=0.0001). Significant differences were also observed in the Organ Donation Attitudes Scale, the Humanity and Moral Conviction sub-dimension, the Fears of Medical Neglect sub-dimension, the Fears of Bodily Mutilation sub-dimension, and the Total Negative Attitudes sub-dimension (p=0.0001). Healthcare professionals play a critical role in informing and guiding people about organ donation for increasing awareness and encouraging positive attitudes. Therefore, providing comprehensive and effective education on organ donation and transplantation to physiotherapists can significantly enhance their ability to improve public knowledge and attitudes towards organ donation.

Potential donor family behaviours, experiences and decisions following implementation of the Organ Donation (Deemed Consent) Act 2019 in England: A qualitative study

BackgroundIn May 2020, England implemented “deemed consent” legislation, to make it easier for individuals to donate their organs and convey their decision when alive. Families are supposed to support the decision but can still override it if they disagree. We aimed to learn more about this changed role when families were approached about organ donation. MethodsA qualitative study using semi-structured interviews with families, feedback from nurses, comparisons with audit data, and public involvement. We used framework analysis with a health systems perspective and utilitarian theory to explore if the law worked. Findings103 participants were interviewed representing 83 potential donation cases. In 31/83 (37%) cases donation was fully supported, in 41/83 (49%) cases families supported retrieval of some organs, tissues and procedures, and in 11/83 (13%) cases families declined completely. Themes explaining why the law was not (yet) working included: Understanding and agreeing the family’s role, confusion about deemed consent, not supporting the deceased expressed decisions, organ donation as too much of a harm, the different experiences of donation pathways, transition from end-of-life to organ donation discussions, experiences of ‘consent’, paperwork and processes. Families frequently questioned if their relative wanted to have a surgery rather than supporting the person who died to save lives. ConclusionFamilies use the unique experience of their relative dying in intensive care to create alternate narratives whereby the outcome satisfies their own utility and not necessarily those of the potential donor. New public ongoing media campaigns crafted to be more supportive of organ donation as a benefit to transplant recipients could help families overcome the many difficulties they encounter at the bedside. Implications for clinical practiceThe soft opt-out policy has not empowered nurses to help families at their most vulnerable to increase their support for and consent to deceased organ donation.

Outcome-Orientated Organ Allocation-A Composite Risk Model for Pancreas Graft Evaluation and Acceptance.

Background: Pancreas transplantation (PTX) remains the most effective treatment to prevent long-term complications and provide consistent euglycemia in patients with endocrine pancreatic insufficiency, mainly in type I diabetic patients. Considering early graft loss (EGL) and the perioperative complication rate, an optimal risk stratification based on donor risk factors is paramount. Methods: In our single-center study, we retrospectively assessed the risk factors for EGL and reduced graft survival in 97 PTXs (82 simultaneous pancreas and kidney [SPK], 11 pancreases transplanted after kidney [PAK] and 4 pancreases transplanted alone [PTA]) between 2010 and 2021. By statistically analyzing the incorporation of different donor risk factors using the Kaplan-Meier method and a log-rank test, we introduced a composite risk model for the evaluation of offered pancreas grafts. Results: The overall EGL rate was 6.5%. In the univariate analysis of donor characteristics, age > 45 years, BMI > 25 kg/m2, lipase > 60 U/L, cerebrovascular accident (CVA) as the cause of death, mechanical cardiopulmonary resuscitation (mCPR), cold ischemia time (CIT) > 600 min and retrieval by another center were identified as potential risk factors; however, they lacked statistical significance. In a multivariate model, age > 45 years (HR 2.05, p = 0.355), BMI > 25 kg/m2 (HR 3.18, p = 0.051), lipase > 60 U/L (HR 2.32, p = 0.148), mCPR (HR 8.62, p < 0.0001) and CIT > 600 min (HR 1.89, p = 0.142) had the greatest impact on pancreas graft survival. We subsumed these factors in a composite risk model. The combination of three risk factors increased the rate of EGL significantly (p = 0.003). Comparing the pancreas graft survival curves for ≥3 risk factors to <3 risk factors in a Kaplan-Meier model revealed significant inferiority in the pancreas graft survival rate (p = 0.029). Conclusions: When evaluating a potential donor organ, grafts with a combination of three or more risk factors should only be accepted after careful consideration to reduce the risk of EGL and to significantly improve outcomes after PTX.

Education in the National Transplant Law as an ethical pathway for the construction of the health care value in Colombia

The national transplant law in Colombia, Law 1805 of 2016, modified the Colombian legislation regarding how a person accesses an organ transplant, but above all, it changed the donor figure, establishing the term derived from the presumptive consent right. This term implies a person’s hypothetical willingness to be an organ donor as a manifestation of solidarity and charity towards another person in a situation of need and vulnerability concerning his/her health and the dimensions that define it. In the following text, seven moments are considered fundamental facts when constructing a culture about the value of healthcare in the national transplant policy in Colombia.

Identification of HIV infection in two solid organ recipients three years after transplantation

Routine screening of organ donors to detect human immunodeficiency virus (HIV) infection has detected the rare transmission of the virus through organ transplantation. However, despite routine screening, HIV transmission remains a risk in organ transplantation since, unlike tissues, solid organs cannot be processed, disinfected, or modified to inactivate infectious pathogens. A case of possible transmission of HIV by organ transplant is described below, from a previously seronegative donor to two recipients.

Organ Markets, Options, and an Over-Inclusiveness Objection: On Rippon's Argument.

Human organs available for transplant are in short supply. One way to increase the supply of organs consists in legalizing a live donor market. Such a market is, however, controversial. This article is about an objection to live donor organ markets made by Simon Rippon. Rippon's objection is that the presence of a market option creates new social and legal pressures that harm the poor. Legalizing the option of selling your organs transforms into a harmful, and morally indefensible, social, and legal pressure to sell on the financially desperate. This article defends the conclusion that Rippon's argument fails as an objection to live donor organ markets. It fails because it has implausibly expansive implications about which markets are morally problematic. In short, Rippon's argument proves too much. Sections one and two introduce Rippon's argument. Sections three and four contain the argument against Rippon. The main argumentative move is that the features of an organ market that, according to Rippon, justify a ban on such a market are features that also characterize several other markets that are normally considered unproblematic, for example, markets where individuals sell their labour abroad in jobs that are dangerous. So, if an organ market should be legally impermissible, so should these labour markets. Section five considers several objections to the argument against Rippon. It is argued that these objections fail. Section six is a conclusion that sums up the findings of the article.

Ontogeny of Hepatic Organic Cation Transporter-1 in Rat and Human.

The organic cation transporter (OCT)-1 mediates hepatic uptake of cationic endogenous compounds and xenobiotics. To date, limited information exists on how Oct1/OCT1 functionally develops with age in rat and human livers and how this would affect the pharmacokinetics of OCT substrates in children or juvenile animals. The functional ontogeny of rOct/hOCT was profiled in suspended rat (2-57 days old) and human hepatocytes (pediatric liver tissue donors: age 2-12 months) by determining uptake clearance of 4-[4-(dimethylamino)styryl]-N-methylpyridinium iodide (ASP+) as a known rOct/hOCT probe substrate. mRNA expression was determined in rat liver tissue corresponding to rat ages used in the functional studies, while hOCT1 mRNA expressions were determined in the same hepatocyte batches as those used for uptake studies. Maturation of rOct/hOCT activity and expression were evaluated by comparing values obtained at the various ages to the adult values. Relative to adult values (at 8 weeks), ASP+ uptake clearance in suspended rat hepatocytes aged 0, 1, 2, 3, 4, 5, and 6 weeks reached 26%, 29%, 33%, 37%, 72%, 63%, and 71%, respectively. Hepatic Oct1 mRNA expression was consistent with Oct activity (correlation coefficient of 0.92). In human hepatocytes, OCT1 activity was age dependent and also correlated with mRNA levels (correlation coefficient of 0.88). These data show that Oct1/OCT1 activities and expression mature gradually in rat/human liver, thereby mirroring the expression pattern of organic anion transporting polypeptide in rat. These high-resolution transporter ontogeny profiles will allow for more accurate prediction of the pharmacokinetics of OCT1/Oct1 substrates in pediatric populations and juvenile animals. SIGNIFICANCE STATEMENT: Organic cation transporter-1 (OCT1) represents a major drug uptake transporter in human liver. This study provides high-resolution data regarding the age-dependent function of OCT1 in the liver, based on in vitro experiments with rat and human hepatocytes obtained from donors between birth and adulthood. These ontogeny profiles will inform improved age-specific physiologically based pharmacokinetic models for OCT1 drug substrates in neonates, infants, children, and adults.

Knowledge and Attitude Toward Organ Donation and Transplantation Among the Adult Population in Bisha, Saudi Arabia

Background and ObjectiveOrgan donation is a procedure in which an organ is surgically removed from a human to be transplanted into another. The need for organ transplantation is increasing with time, and thus, the gap in the awareness of organ donors about the process must be recognized. This study aims to raise awareness and perceptions regarding organ donation and transplantation among the adult population. MethodsBetween May 2021 and April 2022, we conducted an analytical cross-sectional study involving residents of Bisha. We used a vetted, well-structured questionnaire distributed on media for data collection. We gathered sociodemographic data from the participants and evaluated their awareness and perspective on organ donation. ResultsA total of 417 responses were recorded, and out of them, 65.7% had an average to good level of knowledge about organ donation, and 69.8% were shown to have a positive attitude toward organ donation. Mass media, comprising television, newspapers, magazines, and radio, accounted for the primary information source, constituting 29%. Participants who were willing to donate chose "to save someone's life" and "out of compassion and sympathy" as reasons for donation 71.7%. Meanwhile, those who disagreed to donate were hesitant due to the fear of health complications 56.6%. ConclusionsThe level of awareness and willingness to donate are correlated, especially regarding knowledge regarding the procedure outcomes from the donor side. So, improving the knowledge and attitude is crucial to face the shortage and increasing organ donation and transplantation demands.

A scoping review of nonmedical barriers to living donor liver transplant.

This study aims to identify and categorize nonmedical barriers encountered by recipients, donors, and health care providers in the context of living donor liver transplantation (LDLT). Liver transplantation is vital for individuals with liver failure, yet high mortality rates on the transplant waitlist persist. LDLT was introduced to address deceased donor organ shortages; however, its adoption varies widely across regions, prompting the need to explore barriers hindering its implementation. The scoping review employed inclusion and exclusion criteria to identify studies focusing on nonmedical barriers to LDLT in both adult and pediatric populations. Qualitative, quantitative, and mixed-method studies were considered, covering the period from January 2005 to February 2023. The review's search strategy was conducted in the Ovid MEDLINE and Ovid EMBASE databases. Studies meeting the criteria were assessed for their characteristics and findings, which were synthesized into recipient, donor, and provider-level barriers. Among 2394 initially screened articles, 17 studies were eligible for inclusion. Recipient-level barriers encompassed systemic disparities in access, limited social support, immigration status, and inadequate awareness of LDLT. Donor-level barriers involved surgery-related risks, recovery time concerns, financial burdens, and religious beliefs. Provider-level barriers highlighted institutional support inadequacies and specialized surgeon shortages. The scoping review underscores nonmedical barriers to LDLT across recipient, donor, and provider levels. These barriers include socioeconomic disparities, information gaps, and inadequate institutional support. The findings underscore the need for comprehensive national efforts to raise awareness about LDLT and provide essential financial support.

Mitigating Cold Ischemic Injury: HTK, UW and IGL-2 Solution's Role in Enhancing Antioxidant Defence and Reducing Inflammation in Steatotic Livers.

Liver transplantation remains the only definitive treatment for end-stage liver diseases. However, the increasing prevalence of fatty liver disease among potential donors exacerbates the shortage of suitable organs. This study evaluates the efficacy of the preservation solution Institut Georges Lopez-2 (IGL-2) compared to Histidine-Tryptophan-Ketoglutarate (HTK) and University of Wisconsin (UW) preservation solutions in mitigating ischemia-reperfusion injury (IRI) in steatotic livers. Using Zucker Obese rat livers, we assessed the impact of 24-h static cold storage (SCS) with each solution on transaminase release, glutathione redox balance, antioxidant enzyme activity, lipoperoxidation, and inflammation markers. IGL-2 and UW solutions demonstrated reduced transaminase and lactate levels compared to HTK, indicating better preservation of liver integrity. IGL-2 maintained a higher reduced glutathione/oxidized glutathione (GSH/GSSG) ratio, suggesting more effective management of oxidative stress. Antioxidant enzyme activities catalase, superoxide dismutase, and glutathione peroxidase (CAT, SOD, GPX) were higher in IGL-2 preserved livers, contributing to decreased oxidative damage. Lipid peroxidation markers and inflammatory markers were lower in IGL-2 than in HTK, indicating reduced oxidative stress and inflammation. Additionally, improved mitochondrial function was observed in the IGL-2 group, correlating with reduced reactive oxygen species (ROS) production and lipid peroxidation. These findings suggest that IGL-2 offers superior preservation of liver viability, reduces oxidative stress, and minimizes inflammation compared to HTK and UW solutions. By maintaining a higher ratio of reduced glutathione and antioxidant enzyme activity, IGL-2 effectively mitigates the harmful effects of ischemia-reperfusion injury. The reduced lipid peroxidation and inflammation in the IGL-2 group further underscore its potential in improving liver transplant outcomes. These results highlight the importance of optimizing preservation solutions to enhance the viability and functionality of donor organs, potentially expanding the donor pool and improving the success rates of liver transplantation. Future research should focus on refining preservation techniques and exploring additional protective agents to further improve organ preservation and transplant outcomes.

A Survey of United States Transplant Center Donation After Circulatory Death Kidney Transplant Practices in the Modern Era

IntroductionThe mismatch between the number of patients awaiting kidney transplantation and the supply of donor organs has in part resulted in a rise in kidney transplantation from donors after circulatory death (DCD). Persistently long waiting times have led the transplant community to continue to explore the use of expanded criteria DCD kidneys. In parallel, advances in organ preservation strategies have contributed to an overall increase in DCD organ transplantation and are altering the transplant landscape. Some of these techniques may improve kidney allograft outcomes and affect how DCD kidneys are utilized. We aimed to better understand practices in accepting DCD kidney offers in the modern era. MethodsDirectors of 196 U.S. kidney transplant centers were emailed a link to an online survey over a 5-week period. Results48 (13%) out of the 364 directors responded with all UNOS regions represented. Definitions of warm ischemia time (WIT) used in DCD kidney evaluation varied widely amongst respondents. The maximum total WIT limit varied with 19 (39.6%) less than 60 minutes responses, followed by 16 (33%) less than 90 minutes responses, and 10 (20.8%) less than 120 minutes responses. ConclusionDespite increasing DCD kidney transplantation volumes in the U.S. there are no standardized procurement biopsy practices, OPO pre-operative protocols, or consensus definition or limits of WIT. Agreement upon terminology may facilitate rapid clinical communication, efficiency of organ allocation and utilization, recording of data, research, and improvements in policy.

The Different Policies and Legal Frameworks Governing Organ Donation and its Impact and Outcome

The awareness about organ donation is more important during this period because it is a life saving measure for many dying people who requires organs for their survival . The study's aim was to estimate Chennai student’s level of awareness of organ donation. Methods: It is an empirical cross-sectional study, and a convenience sample of 231 people were established. To gather information, semistructured questionnaires were used. SPSS software was used to examine the data. With the cooperation of all the stakeholders, including the media, medical professionals, and religious authorities, an efficient campaign must be launched to provide people with pertinent information