Transplantation Process Research Articles

Depressive Symptoms at Kidney Transplant Evaluation and Access to the Kidney Transplant Waitlist

IntroductionDepressive symptoms, even without a clinical diagnosis of depression, are common in kidney failure patients and may be a barrier to completing the complex process of kidney transplant (KT) evaluation. We assessed depressive symptom burden and association between depressive symptoms and access to KT waitlist by age.MethodsIn a prospective cohort of 3728 KT patients (aged 18–88 years), the Center for Epidemiologic Studies—Depression (CES-D) scale was used to measure depressive symptoms at evaluation. Depressive symptom severity was defined as follows: none: 0; minimal: 1 to 15; mild: 16 to 20; moderate: 21 to 25; severe: 26 to 60. Hazard ratios (HRs) of active listing within 1 year after evaluation were estimated using Cox proportional hazards models, adjusted for clinical and social factors.ResultsAt evaluation, 85.8% of the patients reported at least minimal depressive symptoms; the proportion was lower among older patients: 18 to 29 years = 92.0%; 30 to 39 years = 88.3%; 40 to 49 years = 87.2%; 50 to 59 years = 87.0%; 60 to 69 years = 83.4%; and ≥70 years = 82.0%. Chance of active listing decreased with more severe depressive symptoms (log-rank, P < 0.001). After adjustment, every 5-point higher CES-D score (more depressive symptoms) was associated with a 13% lower chance of listing (HR = 0.87, 95% CI: 0.85–0.90); the strongest association was found among patients aged ≥70 years (adjusted HR [aHR] = 0.73, 95% CI: 0.62–0.86). Furthermore, minimal (HR = 0.69, 95% CI: 0.60–0.79), mild (HR = 0.57, 95% CI: 0.44–0.72), moderate (HR = 0.53, 95% CI: 0.39–0.71), and severe (HR = 0.44, 95% CI: 0.34–0.57) depressive symptoms were all associated with a lower chance of listing.ConclusionOlder candidates were less likely to report depressive symptoms at KT evaluation. Regardless of age, candidates who did report depressive symptoms, and even minimal symptoms, had a lower chance of listing. Transplant centers should routinely screen patients for depressive symptoms and refer the affected patients to mental health services to improve access to KT.

Design and Optimization of a Boat-Bottom-Shaped Transplanting Device for Sweet Potato (Ipomoea batatas) with Low Seedling Damage Rate

A transplanting manipulator and a transplanting conveyance device were devised to address the problems with current sweet potato transplanters, which cannot properly finish boat-bottom-shaped transplanting and have a high seedling damage rate. The ground wheel transmits power to the two devices in a specific transmission ratio to ensure their synchronous movement and avoid accumulated deviations. We selected the transplanting manipulator’s parameter combination that satisfies the optimal transplanting trajectory by the VB program. To avoid damage to the seedlings during clamping, the clamping force is only provided by the spring through the structural design. Combined with the agronomic requirements of boat-bottom-shaped transplanting and the characteristics of soil resistance during the transplanting process, the transplanting depth and crank rotation speed were selected as test factors. The qualified rates of node depth in the seedling middle (QRNDSM), the qualified rates of seedling root depth (QRSRD), and the qualified rates of stalk length into the soil (QRSLS) were established, and Design-Expert was used for the quadratic regression and orthogonal combination tests to optimize the factors. The results of the verification tests reveal that when the transplanting depth is in the range of 45.56 to 58.26 mm and the crank rotation speed is in the range of 39.39 to 43.45 rpm, the maximum QRNDSM is 94.91%, the maximum QRSRD is 95.42%, and the maximum QRSLS is 94.93%, which satisfies the industry standards. Research into sweet potato transplanting can benefit from this work, especially in the direction of sweet potato boat-bottom-shaped transplanting.

Organ Transplantation Preparations During the COVID-19 Pandemic.

The COVID-19 pandemic has led to a decrease in organ donation rates and the temporary mandatory closure of transplantation centers. The suspension or restriction of organ transplantation operations during the pandemic has led to adverse situations affecting patients waiting for organs, and complicating the care of recipients. In Turkey, as throughout the world, the allocation of the majority of intensive care beds to COVID-19 patients has caused a significant decrease in the number of cadaver donors. In the light of current information, very little is known about the spread of COVID-19, the biological behavior, pathogenesis, and long-term morbidity. Therefore, organ donors who have tested positive for COVID-19 may cause negative outcomes, not only for the recipient, but also for the transplantation team, the organ supply organization, and the hospital personnel. When all these points are taken into consideration, it is recommended that COVID-19-positive patients should not be organ donors. Nurses working at several stages of the organ transplantation process should be aware of this. When the necessary collaboration with nurses is achieved, the organ transplantation process will be successful. This paper can be considered to shed light on unknown aspects of the COVID-19 pandemic and to contribute to nursing training.

A Population Health Approach to Transplant Access: Challenging the Status Quo

Transplant referral and evaluation are critical steps to waitlisting yet remain an elusive part of the transplant process. Despite calls for more data collection on pre-waitlisting steps, there are currently no national surveillance data to aid in understanding the causes and potential solutions for the extreme variation in access to transplantation. As population health scientists, epidemiologists, clinicians, and ethicists we submit that the transplant community has an obligation to better understand disparities in transplant access as a first necessary step to effectively mitigating these inequities. Our position is grounded in a population health approach, consistent with several new overarching national policy and quality initiatives. The purpose of this Perspective is to (1) provide an overview of how a population health approach should inform current multisystem policies impacting kidney transplantation and demonstrate how these efforts could be enhanced with national data collection on pre-waitlisting steps; (2) demonstrate the feasibility and concrete next steps for pre-waitlisting data collection; and (3) identify potential opportunities to use these data to implement effective population-level interventions, policies, and quality measures to improve equity in access to kidney transplantation.

Fresh and cryopreserved ovarian tissue transplantation for preserving reproductive and endocrine function: a systematic review and individual patient data meta-analysis.

Ovarian tissue cryopreservation involves freezing and storing of surgically retrieved ovarian tissue in liquid or vapour nitrogen below -190°C. The tissue can be thawed and transplanted back with the aim of restoring fertility or ovarian endocrine function. The techniques for human ovarian tissue freezing and transplantation have evolved over the last 20 years, particularly in the context of fertility preservation in pre-pubertal cancer patients. Fresh ovarian tissue transplantation, using an autograft or donor tissue, is a more recent development; it has the potential to preserve fertility and hormonal function in women who have their ovaries removed for benign gynaecological conditions. The techniques of ovarian tissue cryopreservation and transplantation have progressed rapidly since inception; however, the evidence on the success of this intervention is largely based on case reports and case series. The aim of this study was to systematically review the current evidence by incorporating study-level and individual patient-level meta-analyses of women who received ovarian transplants, including frozen-thawed transplant, fresh or donor graft. The review protocol was registered with PROSPERO (CRD42018115233). A comprehensive literature search was performed using MEDLINE, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials from database inception to October 2020. Authors were also contacted for individual patient data if relevant outcomes were not reported in the published manuscripts. Meta-analysis was performed using inverse-variance weighting to calculate summary estimates using a fixed-effects model. The review included 87 studies (735 women). Twenty studies reported on ≥5 cases of ovarian transplants and were included in the meta-analysis (568 women). Fertility outcomes included pregnancy, live birth and miscarriage rates, and endocrine outcomes included oestrogen, FSH and LH levels. The pooled rates were 37% (95% CI: 32-43%) for pregnancy, 28% (95% CI: 24-34%) for live birth and 37% (95% CI: 30-46%) for miscarriage following frozen ovarian tissue transplantation. Pooled mean for pre-transplant oestrogen was 101.6 pmol/l (95% CI: 47.9-155.3), which increased post-transplant to 522.4 pmol/l (95% CI: 315.4-729; mean difference: 228.24; 95% CI: 180.5-276). Pooled mean of pre-transplant FSH was 66.4 IU/l (95% CI: 52.8-84), which decreased post-transplant to 14.1 IU/l (95% CI: 10.9-17.3; mean difference 61.8; 95% CI: 57-66.6). The median time to return of FSH to a value <25 IU/l was 19 weeks (interquartile range: 15-26 weeks; range: 0.4-208 weeks). The median duration of graft function was 2.5 years (interquartile range: 1.4-3.4 years; range: 0.7-5 years). The analysis demonstrated that ovarian tissue cryopreservation and transplantation could restore reproductive and hormonal functions in women. Further studies with larger samples of well-characterized populations are required to define the optimal retrieval, cryopreservation and transplantation processes. Ovarian tissue cryopreservation and transplantation may not only be effective in restoring fertility but also the return of reproductive endocrine function. Although this technology was developed as a fertility preservation option, it may have the scope to be considered for endocrine function preservation.

Early liver transplantation for severe alcohol-related hepatitis not responding to medical treatment: a prospective controlled study

Early liver transplantation for severe alcohol-related hepatitis is an emerging treatment option. We aimed to assess the risk of alcohol relapse 2 years after early liver transplantation for alcohol-related hepatitis compared with liver transplantation for alcohol-related cirrhosis after at least 6 months of abstinence. We conducted a multicentre, non-randomised, non-inferiority, controlled study in 19 French and Belgian hospitals. All participants were aged 18 years or older. There were three groups of patients recruited prospectively: patients with severe alcohol-related hepatitis who did not respond to medical treatment and were eligible for early liver transplantation according to a new selection scoring system based on social and addiction items that can be quantified in points (early transplantation group); patients with alcohol-related cirrhosis listed for liver transplantation after at least 6 months of abstinence (standard transplantation group); patients with severe alcohol-related hepatitis not responding to medical treatment not eligible for early liver transplantation according to the selection score (not eligible for early transplantation group), this group did not enter any further liver transplantation processes. We also defined a historical control group of patients with severe alcohol-related hepatitis unresponsive to medical therapy and non-transplanted. The primary outcome was the non-inferiority of 2-year rate of alcohol relapse after transplantation in the early transplantation group compared with the standard transplantation group using the alcohol timeline follow back (TLFB) method and a prespecified non-inferiority margin of 10%. Secondary outcomes were the pattern of alcohol relapse, 2-year survival rate post-transplant in the early transplantation group compared with the standard transplantation group, and 2-year overall survival in the early transplantation group compared with patients in the not eligible for early transplantation group and historical controls. This trial is registered with ClinicalTrials.gov, NCT01756794. Between Dec 5, 2012, and June 30, 2016, we included 149 patients with severe alcohol-related hepatitis: 102 in the early transplantation group and 47 in the not eligible for early transplantation group. 129 patients were included in the standard transplantation group. 68 patients in the early transplantation group and 93 patients in the standard transplantation group received a liver transplant. 23 (34%) patients relapsed in the early transplantation group, and 23 (25%) patients relapsed in the standard transplantation group; therefore, the non-inferiority of early transplantation versus standard transplantation was not demonstrated (absolute difference 9·1% [95% CI -∞ to 21·1]; p=0·45). The 2-year rate of high alcohol intake was greater in the early transplantation group than the standard transplantation group (absolute difference 16·7% [95% CI 5·8-27·6]) The time spent drinking alcohol was not different between the two groups (standardised difference 0·24 [95% CI -0·07 to 0·55]), but the time spent drinking a large quantity of alcohol was higher in the early transplantation group than the standard transplantation group (standardised difference 0·50 [95% CI 0·17-0·82]). 2-year post-transplant survival was similar between the early transplantation group and the standard transplantation group (hazard ratio [HR] 0·87 [95% CI 0·33-2·26]); 2-year overall survival was higher in the early transplantation group than the not eligible for early transplantation group and historical controls (HR 0·27 [95% CI 0·16-0·47] and 0·21 [0·13-0·32]). We cannot conclude non-inferiority in terms of rate of alcohol relapse post-transplant between early liver transplantation and standard transplantation. High alcohol intake is more frequent after early liver transplantation. This prospective controlled study confirms the important survival benefit related to early liver transplantation for severe alcohol-related hepatitis; and this study provides objective data on survival and alcohol relapse to tailor the management of patients with severe alcohol-related hepatitis. The present study has been granted by the French Ministry of Health-Programme Hospitalier de Recherche Clinique 2010.

Cold or Not So Cold?-Static Organ Preservation at 10 °C May Prolong Organ Preservation and Facilitate Transplant Logistics.

Cold or Not So Cold?-Static Organ Preservation at 10 °C May Prolong Organ Preservation and Facilitate Transplant Logistics.

Waiting for kidney transplantation from deceased donors: Experiences and support needs during the waiting time -A qualitative study

ObjectivesThe study aimed to explore and describe patients’ experiences of the transplantation process and the support they had received during the waiting time. MethodSemi-structured interviews were conducted with 14 patients currently waiting for kidney transplantation from deceased donors (n = 7) or recently having received kidney transplantation (n = 7). Interviews were transcribed, anonymized and analysed inductively using thematic analysis. ResultsTwo themes and seven sub-themes were identified. The first theme, “Swaying between hope and despair” describes patients’ perceptions of waiting for transplantation as a struggle, their expectations for life after the upcoming transplantation and experienced disappointments. The second theme, “Making your way through the waiting time”, describes support, strategies and behaviours used to manage the waiting time. ConclusionPatients described life while waiting for kidney transplantation as challenging, involving unexpected events, not understanding the transplantation process and having unrealistic expectations on life after transplantation. They also described support, strategies and behaviours used, some of which led to unwanted consequences. Practice implicationsPatients waiting for kidney transplantation from deceased donors need continuous and easily available education, practical and emotional support to manage the waiting time. Transplantation specific education is also needed to facilitate preparation for transplantation and adjustment to life after transplantation.

Recent Progress of Research Regarding the Applications of Stem Cells for Treating Diabetes Mellitus

At present, the number of diabetes patients has exceeded 537 million worldwide and this number continues to increase. Stem cell therapy represents a new direction for the treatment of diabetes; the use of stem cells overcomes some shortcomings associated with traditional therapies. Functional β cells play an important role in the pathogenesis of diabetes. As therapeutic targets, functional β cells are restored by a variety of stem cells, including pluripotent stem cells, mesenchymal cells, and urine-derived stem cells. Although all types of stem cells have their own characteristics, they mainly promote the repair and regeneration of β cells through directional differentiation, immunomodulation, and paracrine signaling after homing to the injured site. However, stem cell therapy still faces many obstacles, such as low long-term cell survival rate after transplantation, low maintenance time of blood glucose homeostasis, immune rejection, and tumorigenesis. Recently, genetically edited pluripotent stem cells and the cotransplantation of mesenchymal stem cells and islet cells have made significant progress in improving the efficacy of stem cell transplantation processes, also providing powerful tools for the study of the mechanisms underlying diabetes and disease modeling. In this review, we first focused on: (1) stem cells as a pool for the differentiation of insulin-producing cells; (2) stem cells as a source for regenerative repair of damaged islets and as a potential cotransplanted population with islets; (3) the potential of combining gene editing with stem cell therapy; and (4) selection of the stem cell transplantation approach. Based on these topics, we discuss the challenges within the field of adapting stem cell-supported and stem cell-derived transplantations and the promising routes for overcoming these problems.

Outcomes of Liver Transplantation from Deceased Donors with Coronavirus- Disease 2019 and Late Complications of Infection

Background: The transplant patients should be considered a main high-risk population during the COVID-19 outbreak due to the use of immunosuppressive regimens and comorbidities. Objective: This study aimed to evaluate the possibility of COVID-19 transmission by liver transplantation from a donor with a late complication of COVID-19 to the recipients. Method: This descriptive study was conducted on all the recipients of liver transplantation who had an acute liver failure or were the models for the End-Stage Liver Disease (MELD) higher than 20. Results: In general, 36 liver transplantation was performed during the study period. Out of these patients, only 14 cases (deceased donors) had hemorrhagic cerebrovascular accidents, and other donors died of trauma (n=7) and anoxia (n=15). All patients showed negative results for polymerase chain reaction (PCR) (two negative 24 h PCR), whereas their high-resolution computed tomography (HRCT) test revealed that they had previously lung involvement with COVID-19 as the late complication of the disease. Conclusion: This study supports the safety of continuing donation and transplant process during the outbreak even the transplant donor be infected previously with the COVID-19, which is reinforced by other similar pieces of evidence.

Making it happen: data practices and the power of diplomacy among Danish organ transplant coordinators

Danish transplant coordinators handle all data and logistics involved with the removal and transfer of organs from the body of an organ donor into several recipients in other Scandinavian hospitals. This entails a wide range of data work, not only in relation to sudden organ donation cases, but also to documenting transplantations, providing feedback on donation outcomes, and facilitating the data needed by surgeons or other health professionals. This article investigates the data practices of organ transplant coordinators through the lens of diplomacy. Based on participant observation and interviews among Danish transplant coordinators, I focus on the cross-disciplinary relations and negotiations characterizing organ exchanges and show how datafication in itself is not enough to ensure smooth transplantation processes. Organ transplantation depends on the diplomatic social skills of the coordinator and the personal relationships between coordinators, surgeons and ICU staff. By bringing into focus the power of diplomacy, I conceptualize these structurally invisible efforts enabling organ donation and its associated data practices. Diplomacy enables us to recognize and understand the relational efforts and aspects of datafication, and the tremendous amount of work and social skill that go into producing and exchanging data in contemporary healthcare.

Nurses’ Perspectives and Experiences Regarding Organ Transplantation in Turkey: A Qualitative Study

As professionals, nurses are often required to provide care for patients from different cultural and religiousbackgrounds during an organ transplantation process. It is therefore important to understand the views and experiences of nurses regarding the organ transplantation process. The aim of this study was to explore nurses' perspectives and experiences in providing care to donors and transplant recipients. In this descriptive qualitative study, semistructured in-depth interviews were conducted with 17 nurses in Turkey. The qualitative interviews were analyzed usingthematic analysis. At the end of the study, four themes were represented: nurses' characteristics, nurses' roles and responsibilities, nurses' views on organ transplantation, and nurses' experiences with providing care. The results of the study revealed that nurses have positive and negative attitudes about organ transplantation, and they need education on this topic. In addition, considering the cultural factors and religious beliefs that prevent organ donation, cooperation between health professionals and religious authorities is necessary. Furthermore, support systems should be developed to reduce the problems that nurses face. The relevant authorities should collaborate to increase the number of donors by informing the public that the religious view is favorable to organ donation.

Ranking patients on the kidney transplant waiting list based on fuzzy inference system

BackgroundKidney transplantation is the best treatment for people with End-Stage Renal Disease (ESRD). Kidney allocation is the most important challenge in kidney transplantation process. In this study, a Fuzzy Inference System (FIS) was developed to rank the patients based on kidney allocation factors. The main objective was to develop an expert system, which would mimic the expert intuitive thinking and decision-making process in the face of the complexity of kidney allocation.MethodsIn the first stage, kidney allocation factors were identified. Next, Intuitionistic Fuzzy Analytic Hierarchy Process (IF-AHP) has been used to weigh them. The purpose of this stage is to develop a point scoring system for kidney allocation. Fuzzy if-then rules were extracted from the United Network for Organ Sharing (UNOS) dataset by constructing the decision tree, in the second stage. Then, a Multi-Input Single-Output (MISO) Mamdani fuzzy inference system was developed for ranking the patients on the waiting list.ResultsTo evaluate the performance of the developed Fuzzy Inference System for Kidney Allocation (FISKA), it was compared with a point scoring system and a filtering system as two common approaches for kidney allocation. The results indicated that FISKA is more acceptable to the experts than the mentioned common methods.ConclusionGiven the scarcity of donated kidneys and the importance of optimal use of existing kidneys, FISKA can be very useful for improving kidney allocation systems. Countries that decide to change or improve the kidney allocation system can simply use the proposed model. Furthermore, this model is applicable to other organs, including lung, liver, and heart.

Transplantation of umbilical cord-derived mesenchymal stem cells promotes the recovery of thin endometrium in rats

The endometrium plays a critical role in embryo implantation and pregnancy, and a thin uterus is recognized as a key factor in embryo implantation failure. Umbilical cord mesenchymal stem cells (UC-MSCs) have attracted interest for the repair of intrauterine adhesions. The current study investigated the repair of thin endometrium in rats using the UC-MSCs and the mechanisms involved. Rats were injected with 95% ethanol to establish a model of thin endometrium. The rats were randomly divided into normal, sham, model, and UC-MSCs groups. Endometrial morphological alterations were observed by hematoxylin–eosin staining and Masson staining, and functional restoration was assessed by testing embryo implantation. The interaction between UC-MSCs and rat endometrial stromal cells (ESCs) was evaluated using a transwell 3D model and immunocytochemistry. Microarray mRNA and miRNA platforms were used for miRNA-mRNA expression profiling. Gene ontology (GO) and Kyoto encyclopedia of genes and genomes (KEGG) analyses were performed to identify the biological processes, molecular functions, cellular components, and pathways of endometrial injury and UC-MSCs transplantation repair and real-time quantitative reverse transcription PCR (qRT-PCR) was performed to further identify the expression changes of key molecules in the pathways. Endometrium thickness, number of glands, and the embryo implantation numbers were improved, and the degree of fibrosis was significantly alleviated by UC-MSCs treatment in the rat model of thin endometrium. In vitro cell experiments showed that UC-MSCs migrated to injured ESCs and enhanced their proliferation. miRNA microarray chip results showed that expression of 45 miRNAs was downregulated in the injured endometrium and upregulated after UC-MSCs transplantation. Likewise, expression of 39 miRNAs was upregulated in the injured endometrium and downregulated after UC-MSCs transplantation. The miRNA-mRNA interactions showed the changes in the miRNA and mRNA network during the processes of endometrial injury and repair. GO and KEGG analyses showed that the process of endometrial injury was mainly attributed to the decomposition of the extracellular matrix (ECM), protein degradation and absorption, and accompanying inflammation. The process of UC-MSCs transplantation and repair were accompanied by the reconstruction of the ECM, regulation of chemokines and inflammation, and cell proliferation and apoptosis. The key molecules involved in ECM-receptor interaction pathways were further verified by qRT-PCR. Itga1 and Thbs expression decreased in the model group and increased by UC-MSCs transplantation, while Laminin and Collagen expression increased in both the model group and MSCs group, with greater expression observed in the latter. This study showed that UC-MSCs transplantation could promote recovery of thin endometrial morphology and function. Furthermore, it revealed the expression changes of miRNA and mRNA after endometrial injury and UC-MSCs transplantation repair processed, and signaling pathways that may be involved in endometrial injury and repair.

A coordinated national UK liver transplant program response, prioritizing waitlist recipients with the highest need, provided excellent outcomes during the first wave of the COVID‐19 pandemic

Healthcare provision has been severely affected by COVID-19, with specific challenges in organ transplantation. Here, we describe the coordinated response to, and outcomes during the first wave, across all UK liver transplant (LT) centers. Several policy changes affecting the liver transplant processes were agreed upon. These included donor age restrictions and changes to offering. A "high-urgency" (HU) category was established, prioritizing only those with UKELD>60, HCC reaching transplant criteria, and others likely to die within 90 days. Outcomes were compared with the same period in 2018 and 2019. The retrieval rate for deceased donor livers (71%vs. 54%; P<.0001) and conversion from offer to completed transplant (63%vs. 48%; P<.0001) was significantly higher. Pediatric LT activity was maintained; there was a significant reduction in adult (42%) and total (36%) LT. Almost all adult LT were super-urgent (n=15) or HU (n=133). We successfully prioritized those with highest illness severity with no reduction in 90-day patient (P=.89) or graft survival (P=.98). There was a small (5% compared with 3%; P=.0015) increase in deaths or removals from the waitlist, mainly amongst HU cohort. We successfully prioritized LT recipients in highest need, maintaining excellent outcomes, and waitlist mortality was only marginally increased.

Inhibition of HDAC3 protects against kidney cold storage/transplantation injury and allograft dysfunction.

Cold storage/rewarming is an inevitable process for kidney transplantation from deceased donors, which correlates closely with renal ischemia-reperfusion injury (IRI) and the occurrence of delayed graft function. Histone deacetylases (HDAC) are important epigenetic regulators, but their involvement in cold storage/rewarming injury in kidney transplantation is unclear. In the present study, we showed a dynamic change of HDAC3 in a mouse model of kidney cold storage followed by transplantation. We then demonstrated that the selective HDAC3 inhibitor RGFP966 could reduce acute tubular injury and cell death after prolonged cold storage with transplantation. RGFP966 also improved renal function, kidney repair and tubular integrity when the transplanted kidney became the sole life-supporting graft in the recipient mouse. In vitro, cold storage of proximal tubular cells followed by rewarming induced remarkable cell death, which was suppressed by RGFP966 or knockdown of HDAC3 with shRNA. Inhibition of HDAC3 decreased the mitochondrial pathway of apoptosis and preserved mitochondrial membrane potential. Collectively, HDAC3 plays a pathogenic role in cold storage/rewarming injury in kidney transplantation, and its inhibition may be a therapeutic option.

Digital tools towards transplant first policy: Improving health literacy

End stage kidney disease (ESKD) is a prevalent health issue across the world and it is well established that kidney transplantation (KT), specifically from a living donor, is currently the best value-based treatment method. Ergo, it is crucial to invest heavily in making this care strategy the best possible option for the majority of eligible patients. Barriers to the kidney transplant process are mainly related to education and accessibility: awareness of the clinical and societal relevance of the therapy must be promoted at the level of patients, clinicians and health providers. A health-literacy-focused website has been developed as part of this, aiming to provide the general population, particularly potential organ receptors and donors, with better access to trustworthy information and data. This was meant to be the effective expression of knowledge diffusion and innovation as a result of an academic master thesis. This communication-focused digital resource is designed to combat these obstacles and to create a long-lasting, positive and significant impact.

ENTRE(LAÇAR) PARA GOVERNAR: ESTRATÉGIAS BIOPOLÍTICAS EM CAMPANHAS PUBLICITÁRIAS PARA DOAÇÃO DE ÓRGÃOS E TECIDOS

ABSTRACT Objective to analyze the organ and tissue donation advertising campaigns as biopolitical strategies. Method a qualitative research study inspired on the Post-Structuralist strand of Cultural Studies. Data collection took place between July and September 2020 and the research corpus consisted in the visual and textual components of 421 organ and tissue donation advertising pieces from institutional websites of the Ministry of Health, State Health Secretariats, State Transplantation Centers and the Brazilian Association of Organ Transplantation. The data were managed using the Ethnograph v6 program, submitted to analysis as proposed by Janice Morse and discussed following Michel Foucault's theoretical notions of Biopower and Biopolitics. Results two categories are presented. In the first, the representation of cultural and age diversity in the campaigns was discussed as a way to include all people in the donation and transplantation process; in the second, the use of heroism, altruism and empathy to mobilize the donor's “I” was addressed. Conclusion the inclusion of cultural and age diversity and the use of characteristics such as empathy, altruism and heroism in advertising campaigns are biopolitical strategies used by the Brazilian State to drive the population towards organ donation.

Global Ischemic Penumbra and Brain Death Declaration

Brain death is a contentious subject, especially in the area of Catholic bioethics. Answering the question of when an individual is truly dead has a wide application in the field of medicine, particularly when determining when it is licit to begin the process of organ transplantation. Global Ischemic Penumbra raises an additional issue in that it closely mimics brain death, but is not in fact a terminal condition.

THE HUMAN RIGHT TO TRANSPLANTATION OF ORGANS AND TISSUES: MEDICINE, ETHICS AND LAW.

The aim: To study the combination of medical, legal, ethical principles and regulations in the field of transplantology, as one of the key problems of bioethics. Materials and methods: Formal-logical methods of analysis and synthesis allowed to reveal the content of the concepts that make up the subject of research, to classify them, as well as to formulate intermediate and general conclusions. The systematic method allowed to study the role and significance of human right to transplantation among other somatic human and civil rights and freedoms. Using the historical method, the doctrinal basis of the study was analyzed, and the main stages of the formation of human right to transplantation were identified. Conclusions: The level of modern development of the Institute of Transplantology depends primarily on the tolerance of the society itself regarding the concept of brain death. The actual normalization of the concept of death in one or another state determines the level of realization of the human right to organ and tissue transplantation. Regarding the reform of the current legislation in the field of transplantology, as one of the key problems of bioethics, first of all, moral principles should be taken into account (at the same time, today morality in its development is even slightly ahead of the development of international law, although progressive principles of legal regulation of transplantation processes have been distinguished at the international level ). Therefore, during the development of norms of both international and national law regarding transplantology, existing moral principles should be taken as a basis. At the same time, one should not forget that a necessary factor is the presentation of a number of issues for public discussion, as well as their discussion at scientific and practical conferences not only of doctors and lawyers, but also of theologians and philosophers.