Transplant Facilities Research Articles

PCN52 - Hematopoietic Cell Transplantation Facilities: Geographic Access in Colombia

PCN52 - Hematopoietic Cell Transplantation Facilities: Geographic Access in Colombia

Realizing Equity in Organ Donation and Transplantation in a Society of Immense Multicultural and Socioeconomic Diversity, a Report from Qatar

Introduction Qatar is a small prosperous gulf country with vast oil and gas resources that made it one of the largest GDP per capita worldwide, it is populated by 2.6 million including 12% indigenous population and 88% expatriate workers mostly from South East Asia and the Middle East. The inability to meet transplant needs safely and effectively within Qatar prompted the development of the Doha Donation Accord (DDA) in 2009. The DDA is an ethical framework developed in conjunction with the Declaration of Istanbul Custodian Group to increase organ donation and combat transplant commercialism. Methods The DDA and the evolved strategies (the Doha Model of organ donation) are distinguished by equity of access to dialysis, living donation program, donor registry, waiting list, deceased donor organs and the free transplantation facilities regardless of the nationality, religion or financial status. Results Current statistics revealed that The National Donor Registry, has more than 100 nationalities totaling 179,000 registrants including 4.25 % citizens. More than 50% (418/790) of all patients on maintenance dialysis are noncitizen residents of Qatar. Similarly, deceased donation transplant activity from 2011 to 2017 shows that the kidney transplant waiting list include 38%(27/71) citizens and 62%(44/71) non citizens residents, and those who received deceased donors' kidneys are 80.5%(33/41) noncitizen residents Vs. 19.5% (8/41) citizens, similarly for the liver transplant waiting list 95%(19/20) non citizen residents and 5%(1/20) citizens, those who received deceased donor livers were 5.8%(1/17)citizens and 94.2%(16/17) noncitizen residents. As compared to 2009 the living kidney donation increased 20 folds and deceased donation 8 folds.the active kidney waiting list dropped between 3-9% every year, and the commercial kidney transplantation abroad dropped by 65%. Thus, commercial transplantation abroad has largely been replaced by ethically approved living-donor or deceased-donor organ transplantation in Qatar. Conclusion The respect of dignity and equity and the resultant improvement in organ donation and transplantation in Qatar, demonstrate that progress towards true self-sufficiency will be achieved where solidarity and trust are successfully fostered in a resident population. The Doha Model provides a comprehensive strategic framework underpinned by an ethos of inclusion that offers the best chance to unite a diverse society in pursuit of a common goal: meeting needs for transplantation together.

Assessment of Global Kidney Health Care Status

Kidney disease is a substantial worldwide clinical and public health problem, but information about available care is limited. To collect information on the current state of readiness, capacity, and competence for the delivery of kidney care across countries and regions of the world. Questionnaire survey administered from May to September 2016 by the International Society of Nephrology (ISN) to 130 ISN-affiliated countries with sampling of key stakeholders (national nephrology society leadership, policy makers, and patient organization representatives) identified by the country and regional nephrology leadership through the ISN. Core areas of country capacity and response for kidney care. Responses were received from 125 of 130 countries (96%), including 289 of 337 individuals (85.8%, with a median of 2 respondents [interquartile range, 1-3]), representing an estimated 93% (6.8 billion) of the world's population of 7.3 billion. There was wide variation in country readiness, capacity, and response in terms of service delivery, financing, workforce, information systems, and leadership and governance. Overall, 119 (95%), 95 (76%), and 94 (75%) countries had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. In contrast, 33 (94%), 16 (45%), and 12 (34%) countries in Africa had facilities for hemodialysis, peritoneal dialysis, and kidney transplantation, respectively. For chronic kidney disease (CKD) monitoring in primary care, serum creatinine with estimated glomerular filtration rate and proteinuria measurements were reported as always available in only 21 (18%) and 9 (8%) countries, respectively. Hemodialysis, peritoneal dialysis, and transplantation services were funded publicly and free at the point of care delivery in 50 (42%), 48 (51%), and 46 (49%) countries, respectively. The number of nephrologists was variable and was low (<10 per million population) in Africa, the Middle East, South Asia, and Oceania and South East Asia (OSEA) regions. Health information system (renal registry) availability was limited, particularly for acute kidney injury (8 countries [7%]) and nondialysis CKD (9 countries [8%]). International acute kidney injury and CKD guidelines were reportedly accessible in 52 (45%) and 62 (52%) countries, respectively. There was relatively low capacity for clinical studies in developing nations. This survey demonstrated significant interregional and intraregional variability in the current capacity for kidney care across the world, including important gaps in services and workforce. Assuming the responses accurately reflect the status of kidney care in the respondent countries, the findings may be useful to inform efforts to improve the quality of kidney care worldwide.

490 - Seventy Nine Miles, Two Sites and One Fact Accreditation: Integrating Effective Quality Management Between Two Affiliated but Physically Remote Hematopoietic Cellular Transplantation (HCT) Facilities

490 - Seventy Nine Miles, Two Sites and One Fact Accreditation: Integrating Effective Quality Management Between Two Affiliated but Physically Remote Hematopoietic Cellular Transplantation (HCT) Facilities

Involvement of Recipient Transplant Coordinators in Transplant Outpatient Clinics in Japan.

Transplant recipients require long-term immunosuppressive therapy, so continued medical follow-up is necessary for long-term survival. To investigate the current role of recipient transplant coordinators (RTCs) in the outpatient care of organ transplant recipients in Japan. We sent a questionnaire survey to doctors in transplant facilities affiliated with the Japan Society for Transplantation probing attitudes on the role of RTCs in outpatient clinics. The questionnaire assessed responses using an ordinal scale of 5 ranks. In total, 139 responses were obtained from 233 transplant facilities. Respondents were divided into 2 groups, doctors currently working with RTCs (group A) and doctors not currently working with RTCs (group B). Differences in response rates between groups were analyzed using the Mann-Whitney U test. The overall attendance rate of RTCs in outpatient clinics was only 45%. Of all items on transplant outpatient clinics, group A exhibited a significantly higher response rate of "strongly agree" for "The involvement of an RTC in outpatient work can be expected to help prevent complications in transplant patients" ( P < .01) and "The involvement of an RTC in outpatient work can be expected to help prevent or reduce drug-related side effects in transplant patients" ( P < .01). Those with the highest rate of "strongly agree" were "It is necessary for RTCs to provide outpatient follow-up for transplant patients alongside doctors" (82.1% vs 67.3%, P < .07). We suggest that Japanese RTCs must participate more frequently in posttransplant outpatient care.

Challenges of organ transplantation in Nigeria

Life is sacred and as such, all human beings crave to utilise all available means to sustain living. This is one desire that is pitched against the reality of human life, which is attached to the health conditions of human organs. Organ transplantation therefore, is a potential solution to achieve replacement of damaged human organs. However, this opportunity is not fully available in Nigeria due to the several constraints and challenges involved in such transplants. This paper therefore examines the challenges affecting Nigerians who wish to have a better chance of a quality healthy life with new organs. It found that the challenges of organ transplantation such as the need for regulation, lack of public awareness, high cost of transplantation and inadequate facilities in hospitals are all factors that hinder an efficient process of organ transplantation. These factors thus need to be resolved in order to make progress.

Upgradation and modernization of eye banking services: Integrating tradition with innovative policies and current best practices.

Purpose:The purpose of this study is to review the history and evolution of the National Eye Bank (NEB) and analyze the impact over the years and report the outcome of the invested resources.Methods:Review of archival material, records, project reports, policy and procedures' manuals, and publications was done. Descriptive and analytical processing of data obtained was undertaken. Parameters evaluated included total collection, transplantation, utilization rates of donor cornea, changing trends over time in terms of numbers and duration of recipients waiting, impactful research translated into changes in standard operating protocols, new facilities, and subsequent effects on numbers or quality assurance measures and overview of major achievements. Periodic situational analysis with contextual relevance and interpretation of outcomes was done pertaining to national goals and international standards.Results:The NEB and cornea services have played a key leadership role in furthering the development of eye banking and corneal transplantation services. The contribution extends beyond routine patient care to education, training, generation of resources, advocacy, and policymaking. In quantifiable terms, the overall performance has steadily increased over the years. Major contributions include training of doctors, eye bank staff and corneal surgeons, introduction of innovative techniques for corneal transplantation, setting of national standards for eye banking and provision of preservation media, customized corneal, and ocular surface cell replacement therapy in collaboration with other departments and institutes.Conclusion:The eye banking and corneal transplantation facilities have evolved with time providing quality services, modernized as appropriate with updated knowledge and incorporating technological advances supported by the systematic evidence-based approach.

Plasma Cell Leukaemia. Experience from Tertiary Referral Centres in Abu Dhabi

Plasma cell neoplasms range from an indolent disease (MGUS) to highly aggressive and relatively rare Plasma Cell Leukaemia (PCL). The diagnostic criteria for PCL is well established and includes plasmacytosis of greater than 20% of total white cell count or an absolute plasma cell count of greater than 2 X 109/L in peripheral blood. It is classified as either primary (pPCL) if there is no antecedent history of Multiple Myeloma (MM) or secondary (sPCL) arising as a leukemic event of MM. The median survival of PCL remains poor despite the use of novel agents and stem cell transplant. Here we report our experience with PCL.Method:Retrospective review of the medical records of patients with plasma cell dyscrasia identified through the tumour registry between January 2008 and March 2016. Eight patients were identified with diagnosis of PCL.Results:The median age was 53.5 years (range 34-77 years), male to female ratio was 5:3. There were four cases of sPCL while the other four patients had pPCL. The median time for transformation in sPCL was 199 weeks (range 163 to 244 weeks).All 4 patients with sPCL had received treatment with novel agents including bortezomib and IMIDS (lenalidomide/thalidomide) as part of their myeloma therapy. At the time of transformation two patients were unfit for any therapy while the other two patients were re-induced with bortezomib, lenalidomide and dexamethasone (RVd) with no response. None of the four patients had undergone autologous stem cell transplantation (due to unavailability of hematopoietic stem cell transplant facilities in UAE as well as socioeconomic reasons). The median survival after diagnosis of sPCL was 5.4 weeks (range 4-11 weeks).Patients with pPCL were treated with RVd (n=3) and VMP N=1. One patient also had an autologous stem cell transplant. Patients with primary PCL had a better median survival of 37 weeks (range 14 - 133 weeks) with one patient alive and under therapy 14 weeks after diagnosis.Conclusion:Plasma cell leukaemia remains a disease with extreme poor prognosis and an overall mortality of 88 per cent in our experience. Interestingly two patients with pPCL were noted to have evidence of plasma cell disorder (elevated total protein) a median of 8 months before the diagnosis of pPCL. Whether these two cases truly represent pPCL or 2ndry event because of under diagnosis of MM remains speculative at best. One of the above two patients also had a diagnosis of chronic myeloid leukaemia on Imatinib and was in a major molecular remission. Patients with primary plasma cell leukaemia tend to do relatively better as compared to secondary plasma cell leukaemia where the transformation is catastrophic with a very short median survival. The difference in survival between pPCL and sPCL is most likely because the sPCL has a more resistant disease due to previous treatment and clonal evolution of their disease.Second generation novel agents including carfizlomib and the monoclonal antibodies daratumomab and elotuzumab should be evaluated in the induction and maintenance strategy to improve the outcome of PCL. DisclosuresAlam:BMS: Consultancy, Honoraria; Biologix: Honoraria.

Study on energy conversion and storage system for a prototype buoys-array wave energy converter

Wave power in China has an energy density that is one-tenth of that of the wave power in Europe. Therefore, Chinese developers cannot simply replicate and transplant European devices and facilities to East Asia. Instead, to exploit the conditions in East Asia, a combined-oscillating-buoy-based wave energy convertor (WEC) is proposed as an array-type WEC. Sea trials of a 10kW pilot device confirmed the feasibility of its buoy array and hydraulic pressure system (HPS) for wave-energy conversion. Field test data indicated that the energy-converting efficiency of the direct-drive design was relatively low, suggesting the urgency of developing energy storage systems to the increase of power take-off productivity. A hydraulic accumulator system (HAS) was designed to replace the original direct-drive operating mechanism for a 100kW final-prototype device. It was expected that the system will exhibit an improved ability to collect and store energy from smaller waves to enhance the total converting efficiency. Experimental studies were performed to investigate the hydrodynamic characteristics of the heaving buoys under the damping effects, and the operating performance of the accumulator system. A numerical wave-to-wire model based on Simulink, Matlab was set-up to study the energy output of the HPS-HAS under the wave conditions of the test site. It was shown that four buoys could charge ten accumulators in half an hour under local actual sea conditions. Furthermore, in a same running time, the output energy of the HPS-HAS is over forty times larger than that of the HPS without any energy storage device. In addition, energy discharging from three accumulators only could reach about 20kW output power. The numbers of buoys and accumulators should be optimized to improve wave-energy storage and power generation in the future.

Acute hepatic failure with encephalopathy in children

Introduction: Hepatic encephalopathy is a serious and likely to be reversible neurophyschiatric state in the patient of liver failure. Acute hepatic failure is a life-threatening condition in children. Objectives: The study analyses the clinical spectrum, prognosis and factors determining the prognosis of children with acute hepatic failure and associated encephalopathy in a tertiary level hospital. Methodology: Thirty two children (18 males and 14 females) were presented with the diagnosis over a two year period. It is a Prospective study. Results: The commonest cause of acute hepatic failure was hepatitis A virus found in 30% of cases. Only 30% (9 out of 32) children could be survived, in which mostly came in hepatic encephalopathy Stage I and II. Hemorrhagic manifestations were significantly more (P=0.002) in died in contrast to survived. Conclusion: Hepatic failure is a condition associated with high mortality primarily in absence of hepatic transplantation facilities. Focus of efforts should be in providing preventive steps such as immunization and society education.

Treatment of Acute Liver Failure in Resource-Constrained Settings without Transplantation Facilities Can Be Improved.

Treatment of Acute Liver Failure in Resource-Constrained Settings without Transplantation Facilities Can Be Improved.

A guide to managing acute liver failure

Nearly 2,000 cases of acute liver failure occur each year in the United States. This disease carries a high mortality rate, and early recognition and transfer to a tertiary medical care center with transplant facilities is critical. This article reviews the definition, epidemiology, etiology, and management of acute liver failure.

State of deceased donor transplantation in India: A model for developing countries around the world.

Renal replacement therapy (RRT) resources are scarce in India, with wide urban-rural and interstate disparities. The burden of end-stage renal disease is expected to increase further due to increasing prevalence of risk factors like diabetes mellitus. Renal transplantation, the best RRT modality, is increasing in popularity, due to improvements made in public education, the deceased donor transplantation (DDT) programme and the availability of free and affordable transplant services in government hospitals and certain non-governmental philanthropic organizations. There are about 120000 haemodialysis patients and 10000 chronic peritoneal dialysis patients in India, the majority of them waiting for a donor kidney. Shortage of organs, lack of transplant facilities and high cost of transplant in private facilities are major barriers for renal transplantation in India. The DDT rate in India is now 0.34 per million population, among the lowest in the world. Infrastructural development in its infancy and road traffic rules not being strictly implemented by the authorities, have led to road traffic accidents being very common in urban and rural India. Many patients are declared brain dead on arrival and can serve as potential organ donors. The DDT programme in the state of Tamil Nadu has met with considerable success and has brought down the incidence of organ trade. Government hospitals in Tamil Nadu, with a population of 72 million, provide free transplantation facilities for the underprivileged. Public private partnership has played an important role in improving organ procurement rates, with the help of trained transplant coordinators in government hospitals. The DDT programmes in the southern states of India (Tamil Nadu, Kerala, Pondicherry) are advancing rapidly with mutual sharing due to public private partnership providing vital organs to needy patients. Various health insurance programmes rolled out by the governments in the southern states are effective in alleviating financial burden for the transplantation. Post-transplant immunological and pathological surveillance of recipients remains a challenge due to the scarcity of infrastructure and other facilities.

Warren shunt - significance in present time, an experience at tertiary care hospital in India

Background: Portal hypertension is the presence of portal venous pressure more than 10 mm Hg. Surgery was the only treatment available for portal hypertension in the earlier times and the mortality rates were very high. In present times, about 10-15% of patients require surgery. Here we study the significance of the distal splenorenal shunt (Dean Warren shunt). Methods: We studied a total of 45 patients of portal hypertension admitted at SSKM Hospital, IPGMER, Kolkata, over a period of 5 years. This study includes the patients, ranging in age from 5 to 20 years and comprising of 5 women and 40 men. All patients were having non cirrhotic extra-hepatic portal. Results: All of the patients survived postoperatively and are in follow-up without any complication and doing well. Conclusions: Warren’s shunt is a good alternative of liver transplantation, especially for the developing countries where the facilities for liver transplantation and post-operative care are not available or good enough. It has very good results and low complication rates.

Epidemiology and Clinical Features of Adults Myelodysplastic Syndromes in Algeria: A Population-Based Study. Review of the Algerian Myelodysplastic Syndromes Study Group

BACKGROUND: In Algeria, the incidence of hematologic malignancies has been difficult to estimate for many years and MDS incidence is unclear because of historical lack of population-based registration and possibly because of under diagnosis. Today, many hematological centers, including 17 university hospitals, have been developed in the entire north and have useful epidemiological data pertinent to MDS. We studied the incidence of MDS and its subtypes, age distribution, geographic distribution and trends in the rate of diagnosis over the last 5 years in Algeria.DESIGN AND SETTING: Retrospective analysis of nationwide survey of all adult cases of MDS (>16 years) diagnosed between January 2010 and 31 December 2014.PATIENTS AND METHODS: Patients diagnosed with MDS and referred to all departments of hematology at the 17 participating centers between 2010-2014 were identified. Complete demographic and clinical data, laboratory results, treatment modalities were collected and analyzed.RESULTS: Between 2010 and 2014, a total of 243 patients with newly diagnosed MDS have been identified. The sex ratio (M/F) is: 1:08, and the median age is 64.3 years (16 - 82 years). Globally, 27% of MDS are diagnosed in the whole Western region of the country, 56% in the Centre, 14% in the East and 3% in the south. The crude mean annual incidence rate of MDS was 0.07 per 100,000 inhabitants aged ≥15 years old. 11.2% patients were less than 45 years and 42% were older than 70 years.4.3% patients were from rural areas and 6, 2 % were cigarette smokers.Mean hemoglobin level was 7.8 g/dl, mean WBC level was 6134/µl, mean platelets level was 134907/µl, mean VGM level was 92.7 fl and mean ferretin level was 739.31 ng/ml. The mean blood transfusion units were 13.5 units. 36.3% patients had RCMD, 15.9% had RAEB2 and 13.2% had RAEB1. 34.4% patients had cytogenetic abnormalities, and del-5q was more commonly encountered in 22.7%. The IPSS-R was very low in 18.3%, low in 18.3%, intermediate in 11.8%, high in 7.5% and non-specified in 36.6%. Treatment regimens were supportive care (transfusion RBC with chelation, and platelets) and growth factors (EPO, Romiplostine, and G-CSF). At the date of end point, 44% of patients were alive, 26% were death and 31% were lost of follow up.CONCLUSION: Epidemiologic features of our patients are different from the occidental ones. Mean age of presentation of MDS in Algeria is lower than developed countries. The relatively younger age of patients compared to the Western countries may be due to the demographic composition of our population. The annual incidence is still low, but a continuously increasing incidence rate of MDS has been observed throughout the study period and an overall increase in the number of MDS patients diagnosed nationwide over the last five years indicates a need for additional health care resources including curative and therapy-intense strategies, such as stem cell transplant facilities to optimize outcome. Refractory anemia was the most common subtype in both FAB and WHO classification systems and in both genders. The best supportive care was used in all patients in first line treatment and the Iron overload is a permanent feature of MDS. DisclosuresNo relevant conflicts of interest to declare.

High frequency and poor prognosis of late childhood BCR-ABL-positive and MLL-AF4-positive ALL define the need for advanced molecular diagnostics and improved therapeutic strategies in pediatric B-ALL in Pakistan.

Fusion oncogenes (FOs) resulting from chromosomal abnormalities have an important role in leukemogenesis in pediatric B cell acute lymphoblastic leukemia (ALL). The most common FOs are BCR-ABL, MLL-AF4, ETV6-RUNX1, and TCF3-PBX1, all of which have important prognostic and drug selection implications. Moreover, frequencies of FOs have ethnic variations. We studied Pakistani frequencies of FOs, clinical pattern, and outcome in pediatric B-ALL. FOs were studied in 188 patients at diagnosis using reverse transcriptase-polymerase chain reaction (RT-PCR) and interphase fluorescent in situ hybridization (FISH). Data were analyzed using SPSS version 17 (SPSS Inc., Chicago, IL, USA). FOs were detected in 87.2% of patients. Mean overall survival was 70.9weeks, 3-year survival was 31.9%, and 3-year relapse-free survival was 18.1%. Four patients died of drug toxicities. ETV6-RUNX1 (19.14%) had better survival (110.9weeks; p=0.03); TCF3-PBX1 (2.1%) was associated with inferior outcome and higher central nervous system (CNS) relapse risk; MLL-AF4 (18.1%) was more common in the 8- to 15-year age group (24/34; p=0.001) and was associated with organomegaly, low platelet count, and poor survival; and BCR-ABL (47.9%) was associated with older age (7-15years, 52/90), lower remission rates, shorter survival (43.73±4.24weeks) and higher white blood cell count. Overall, MLL-AF4 and BCR-ABL were detected in 66% of B-ALL, presented in later childhood, and were associated with poor prognosis and inferior survival. This study reports the highest ethnic frequency of BCR-ABL FO in pediatric ALL, and is consistent with previous reports from our region. Poor prognosis BCR-ABL and MLL-AF4 was detected in two-thirds of pediatric B-ALL and is likely to be the reason for the already reported poor survival of childhood ALL in South-East Asia. Furthermore, MLL-AF4, usually most common in infants, presented in later childhood in most of the ALL patients, which was one of the unique findings in our study. The results presented here highlight the need for mandatory inclusion of molecular testing for pediatric ALL patients in clinical decision making, together with the incorporation of tyrosine kinase inhibitors, as well as hematopoietic stem cell transplantation facilities, to improve treatment outcome for patients in developing countries.

PRIMARY RESISTANT COURSE AND RECURRENCE OF THE HODGKIN,S LYMPHOMA. PREVENTABLE LOSSES AT “MOST RECOVERABLE” HEMOBLASTOSIS

Not like most malignant tumors, with Hodgkin,s lymphoma (HL) the possibility of curing remains at patients, which tumors did not respond to the 1st line therapy (primary resistance or disease recurrence). Nowadays the standard method of treatment of these patients is the high-dose chemotherapy with transplantation of autologous cells of hemopoiesis precursors ( Т CHP). Anyway, in the RF this treatment method is used much less often than in developed world countries, what is stipulated by the deficit of available transplantation facilities. The impossibility of TCHP administration to all patients, who need it, has a negative impact on the total effectiveness of the HL treatment, requiring to look for factors, allowing to optimize the selection of patients for TCHP. Anyway, the analysis of results of foreign and national research shows, that the only factor, allowing to adequately select patients for TCHP, is the tumor response for the induction therapy (patients off remission should not receive TCHP). Other factors (treatment option, 2nd line therapy in the anamnesis) are not reliable enough to make decision to refuse to perform TCHP. So, all patients, obtaining remission due to the induction therapy, should be considered as candidates for TCHP, and the only method to prevent the peril of patients with recurrences and primary resistant HL course in the RF is the increase of the transplantation activity (number of transplantation centers).

RENAL FUNCTION REPLACEMENT SERVICES IN ROMANIA

Chronic renal failure consists of the progressive, slow loss of the kidney function over several years, as a long-term chronic condition affecting effective kidney functioning. In Romania, nephrology medical care is given in outpatient facilities, nephrology facilities with beds, dialysis facilities (haemo- and peritoneal dialysis) and renal transplant facilities. In 2007 – 2012, the period under study, the number of incident renal replacement therapy patients doubled in Romania, whereas their median age range increased by 4.5 years while area coverage with this type of medical service unfortunately remained poor. Keywords: Chronic renal failure, dialysis, transplant, market share, dialysis centres Normal 0 21 false false false RO X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi; mso-fareast-language:EN-US;}

The Use of Forest Restoration Techniques in the Restoration of Coral Reefs

Coral gardening is a tool useful in restoring coral reefs and is comparable to silviculture through source material, location, type, choice of species and outcome (Table 1). For both trees and corals, resource requirements are similar and include inorganic substances, light, and space [2]. Key criteria for both forest and coral reef restoration include promotion of asexual and sexual reproduction, allowing restored systems to maintain themselves. Asexual culture of corals has great potential in reef restoration in a similar way to how silviculture in land-based nurseries supports forest reforestation projects [3]. For forests, ramets, seeds, and seedlings are used; for reefs, ramets, nubbins, planulae, larvae, and spat are forms of source material. Locations for forest restoration projects are often located in degraded forest areas or on plantations; for reefs, coral nurseries are constructed on or adjacent to degraded reefs or established in land-based aquaculture facilities for later transplantation. Tree species are collected from mono-culture or mixed species plantations as well as natural forests and coral species are collected from marine culture of local key coral species [1].

Securing transplantation medicine. Duties of the German Foundation for Organ Transplantation (DSO)

Due to a lack of confidence, the organ transplantation system in Germany is currently in a crisis. This was triggered by waiting list manipulations at four transplant centers in 2012, which led to a public debate that continues to this day and a dramatic decline in the number of post-mortem organ donations. This problem affects the 11,000 critically ill patients on the waiting list who are in urgent need of a post-mortem organ donation for their own survival. Also affected are transplantation medicine physicians and facilities whose work in organ donations is severely influenced by the resurgent discussion of brain death diagnosis and the medical and ethical criteria for the allocation of organs. Despite extensive documentation of donor/organ data, receiver data, and functional data, the necessary transparency to assess and represent the quality of transplantation medicine in Germany is not available due to systematic segregation of the information by the databases. Therefore, the joint efforts of all stakeholders are required to restore confidence in a transparent high-quality organ donation and transplantation process based on a transplant registry.