The reform stems from honesty and determination. Since 2005, organ donation and transplantation in China has undergone thorough reform, which complies with legislation requirements and ethical principles established b...The reform stems from honesty and determination. Since 2005, organ donation and transplantation in China has undergone thorough reform, which complies with legislation requirements and ethical principles established by the World Health Organization(WHO). Reform in China has demonstrated the unwavering confidence and utmost determination of the Chinese government and the Chinese transplantation community. The year 2015 marked a historic turning point when voluntary donations from Chinese citizens became the sole legitimate source for organ transplantation. Since 2015, China has gradually established and refined the “Chinese Mode” and “China System” for organ donation and transplantation, fulfilling its political pledge of reform, and has garnered international recognition, and fostered a social culture which promotes organ donation. This article reviewed the history of reform on organ donation and transplantation in China, presented a new pattern of establishment of organ donation system in the new era of the country, and the direction of advances in the future.展开更多
China’s rice donation to Uganda’s drought-stricken Karamoja sub-region saves thousands from starvation.Afriend in need is a friend indeed,said Thomas Lokirut,an elder from Uganda’s Karamojong people after learning ...China’s rice donation to Uganda’s drought-stricken Karamoja sub-region saves thousands from starvation.Afriend in need is a friend indeed,said Thomas Lokirut,an elder from Uganda’s Karamojong people after learning that China had donated 1,610 tonnes of rice to his people.展开更多
BACKGROUNDLimited research exists on attitudes and barriers to organ donation in the UnitedArab Emirates, highlighting the need for a deeper understanding of public perceptionsand challenges.AIMTo assess the attitudes...BACKGROUNDLimited research exists on attitudes and barriers to organ donation in the UnitedArab Emirates, highlighting the need for a deeper understanding of public perceptionsand challenges.AIMTo assess the attitudes and barriers toward organ donation.METHODSA cross-sectional study was adopted and included 607 samples consisting ofstudents, faculty, and staff who were selected from three universities in Ajmanand who had signed consent forms. A validated self-administered questionnairethat included 13 attitudes and 14 barrier items was used as a tool. The reliabilityof the tool was 0.89 (Cronbach's alpha). In the analysis of attitude scores, responseswere rated on a scale from 0 to 4, with 0 representing 'strongly disagree'and 4 representing 'strongly agree' for supportive attitudes towards organdonation. Participants with a total attitude score of 39 or higher indicated agreementor strong agreement with all items, reflecting a generally supportiveattitude toward organ donation. Lower scores suggested that the respondent wasneutral or disagreed with one or more items, indicating a less supportive attitudetoward organ donation. Knowledge about organ donation was assessed by selfadministeredquestionnaire that included 13 items. Analysis was done using SPSSversion 29. χ2 was used to assess associations between variables.RESULTSMost participants were young (≤ 30 years old, 83.7%), female (79.2%), from World Health Organization Eastern Mediterranean Region countries (69.5%), Muslim (82.4%), students (80.6%), single(83.9%), and from a nursing college (33.1%). The majority had no personal or family history of organ donation(93.2% and 93.9%, respectively). Supportive attitudes toward organ donation were significantly associated withreligion (P = 0.003), working status (P = 0.009), university (P = 0.019), and knowledge (P < 0.001). Additionally,those with a personal or family history of organ donation were significantly more supportive (56.8% vs 33.3%, P =0.004). Lack of awareness was the most reported barrier for organ donation (64.1%) followed by being afraid oforgan donation due to medical procedures required (51.9%).CONCLUSIONThe findings suggest that supportive attitudes toward organ donation are influenced by demographic factors,personal experiences, and knowledge levels. Lack of awareness and fear of medical procedures were the mostreported barriers to organ donation. These results highlight the need for targeted educational programs to increaseawareness and promote positive attitudes toward organ donation.展开更多
BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vom...BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vomiting,and constipation which may delay discharge.Liposomal bupivacaine,ketorolac,and scheduled acetaminophen have all demonstrated efficacy for management of post-operative pain in this population.AIM To assess the efficacy and safety of an opioid-sparing protocol utilizing a multimodal pain management approach in living kidney donors post-nephrectomy.METHODS Single-center,retrospective chart review study examining 52 living kidney donors(26 pre-protocol implementation,26 post-protocol implementation)from May 24th,2019 to September 27th,2023.Patients in the post-protocol group received intraoperative liposomal bupivacaine,hydromorphone PCA(until able to tolerate oral medications),15 mg of intravenous ketorolac every 6 hours for 3 doses,and scheduled oral acetaminophen,in addition to oxycodone as needed for moderate to severe pain.The primary endpoint was oral morphine equivalent(OME)use within 48 hours post-surgery.Secondary endpoints include average daily pain scale within 48 hours post-surgery,length of stay(LOS)(days),and incidence of new acute kidney injury(AKI)or gastrointestinal(GI)bleed during admission per provider.Differences between the pre-and post-protocol implementation groups were compared utilizing the exact Wilcoxon test for continuous variables and either the Fisher’s Exact orχ^(2) test for categorical variables.RESULTS Patients in the pre-protocol implementation group received more OME(mg)within 48 hours post-surgery when compared to the post-protocol group(median:84.5 vs 69.0).The median of total OME over the course of admission was numerically greater the pre-protocol group(105.0 vs 69.0),and was significantly more per LOS(41.3 vs 25.7,P=0.02).Average daily pain score was not statistically significantly different between the two groups on postoperative day 1(median:5.3 vs 4.4;P=0.43)and post-operative day 2(median:4.7 vs 5.2;P=0.96).No significant differences were found in provider-identified incidences of AKI or GI bleeding during admission.There was no difference in serum creatinine at the time of discharge between the two groups.CONCLUSION A multimodal,opioid-sparing pain management protocol was as effective for pain control and resulted in significantly less opioid daily exposure over LOS.No adverse events were found related to use of ketorolac in patients undergoing donor nephrectomy.Our findings suggest that an opioid-sparing protocol is both safe and effective at minimizing opioid exposure and managing post-operative pain within the first 48 hours post-surgery.展开更多
BACKGROUND Organ donation and transplantation are vital for saving lives,yet awareness remains limited.Health literacy,the ability to understand and use health information,and self-control,which influences decision-ma...BACKGROUND Organ donation and transplantation are vital for saving lives,yet awareness remains limited.Health literacy,the ability to understand and use health information,and self-control,which influences decision-making,are crucial factors in promoting awareness.Understanding their relationship can guide efforts to increase participation in organ donation.AIM To investigate the effect of health literacy on organ donation and transplantation awareness,with self-control acting as a mediator,and to emphasize its importance.METHODS The study comprised 345 adults recruited from five different cities in Türkiye.The sample included 208 women(60.29%)and 137 men(39.71%).The age range of the sample group varies between 18 and 49(median age=24.13;SD=8.81).Selfreport data were collected including psychometric measures assessing organ donation and transplantation awareness,health literacy,and self-control.Reliability analysis,descriptive statistics,correlational analysis,and mediational analysis of the data were carried.RESULTS The analysis showed that health literacy was positively correlated with organ donation and transplantation awareness(r=0.340)and self-control(r=0.376).Self-control was positively related to organ donation and transplantation awareness(r=0.531).Mediating analysis supported a mediation model where health literacy was found to influence organ donation and transplantation awareness via self-control(bootstrap=0.158,95%confidence interval=0.105-0.215).CONCLUSION The results indicate that self-control mediates the positive relationship between health literacy and organ donation and transplantation awareness.Enhancing individuals’health literacy may therefore increase awareness of organ donation and transplantation through improvements in self-control.展开更多
BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury...BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines(CK).The machine perfusion(MP)is a promising device to rescue these grafts.AIM To analyze the role of MP connected to a sorbent cartridge(PerSorb®)and used for very damaged DCD pig livers.METHODS Seven grafts were procured from pigs from a slaughterhouse.Grafts were made very marginal with at least 60 minutes of donor warm ischemia time and 24 hours of static-cold ischemia time:(1)3 grafts were perfused in hypothermic MP with PerSorb(Sorb);(2)2 other grafts in hypothermic MP(HMP)without the cartridge(NoSorb);and(3)The other 2 livers stored in the ice box(NoTreat).The CK were measured at HMP start(T0)and at the end(Tend).Biopsies were taken at T0 and Tend.RESULTS All 5 grafts treated with HMP had a negative lactate trend after 3 hours of treatment(8.83 at T0 vs 6.4 at Tend of Sorb;15 at T0 vs 5.45 at Tend for NoSorb,P value>0.05).At Tend,both Sorb and NoSorb groups had better hemodynamic parameters,comparable between the two groups.Enzyme-linked immunosorbent assay analysis showed a reduction of monocyte chemotactic protein-1,tumor necrosis factor-alpha and interleukin-1βfor NoSorb group at Tend and a complete downregulation to physiological levels of the same CK in Sorb livers after 3 hours of treatment.Biopsies showed a reduction of the perisinusoidal edema for the Sorb grafts compared with the NoSorb livers.CONCLUSION These data suggest a potential protective role of treatment of grafts with MP and sorbent cartridge in reducing the inflammatory response after a severe ischemic injury.展开更多
Evidence is not homogeneous on indicators able to monitor and assess qualityperformance for organ donation. This may be related to differences in healthcareorganizations among countries but also to the scarcity of dat...Evidence is not homogeneous on indicators able to monitor and assess qualityperformance for organ donation. This may be related to differences in healthcareorganizations among countries but also to the scarcity of data on this topic so far.In the present review, we assessed available evidence on quality metrics in solidorgan procurement in the United States and in Europe by means of a PubMedsearch. Evidence was summarized according to countries, considering that thedonation and transplantation systems differ from country to country. In UnitedStates, the assessment of these indicators is periodically performed by the nationalnetwork for organ sharing to evaluate the performance of each Organ ProcurementOrganization (OPO). Quality metrics consider several factors, in primispopulation characteristics (i.e. race/ethnicity, age, socio-economic status). That iswhy the assessment of each OPO performance relies on several quality metrics,not only one single indicator. In Europe, quality improvement programs representa structural element of organ and transplant system in several countries, but fewpapers have to date addressed the results obtained by a quality improvementprogram based on indicators. In Poland, the use of quality indicators and improvementprocedures were associated with better results in those hospitals whichimplemented these programs in respect to hospitals who did not. In TuscanyRegion (Italy) the implementation of a monitoring and reporting approach basedon indicators by the Regional Transplant Center was associated with an increasedin transplant and donation activity (especially in cDCD donors). According toavailable evidence, the development of a method for quality assessment andquality improvement has been recognized as pivotal for donation and transplantauthorities to identify key interventions either at national and/or hospital levels.展开更多
BACKGROUND Knowledge about organ donation and transplantation plays a crucial role in shaping individuals'health behaviors and perceptions,potentially impacting their health-related quality of life(HRQoL).Future a...BACKGROUND Knowledge about organ donation and transplantation plays a crucial role in shaping individuals'health behaviors and perceptions,potentially impacting their health-related quality of life(HRQoL).Future anxiety,defined as the anticipatory worry individuals experience regarding potential negative events and outcomes in their future,may further influence these outcomes.AIM To investigate the effect of such knowledge on HRQoL and to examine whether future anxiety mediates this relationship.METHODS A cross-sectional study was conducted with 659 participants aged 18 to 65 years.Participants completed the Organ Tissue Donation and Transplantation Knowledge Scale,the Dark Future Scale,and the European Health Interview Survey-Quality of Life 8.Correlation analyses were performed,followed by Structural Equation Modeling to test the proposed mediation model.RESULTS The findings indicated that greater knowledge about organ donation and transplantation was positively associated with higher HRQoL and negatively associated with future anxiety.Future anxiety was negatively correlated with HRQoL.Structural Equation Modeling analysis indicated that knowledge directly enhanced HRQoL and reduced future anxiety.Additionally,future anxiety negatively affected HRQoL,mediating the relationship between knowledge and HRQoL.The mediation effect was significant,as confirmed by bootstrapping(bootstrap coefficient=0.068,95%CI:0.046-0.093).CONCLUSION The study concludes that future anxiety partially mediates the positive impact of knowledge about organ donation and transplantation on HRQoL.These results suggest that increasing public knowledge in this area may reduce future anxieties and enhance quality of life.展开更多
BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine pe...BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine perfusion time(MPT)impact and potential clinical benefits is paramount and necessitates exploration.AIM To investigate the relationship between MPT and post-transplant graft function.METHODS Retrospective review of the first 50 donation after circulatory death(DCD)grafts preserved using NMPP in a tertiary institution was performed.Essential preser-vation time points,graft parameters,recipient information,and postoperative outcomes were prospectively recorded.Early allograft dysfunction(EAD),L-Graft7 score and 90-day outcomes were collected for all grafts.The first 20 re-cipients were allocated into the early group,considered the learning curve population for the center.The subsequent 30 were allocated into the late group.Recipients were also stratified into cohorts depending on MPT,i.e.,short(<8 hours),medium(8-16 hours)and long(>16 hours).RESULTS NMPP operational parameters were not predictive of EAD,L-GrAFT7 or 90-day outcomes.The early group had significantly less MPT and cold ischemia time than the late group(553 minutes vs 850 minutes,P<0.001)and(127.5 minutes vs 154 minutes,P=0.025),respectively.MPT had no impact in either group.CONCLUSION Increased MPT of DCD liver grafts had no adverse recipient results for the times utilized in this population,indicating its upper limits,likely beyond 24 hours,are not demonstrated within this study.Future studies are necessary to determine whether longer MPT is beneficial or detrimental to graft function and,if the latter,what is the maximum safe duration.Further studies of the effect of normothermic machine perfusion pump duration on long-term outcomes are also needed.展开更多
This article provides a concise overview of the development of organ transplantation in China.Inspired by international advancements in organ transplantation,China embarked on its own organ transplantation research jo...This article provides a concise overview of the development of organ transplantation in China.Inspired by international advancements in organ transplantation,China embarked on its own organ transplantation research journey in 1958.The clinical evaluation phase is marked by the first cadaveric kidney transplant in 1960 and the first living-donor kidney transplant in 1972.By 1989,the annual number of successful kidney transplants had surpassed 1000.However,57 liver transplants were performed between 1977 and 1983;limitations in technology and the scarcity of cyclosporine A resulted in unfavorable outcomes for most recipients,with the majority succumbing within 3 months of surgery.These factors led to a near-complete halt in liver,heart,and lung transplants for the following decade.With all 4 conditions met-(1)mature surgical techniques,(2)powerful immunosuppressive agents available for clinical use,(3)new organ preservation solutions that ensure the quality and transportation of donor organs,and(4)reasonable and legal sources of organs-China's organ transplantation field has experienced rapid development.In 2014,there were 9652 organ transplants,and this number grew to 20,225 by 2022.Despite the progress,China's organ donation rate per million remains relatively low,3.86 ranking 48th globally in 2022,underscoring the need for increased public awareness and support for organ donation.展开更多
BACKGROUND Liver grafts from donation after circulatory death(DCD)are associated with a higher risk of early graft dysfunction,determined by the warm ischemia and cold ischemia times.It is essential to have precise cr...BACKGROUND Liver grafts from donation after circulatory death(DCD)are associated with a higher risk of early graft dysfunction,determined by the warm ischemia and cold ischemia times.It is essential to have precise criteria to identify this complication in order to guide therapeutic strategies.AIM To validate different graft and recipient survival scores in patients undergoing liver transplantation(LT)with DCD grafts.METHODS A retrospective and observational unicentric study was conducted on 65 LT patients with grafts obtained from controlled DCD donors from November 2013 to November 2022.The United Kingdom(UK)risk score,early allograft dysfunction(EAD)Olthoff score,and model for early allograft function(MEAF)score were used to evaluate the risk of graft and recipient survival post-transplant.For survival analysis purposes,we used the Kaplan-Meier method,and the differences between subgroups were compared using the log-rank(Mantel-Cox)test.RESULTS Sixty-five patients were included in the study.The UK risk score did not demonstrate predictive capacity for recipient or graft survival.However,in donors aged over 70 years old(18.4%),it significantly predicted graft survival(P<0.05).According to Kaplan-Meier survival curves,graft survival rates at 6 months,2 years,and 5 years in the futility group dramatically decreased to 50%compared to the other groups(log-rank 8.806,P<0.05).The EAD Olthoff and MEAF scores did not demonstrate predictive capacity for recipient or graft survival.Based on Kaplan-Meier survival curves,patients with a MEAF score≥7 had a lower graft survival rate at 6 months,2 years,and 5 years compared to patients with a lower MEAF score(log-rank 4.667,P<0.05).CONCLUSION In our series,both UK DCD risk score and MEAF score showed predictive capability for graft survival.展开更多
Objective:To assess the attitude and willingness of medical students of the Faculty of Medicine,University of Jaffna,regarding gamete donation.Methods:An institutional-based descriptive cross-sectional study was condu...Objective:To assess the attitude and willingness of medical students of the Faculty of Medicine,University of Jaffna,regarding gamete donation.Methods:An institutional-based descriptive cross-sectional study was conducted at the Faculty of Medicine,University of Jaffna,from September 2022 to May 2023 among undergraduate medical students who gave their voluntary participation.A self-administered questionnaire was used as a study instrument to collect data regarding their attitude and willingness toward gamete donation.Results:A total of 345 participants were recruited and their sociodemographic data revealed that 56.8%of the participants were female,62.3%aged between 26 and 30 years,and 92.2%were unmarried.Many of them received information regarding gamete donations during their clinical appointments.Over half(67.8%)of them showed a negative attitude towards gamete donation.Regarding willingness,only 39.7%of participants had a positive approach for being a gamete donor;among them,84.7%preferred anonymous donations.Religion and ethnicity had a significant influence on their attitudes and willingness.In addition,male was also found to be more willing to donate gametes.Conclusions:Most medical students have negative views about gamete donation.Imparting awareness and knowledge of assisted reproductive technology and gamete donation within medical students'sociocultural and ethical backgrounds might facilitate a change in attitude towards gamete donation amongst future medical practitioners.展开更多
There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting gluco...There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting glucose and impaired glucose tolerance,is on the rise across the globe.Transplant teams frequently come across prediabetic kidney donors for evaluation.Prediabetics are at risk of diabetes,chronic kidney disease,cardiovascular events,stroke,neuropathy,retinopathy,dementia,depression and nonalcoholic liver disease along with increased risk of all-cause mortality.Unfortunately,most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period.There is lack of prospective long-term studies to know about the real risk of complications after donation.Furthermore,there are variations in recommendations from various guidelines across the globe for donations in prediabetics,leading to more confusion among clinicians.This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients.This review focuses on pathophysiological changes of PD in kidneys,potential complications of PD,other risk factors for development of type 2 diabetes,a review of guidelines for kidney donation,the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.展开更多
BACKGROUND Organ donation is a critical issue that is receiving greater attention worldwide.In Jordan,the public’s knowledge about and attitudes toward organ donation play a significant role in the availability of or...BACKGROUND Organ donation is a critical issue that is receiving greater attention worldwide.In Jordan,the public’s knowledge about and attitudes toward organ donation play a significant role in the availability of organs for transplantation.AIM To assess the public knowledge about and attitudes toward organ donation in Jordan.METHODS A cross-sectional design was used to collect data from 396 Jordanian citizens via an online self-reported questionnaire.RESULTS Overall,396 participants were recruited.Of the entire sample,93.9%of the participants had heard about and had sufficient knowledge about organ donation but they had limited knowledge about brain death.The most common source of information about organ donation was social media networks.Females were found to score significantly higher than males for attitude.Those who had thought about organ donation or registered their names to donate scored signi-ficantly higher in terms of attitudes to donation than their counterparts who had not.The most common reasons for limited organ donation practices in Jordan were a lack of awareness programs and insufficient knowledge in society.CONCLUSION Greater public understanding of organ donation appears to be associated with more positive attitudes toward organ donation.Most participants responded positively regarding their attitude toward organ donation as they believed that this action could give another person a chance to live.Moreover,most agreed that they would donate their organs after their death.Otherwise,the participants had limited general knowledge about brain death,and most had not registered their names to donate their organs.These findings indicate the need for public awareness campaigns and educational programs to encourage more people to become organ donors.展开更多
Introduction: One of the most frequent observations in long-term blood donation is chronic iron deficiency, which can develop into anaemia. The majority of blood screening methods employed by blood banks do not incorp...Introduction: One of the most frequent observations in long-term blood donation is chronic iron deficiency, which can develop into anaemia. The majority of blood screening methods employed by blood banks do not incorporate iron-status markers, which may result in potential subclinical iron deficiency. The aim of this study was to evaluate the effects of repeated blood donation on the levels of iron in the body and to guide blood donors in preventing the depletion of iron stores. Methods: Regular blood donors were categorised into distinct groups according to the number of donations they gave, and then the correlation between these groups and their bodies’ iron levels was examined. Different parameters were employed to identify iron deficiency and iron depletion in blood donors: serum ferritin, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), total iron-binding capacity (TIBC), and serum iron. Results: The study included 300 individuals who regularly and willingly donated blood. There were no iron insufficiency cases among those donating blood for the first time (Group I). However, 15.5% of individuals who had donated once before (Group II) had ferritin levels of 15 - 30 μg/dl (ng/ml), indicating reduced iron stores. The rate increased to 18% (37 out of 206 individuals) among regular blood donors (Groups III, IV, and V). Iron deficiency (depletion) prevalence among regular blood donors in Groups III, IV, and V was 5.9% (12 out of 206) and 50.4% (100 out of 206). Donors who had donated blood most frequently had the lowest levels of haematological markers MCH, MCHC, and TIBC. Provide the p-values representing the differences between the means of MCV, MCH, iron, TIBC, and ferritin levels when comparing donor groups with the control group (Group I) based on the frequency of donations. Indicate statistically significant differences where the p-value is less than 0.0125. This significance level is adjusted based on the Bonferroni method, considering multiple independent tests. The result shows that the Iron parameter for the comparison between Group I and Group III and Group I and Group IV suggests a statistically significant difference in iron levels between these donor groups. Conclusion: The findings of this study show that a higher times of donations lads to a higher occurrence of depleted iron stores and subsequent erythropoiesis with iron deficiency by one donor from every three healthy donors. The iron and ferritin concentrations were within the normal range in group one (Control group) and reduced in the other four groups (G-2 to G-5). However, the level of haemoglobin remained within an acceptable range for blood donation. This outcome suggests that it may be necessary to reassess the criteria for accepting blood donors. The average serum ferritin levels were examined in all five groups (G-1 to G-5), both for males and females, and significant variations were seen among the groups under study. This study found that 35% of the individuals who regularly donate blood have iron-deficient anaemia (sideropenia). This suggests that it would be beneficial to test for serum ferritin at an earlier stage, ideally after three donations.展开更多
To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italia...To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD pathway.While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP teams.Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway.Thus,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile team.We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the program.Differences were identified between the mobile ECMO team and NRP mobile team.The common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic time.Dedicated training programs should be developed for the launch of de novo NRP teams.展开更多
Objective:To assess the management effect of comprehensive nursing management on blood donation services in blood stations.Methods:Sixty-four individuals who donated blood at a blood station between September 2021 and...Objective:To assess the management effect of comprehensive nursing management on blood donation services in blood stations.Methods:Sixty-four individuals who donated blood at a blood station between September 2021 and September 2023 were selected and randomly assigned into two groups of 32 each.The first group received comprehensive nursing management,while the second group received routine nursing management.Blood donation indexes and observational indexes such as adverse reactions were compared between the groups.Results:The total blood donation volume and qualified blood donation volume were higher in the first group than in the second group.The amount of discarded blood and the rate of blood discards were lower in the first group compared to the second group(P<0.05).Additionally,the adverse reaction rate in the first group was lower,the blood donation comfort scores were higher,the psychological state scores were lower,and the quality of care scores were higher than those in the second group(P<0.05).Conclusion:Comprehensive nursing management can improve the efficiency of blood donation,reduce the rate of blood discards,decrease the incidence of adverse reactions,alleviate negative psychological states of blood donors,and enhance both the comfort level of blood donation and the quality of care provided.展开更多
There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death （DCD） and provides recommendations for a way...There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death （DCD） and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to con-trolled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function （DGF） and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that signifcantly infuences the outcome of allografts, for example, limiting it to 〈 12 h markedly reduces DGF. DCD kidneys from donors 〈 50 function like stan-dard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled dona-tion, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kid-neys from DCD include： implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.展开更多
BACKGROUND The most important factors affecting attitudes on organ donation are socioeconomic, educational, cultural, and religious factors in many countries.AIM To evaluate the attitudes, awareness, and knowledge lev...BACKGROUND The most important factors affecting attitudes on organ donation are socioeconomic, educational, cultural, and religious factors in many countries.AIM To evaluate the attitudes, awareness, and knowledge levels of the Turkish adult population toward organ donation.METHODS This nationwide study surveyed 3000 adults(≥ 18 years) in Turkey. To ensure a representative sample, the Nomenclature of Territorial Units for Statistics-Ⅱ(modified for Turkey) was used. Turkey was divided into 26 regions based on social, economic, and geographic criteria as identified by the Turkish Statistical Institute. A stratified sampling method was used with an even distribution of adults across cities and towns based on population data. Data were collected by the PRP Research and Consultancy Company using computer-assisted personal interviews.RESULTS Out of 3000 individuals represented in the study population, 1465(48.8%) were male and 1535(51.2%) female. The results showed that most participants were under 45 years(59.0%) and married(72.1%), some had a bachelor’s degree or higher(21.9%), and very few(1.5%) had any direct experience with organ transplantation-whether in the family, or a family member on a transplantation waiting list. Most of the study population(88.3%) had not considered donating an organ, however, most(87.9%) said that they would accept an organ from a donor if they needed one. Among the individuals surveyed, 67% were willing to donate an organ to a close relative, while 26.8% would donate an organ to an unrelated person. Only 47.2% said they had adequate information about brain death, and 85.2% refused to consent to donating organs of family members declared brain dead. Only 33.9% thought they had adequate information about organ donation. The main source of information was the television. The two main reasons for refusing organ donation were that it was too soon to think about organ donation and the importance of retaining the integrity of the dead person’s body.CONCLUSION This study showed that Turkey’s adult population has inadequate knowledge about organ donation. The study advocates for public education programs to increase awareness among the general population about legislation related to organ donation.展开更多
AIM: To analyze the attitude of Spanish medical students toward living liver donation(LLD) and to establish which factors have an influence on this attitude.METHODS: Study type: A sociological, interdisciplinary, mult...AIM: To analyze the attitude of Spanish medical students toward living liver donation(LLD) and to establish which factors have an influence on this attitude.METHODS: Study type: A sociological, interdisciplinary, multicenter and observational study. Study population: Medical students enrolled in Spain(n = 34000) in the university academic year 2010-2011. Sample size: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire(PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions. Statistical analysis: Student′s t test, χ^(2 )test and logistic regression analysis.RESULTS: The completion rate was 95.7%(n = 9275). 89%(n = 8258) were in favor of related LLD, and 32%(n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude:(1) age(P = 0.008);(2) sex(P < 0.001);(3) academic year(P < 0.001);(4) geographical area(P = 0.013);(5) believing in the possibility of needing a transplant oneself in the future(P < 0.001);(6) attitude toward deceased donation(P < 0.001);(7) attitude toward living kidney donation(P < 0.001);(8) acceptance of a donated liver segment from a family member if one were needed(P < 0.001);(9) having discussed the subject with one's family(P < 0.001) and friends(P < 0.001);(10) a partner's opinion about the subject(P < 0.001);(11) carrying out activities of an altruistic nature; and(12) fear of the possible mutilation of the body after donation(P < 0.001).CONCLUSION: Spanish medical students have a favorable attitude toward LLD.展开更多
文摘The reform stems from honesty and determination. Since 2005, organ donation and transplantation in China has undergone thorough reform, which complies with legislation requirements and ethical principles established by the World Health Organization(WHO). Reform in China has demonstrated the unwavering confidence and utmost determination of the Chinese government and the Chinese transplantation community. The year 2015 marked a historic turning point when voluntary donations from Chinese citizens became the sole legitimate source for organ transplantation. Since 2015, China has gradually established and refined the “Chinese Mode” and “China System” for organ donation and transplantation, fulfilling its political pledge of reform, and has garnered international recognition, and fostered a social culture which promotes organ donation. This article reviewed the history of reform on organ donation and transplantation in China, presented a new pattern of establishment of organ donation system in the new era of the country, and the direction of advances in the future.
文摘China’s rice donation to Uganda’s drought-stricken Karamoja sub-region saves thousands from starvation.Afriend in need is a friend indeed,said Thomas Lokirut,an elder from Uganda’s Karamojong people after learning that China had donated 1,610 tonnes of rice to his people.
文摘BACKGROUNDLimited research exists on attitudes and barriers to organ donation in the UnitedArab Emirates, highlighting the need for a deeper understanding of public perceptionsand challenges.AIMTo assess the attitudes and barriers toward organ donation.METHODSA cross-sectional study was adopted and included 607 samples consisting ofstudents, faculty, and staff who were selected from three universities in Ajmanand who had signed consent forms. A validated self-administered questionnairethat included 13 attitudes and 14 barrier items was used as a tool. The reliabilityof the tool was 0.89 (Cronbach's alpha). In the analysis of attitude scores, responseswere rated on a scale from 0 to 4, with 0 representing 'strongly disagree'and 4 representing 'strongly agree' for supportive attitudes towards organdonation. Participants with a total attitude score of 39 or higher indicated agreementor strong agreement with all items, reflecting a generally supportiveattitude toward organ donation. Lower scores suggested that the respondent wasneutral or disagreed with one or more items, indicating a less supportive attitudetoward organ donation. Knowledge about organ donation was assessed by selfadministeredquestionnaire that included 13 items. Analysis was done using SPSSversion 29. χ2 was used to assess associations between variables.RESULTSMost participants were young (≤ 30 years old, 83.7%), female (79.2%), from World Health Organization Eastern Mediterranean Region countries (69.5%), Muslim (82.4%), students (80.6%), single(83.9%), and from a nursing college (33.1%). The majority had no personal or family history of organ donation(93.2% and 93.9%, respectively). Supportive attitudes toward organ donation were significantly associated withreligion (P = 0.003), working status (P = 0.009), university (P = 0.019), and knowledge (P < 0.001). Additionally,those with a personal or family history of organ donation were significantly more supportive (56.8% vs 33.3%, P =0.004). Lack of awareness was the most reported barrier for organ donation (64.1%) followed by being afraid oforgan donation due to medical procedures required (51.9%).CONCLUSIONThe findings suggest that supportive attitudes toward organ donation are influenced by demographic factors,personal experiences, and knowledge levels. Lack of awareness and fear of medical procedures were the mostreported barriers to organ donation. These results highlight the need for targeted educational programs to increaseawareness and promote positive attitudes toward organ donation.
文摘BACKGROUND Opioids are commonly used for management of post-operative pain in living kidney donors.Reducing exposure to opioids is desirable to minimize risk of dependence and potential side effects such as nausea,vomiting,and constipation which may delay discharge.Liposomal bupivacaine,ketorolac,and scheduled acetaminophen have all demonstrated efficacy for management of post-operative pain in this population.AIM To assess the efficacy and safety of an opioid-sparing protocol utilizing a multimodal pain management approach in living kidney donors post-nephrectomy.METHODS Single-center,retrospective chart review study examining 52 living kidney donors(26 pre-protocol implementation,26 post-protocol implementation)from May 24th,2019 to September 27th,2023.Patients in the post-protocol group received intraoperative liposomal bupivacaine,hydromorphone PCA(until able to tolerate oral medications),15 mg of intravenous ketorolac every 6 hours for 3 doses,and scheduled oral acetaminophen,in addition to oxycodone as needed for moderate to severe pain.The primary endpoint was oral morphine equivalent(OME)use within 48 hours post-surgery.Secondary endpoints include average daily pain scale within 48 hours post-surgery,length of stay(LOS)(days),and incidence of new acute kidney injury(AKI)or gastrointestinal(GI)bleed during admission per provider.Differences between the pre-and post-protocol implementation groups were compared utilizing the exact Wilcoxon test for continuous variables and either the Fisher’s Exact orχ^(2) test for categorical variables.RESULTS Patients in the pre-protocol implementation group received more OME(mg)within 48 hours post-surgery when compared to the post-protocol group(median:84.5 vs 69.0).The median of total OME over the course of admission was numerically greater the pre-protocol group(105.0 vs 69.0),and was significantly more per LOS(41.3 vs 25.7,P=0.02).Average daily pain score was not statistically significantly different between the two groups on postoperative day 1(median:5.3 vs 4.4;P=0.43)and post-operative day 2(median:4.7 vs 5.2;P=0.96).No significant differences were found in provider-identified incidences of AKI or GI bleeding during admission.There was no difference in serum creatinine at the time of discharge between the two groups.CONCLUSION A multimodal,opioid-sparing pain management protocol was as effective for pain control and resulted in significantly less opioid daily exposure over LOS.No adverse events were found related to use of ketorolac in patients undergoing donor nephrectomy.Our findings suggest that an opioid-sparing protocol is both safe and effective at minimizing opioid exposure and managing post-operative pain within the first 48 hours post-surgery.
文摘BACKGROUND Organ donation and transplantation are vital for saving lives,yet awareness remains limited.Health literacy,the ability to understand and use health information,and self-control,which influences decision-making,are crucial factors in promoting awareness.Understanding their relationship can guide efforts to increase participation in organ donation.AIM To investigate the effect of health literacy on organ donation and transplantation awareness,with self-control acting as a mediator,and to emphasize its importance.METHODS The study comprised 345 adults recruited from five different cities in Türkiye.The sample included 208 women(60.29%)and 137 men(39.71%).The age range of the sample group varies between 18 and 49(median age=24.13;SD=8.81).Selfreport data were collected including psychometric measures assessing organ donation and transplantation awareness,health literacy,and self-control.Reliability analysis,descriptive statistics,correlational analysis,and mediational analysis of the data were carried.RESULTS The analysis showed that health literacy was positively correlated with organ donation and transplantation awareness(r=0.340)and self-control(r=0.376).Self-control was positively related to organ donation and transplantation awareness(r=0.531).Mediating analysis supported a mediation model where health literacy was found to influence organ donation and transplantation awareness via self-control(bootstrap=0.158,95%confidence interval=0.105-0.215).CONCLUSION The results indicate that self-control mediates the positive relationship between health literacy and organ donation and transplantation awareness.Enhancing individuals’health literacy may therefore increase awareness of organ donation and transplantation through improvements in self-control.
文摘BACKGROUND Marginal donation after circulatory death(DCD)liver grafts are carefully used to combat the constant shortage of donors.Clinically,the worst outcomes are mainly related to severe ischemia-reperfusion-injury and the dangerous effect of various inflammatory cytokines(CK).The machine perfusion(MP)is a promising device to rescue these grafts.AIM To analyze the role of MP connected to a sorbent cartridge(PerSorb®)and used for very damaged DCD pig livers.METHODS Seven grafts were procured from pigs from a slaughterhouse.Grafts were made very marginal with at least 60 minutes of donor warm ischemia time and 24 hours of static-cold ischemia time:(1)3 grafts were perfused in hypothermic MP with PerSorb(Sorb);(2)2 other grafts in hypothermic MP(HMP)without the cartridge(NoSorb);and(3)The other 2 livers stored in the ice box(NoTreat).The CK were measured at HMP start(T0)and at the end(Tend).Biopsies were taken at T0 and Tend.RESULTS All 5 grafts treated with HMP had a negative lactate trend after 3 hours of treatment(8.83 at T0 vs 6.4 at Tend of Sorb;15 at T0 vs 5.45 at Tend for NoSorb,P value>0.05).At Tend,both Sorb and NoSorb groups had better hemodynamic parameters,comparable between the two groups.Enzyme-linked immunosorbent assay analysis showed a reduction of monocyte chemotactic protein-1,tumor necrosis factor-alpha and interleukin-1βfor NoSorb group at Tend and a complete downregulation to physiological levels of the same CK in Sorb livers after 3 hours of treatment.Biopsies showed a reduction of the perisinusoidal edema for the Sorb grafts compared with the NoSorb livers.CONCLUSION These data suggest a potential protective role of treatment of grafts with MP and sorbent cartridge in reducing the inflammatory response after a severe ischemic injury.
文摘Evidence is not homogeneous on indicators able to monitor and assess qualityperformance for organ donation. This may be related to differences in healthcareorganizations among countries but also to the scarcity of data on this topic so far.In the present review, we assessed available evidence on quality metrics in solidorgan procurement in the United States and in Europe by means of a PubMedsearch. Evidence was summarized according to countries, considering that thedonation and transplantation systems differ from country to country. In UnitedStates, the assessment of these indicators is periodically performed by the nationalnetwork for organ sharing to evaluate the performance of each Organ ProcurementOrganization (OPO). Quality metrics consider several factors, in primispopulation characteristics (i.e. race/ethnicity, age, socio-economic status). That iswhy the assessment of each OPO performance relies on several quality metrics,not only one single indicator. In Europe, quality improvement programs representa structural element of organ and transplant system in several countries, but fewpapers have to date addressed the results obtained by a quality improvementprogram based on indicators. In Poland, the use of quality indicators and improvementprocedures were associated with better results in those hospitals whichimplemented these programs in respect to hospitals who did not. In TuscanyRegion (Italy) the implementation of a monitoring and reporting approach basedon indicators by the Regional Transplant Center was associated with an increasedin transplant and donation activity (especially in cDCD donors). According toavailable evidence, the development of a method for quality assessment andquality improvement has been recognized as pivotal for donation and transplantauthorities to identify key interventions either at national and/or hospital levels.
文摘BACKGROUND Knowledge about organ donation and transplantation plays a crucial role in shaping individuals'health behaviors and perceptions,potentially impacting their health-related quality of life(HRQoL).Future anxiety,defined as the anticipatory worry individuals experience regarding potential negative events and outcomes in their future,may further influence these outcomes.AIM To investigate the effect of such knowledge on HRQoL and to examine whether future anxiety mediates this relationship.METHODS A cross-sectional study was conducted with 659 participants aged 18 to 65 years.Participants completed the Organ Tissue Donation and Transplantation Knowledge Scale,the Dark Future Scale,and the European Health Interview Survey-Quality of Life 8.Correlation analyses were performed,followed by Structural Equation Modeling to test the proposed mediation model.RESULTS The findings indicated that greater knowledge about organ donation and transplantation was positively associated with higher HRQoL and negatively associated with future anxiety.Future anxiety was negatively correlated with HRQoL.Structural Equation Modeling analysis indicated that knowledge directly enhanced HRQoL and reduced future anxiety.Additionally,future anxiety negatively affected HRQoL,mediating the relationship between knowledge and HRQoL.The mediation effect was significant,as confirmed by bootstrapping(bootstrap coefficient=0.068,95%CI:0.046-0.093).CONCLUSION The study concludes that future anxiety partially mediates the positive impact of knowledge about organ donation and transplantation on HRQoL.These results suggest that increasing public knowledge in this area may reduce future anxieties and enhance quality of life.
文摘BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine perfusion time(MPT)impact and potential clinical benefits is paramount and necessitates exploration.AIM To investigate the relationship between MPT and post-transplant graft function.METHODS Retrospective review of the first 50 donation after circulatory death(DCD)grafts preserved using NMPP in a tertiary institution was performed.Essential preser-vation time points,graft parameters,recipient information,and postoperative outcomes were prospectively recorded.Early allograft dysfunction(EAD),L-Graft7 score and 90-day outcomes were collected for all grafts.The first 20 re-cipients were allocated into the early group,considered the learning curve population for the center.The subsequent 30 were allocated into the late group.Recipients were also stratified into cohorts depending on MPT,i.e.,short(<8 hours),medium(8-16 hours)and long(>16 hours).RESULTS NMPP operational parameters were not predictive of EAD,L-GrAFT7 or 90-day outcomes.The early group had significantly less MPT and cold ischemia time than the late group(553 minutes vs 850 minutes,P<0.001)and(127.5 minutes vs 154 minutes,P=0.025),respectively.MPT had no impact in either group.CONCLUSION Increased MPT of DCD liver grafts had no adverse recipient results for the times utilized in this population,indicating its upper limits,likely beyond 24 hours,are not demonstrated within this study.Future studies are necessary to determine whether longer MPT is beneficial or detrimental to graft function and,if the latter,what is the maximum safe duration.Further studies of the effect of normothermic machine perfusion pump duration on long-term outcomes are also needed.
文摘This article provides a concise overview of the development of organ transplantation in China.Inspired by international advancements in organ transplantation,China embarked on its own organ transplantation research journey in 1958.The clinical evaluation phase is marked by the first cadaveric kidney transplant in 1960 and the first living-donor kidney transplant in 1972.By 1989,the annual number of successful kidney transplants had surpassed 1000.However,57 liver transplants were performed between 1977 and 1983;limitations in technology and the scarcity of cyclosporine A resulted in unfavorable outcomes for most recipients,with the majority succumbing within 3 months of surgery.These factors led to a near-complete halt in liver,heart,and lung transplants for the following decade.With all 4 conditions met-(1)mature surgical techniques,(2)powerful immunosuppressive agents available for clinical use,(3)new organ preservation solutions that ensure the quality and transportation of donor organs,and(4)reasonable and legal sources of organs-China's organ transplantation field has experienced rapid development.In 2014,there were 9652 organ transplants,and this number grew to 20,225 by 2022.Despite the progress,China's organ donation rate per million remains relatively low,3.86 ranking 48th globally in 2022,underscoring the need for increased public awareness and support for organ donation.
文摘BACKGROUND Liver grafts from donation after circulatory death(DCD)are associated with a higher risk of early graft dysfunction,determined by the warm ischemia and cold ischemia times.It is essential to have precise criteria to identify this complication in order to guide therapeutic strategies.AIM To validate different graft and recipient survival scores in patients undergoing liver transplantation(LT)with DCD grafts.METHODS A retrospective and observational unicentric study was conducted on 65 LT patients with grafts obtained from controlled DCD donors from November 2013 to November 2022.The United Kingdom(UK)risk score,early allograft dysfunction(EAD)Olthoff score,and model for early allograft function(MEAF)score were used to evaluate the risk of graft and recipient survival post-transplant.For survival analysis purposes,we used the Kaplan-Meier method,and the differences between subgroups were compared using the log-rank(Mantel-Cox)test.RESULTS Sixty-five patients were included in the study.The UK risk score did not demonstrate predictive capacity for recipient or graft survival.However,in donors aged over 70 years old(18.4%),it significantly predicted graft survival(P<0.05).According to Kaplan-Meier survival curves,graft survival rates at 6 months,2 years,and 5 years in the futility group dramatically decreased to 50%compared to the other groups(log-rank 8.806,P<0.05).The EAD Olthoff and MEAF scores did not demonstrate predictive capacity for recipient or graft survival.Based on Kaplan-Meier survival curves,patients with a MEAF score≥7 had a lower graft survival rate at 6 months,2 years,and 5 years compared to patients with a lower MEAF score(log-rank 4.667,P<0.05).CONCLUSION In our series,both UK DCD risk score and MEAF score showed predictive capability for graft survival.
文摘Objective:To assess the attitude and willingness of medical students of the Faculty of Medicine,University of Jaffna,regarding gamete donation.Methods:An institutional-based descriptive cross-sectional study was conducted at the Faculty of Medicine,University of Jaffna,from September 2022 to May 2023 among undergraduate medical students who gave their voluntary participation.A self-administered questionnaire was used as a study instrument to collect data regarding their attitude and willingness toward gamete donation.Results:A total of 345 participants were recruited and their sociodemographic data revealed that 56.8%of the participants were female,62.3%aged between 26 and 30 years,and 92.2%were unmarried.Many of them received information regarding gamete donations during their clinical appointments.Over half(67.8%)of them showed a negative attitude towards gamete donation.Regarding willingness,only 39.7%of participants had a positive approach for being a gamete donor;among them,84.7%preferred anonymous donations.Religion and ethnicity had a significant influence on their attitudes and willingness.In addition,male was also found to be more willing to donate gametes.Conclusions:Most medical students have negative views about gamete donation.Imparting awareness and knowledge of assisted reproductive technology and gamete donation within medical students'sociocultural and ethical backgrounds might facilitate a change in attitude towards gamete donation amongst future medical practitioners.
文摘There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting glucose and impaired glucose tolerance,is on the rise across the globe.Transplant teams frequently come across prediabetic kidney donors for evaluation.Prediabetics are at risk of diabetes,chronic kidney disease,cardiovascular events,stroke,neuropathy,retinopathy,dementia,depression and nonalcoholic liver disease along with increased risk of all-cause mortality.Unfortunately,most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period.There is lack of prospective long-term studies to know about the real risk of complications after donation.Furthermore,there are variations in recommendations from various guidelines across the globe for donations in prediabetics,leading to more confusion among clinicians.This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients.This review focuses on pathophysiological changes of PD in kidneys,potential complications of PD,other risk factors for development of type 2 diabetes,a review of guidelines for kidney donation,the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.
文摘BACKGROUND Organ donation is a critical issue that is receiving greater attention worldwide.In Jordan,the public’s knowledge about and attitudes toward organ donation play a significant role in the availability of organs for transplantation.AIM To assess the public knowledge about and attitudes toward organ donation in Jordan.METHODS A cross-sectional design was used to collect data from 396 Jordanian citizens via an online self-reported questionnaire.RESULTS Overall,396 participants were recruited.Of the entire sample,93.9%of the participants had heard about and had sufficient knowledge about organ donation but they had limited knowledge about brain death.The most common source of information about organ donation was social media networks.Females were found to score significantly higher than males for attitude.Those who had thought about organ donation or registered their names to donate scored signi-ficantly higher in terms of attitudes to donation than their counterparts who had not.The most common reasons for limited organ donation practices in Jordan were a lack of awareness programs and insufficient knowledge in society.CONCLUSION Greater public understanding of organ donation appears to be associated with more positive attitudes toward organ donation.Most participants responded positively regarding their attitude toward organ donation as they believed that this action could give another person a chance to live.Moreover,most agreed that they would donate their organs after their death.Otherwise,the participants had limited general knowledge about brain death,and most had not registered their names to donate their organs.These findings indicate the need for public awareness campaigns and educational programs to encourage more people to become organ donors.
文摘Introduction: One of the most frequent observations in long-term blood donation is chronic iron deficiency, which can develop into anaemia. The majority of blood screening methods employed by blood banks do not incorporate iron-status markers, which may result in potential subclinical iron deficiency. The aim of this study was to evaluate the effects of repeated blood donation on the levels of iron in the body and to guide blood donors in preventing the depletion of iron stores. Methods: Regular blood donors were categorised into distinct groups according to the number of donations they gave, and then the correlation between these groups and their bodies’ iron levels was examined. Different parameters were employed to identify iron deficiency and iron depletion in blood donors: serum ferritin, mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), total iron-binding capacity (TIBC), and serum iron. Results: The study included 300 individuals who regularly and willingly donated blood. There were no iron insufficiency cases among those donating blood for the first time (Group I). However, 15.5% of individuals who had donated once before (Group II) had ferritin levels of 15 - 30 μg/dl (ng/ml), indicating reduced iron stores. The rate increased to 18% (37 out of 206 individuals) among regular blood donors (Groups III, IV, and V). Iron deficiency (depletion) prevalence among regular blood donors in Groups III, IV, and V was 5.9% (12 out of 206) and 50.4% (100 out of 206). Donors who had donated blood most frequently had the lowest levels of haematological markers MCH, MCHC, and TIBC. Provide the p-values representing the differences between the means of MCV, MCH, iron, TIBC, and ferritin levels when comparing donor groups with the control group (Group I) based on the frequency of donations. Indicate statistically significant differences where the p-value is less than 0.0125. This significance level is adjusted based on the Bonferroni method, considering multiple independent tests. The result shows that the Iron parameter for the comparison between Group I and Group III and Group I and Group IV suggests a statistically significant difference in iron levels between these donor groups. Conclusion: The findings of this study show that a higher times of donations lads to a higher occurrence of depleted iron stores and subsequent erythropoiesis with iron deficiency by one donor from every three healthy donors. The iron and ferritin concentrations were within the normal range in group one (Control group) and reduced in the other four groups (G-2 to G-5). However, the level of haemoglobin remained within an acceptable range for blood donation. This outcome suggests that it may be necessary to reassess the criteria for accepting blood donors. The average serum ferritin levels were examined in all five groups (G-1 to G-5), both for males and females, and significant variations were seen among the groups under study. This study found that 35% of the individuals who regularly donate blood have iron-deficient anaemia (sideropenia). This suggests that it would be beneficial to test for serum ferritin at an earlier stage, ideally after three donations.
文摘To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD pathway.While ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP teams.Although existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD pathway.Thus,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile team.We also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the program.Differences were identified between the mobile ECMO team and NRP mobile team.The common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic time.Dedicated training programs should be developed for the launch of de novo NRP teams.
文摘Objective:To assess the management effect of comprehensive nursing management on blood donation services in blood stations.Methods:Sixty-four individuals who donated blood at a blood station between September 2021 and September 2023 were selected and randomly assigned into two groups of 32 each.The first group received comprehensive nursing management,while the second group received routine nursing management.Blood donation indexes and observational indexes such as adverse reactions were compared between the groups.Results:The total blood donation volume and qualified blood donation volume were higher in the first group than in the second group.The amount of discarded blood and the rate of blood discards were lower in the first group compared to the second group(P<0.05).Additionally,the adverse reaction rate in the first group was lower,the blood donation comfort scores were higher,the psychological state scores were lower,and the quality of care scores were higher than those in the second group(P<0.05).Conclusion:Comprehensive nursing management can improve the efficiency of blood donation,reduce the rate of blood discards,decrease the incidence of adverse reactions,alleviate negative psychological states of blood donors,and enhance both the comfort level of blood donation and the quality of care provided.
文摘There is continuing disparity between demand for and supply of kidneys for transplantation. This review describes the current state of kidney donation after cardiac death （DCD） and provides recommendations for a way forward. The conversion rate for potential DCD donors varies from 40%-80%. Compared to con-trolled DCD, uncontrolled DCD is more labour intensive, has a lower conversion rate and a higher discard rate. The super-rapid laparotomy technique involving direct aortic cannulation is preferred over in situ perfusion in controlled DCD donation and is associated with lower kidney discard rates, shorter warm ischaemia times and higher graft survival rates. DCD kidneys showed a 5.73-fold increase in the incidence of delayed graft function （DGF） and a higher primary non function rate compared to donation after brain death kidneys, but the long term graft function is equivalent between the two. The cold ischaemia time is a controllable factor that signifcantly infuences the outcome of allografts, for example, limiting it to 〈 12 h markedly reduces DGF. DCD kidneys from donors 〈 50 function like stan-dard criteria kidneys and should be viewed as such. As the majority of DCD kidneys are from controlled dona-tion, incorporation of uncontrolled donation will expand the donor pool. Efforts to maximise the supply of kid-neys from DCD include： implementing organ recovery from emergency department setting; improving family consent rate; utilising technological developments to optimise organs either prior to recovery from donors or during storage; improving organ allocation to ensure best utility; and improving viability testing to reduce primary non function.
基金Supported by Inonu University Scientific Research Projects Coordination Unit,No.2018/976.
文摘BACKGROUND The most important factors affecting attitudes on organ donation are socioeconomic, educational, cultural, and religious factors in many countries.AIM To evaluate the attitudes, awareness, and knowledge levels of the Turkish adult population toward organ donation.METHODS This nationwide study surveyed 3000 adults(≥ 18 years) in Turkey. To ensure a representative sample, the Nomenclature of Territorial Units for Statistics-Ⅱ(modified for Turkey) was used. Turkey was divided into 26 regions based on social, economic, and geographic criteria as identified by the Turkish Statistical Institute. A stratified sampling method was used with an even distribution of adults across cities and towns based on population data. Data were collected by the PRP Research and Consultancy Company using computer-assisted personal interviews.RESULTS Out of 3000 individuals represented in the study population, 1465(48.8%) were male and 1535(51.2%) female. The results showed that most participants were under 45 years(59.0%) and married(72.1%), some had a bachelor’s degree or higher(21.9%), and very few(1.5%) had any direct experience with organ transplantation-whether in the family, or a family member on a transplantation waiting list. Most of the study population(88.3%) had not considered donating an organ, however, most(87.9%) said that they would accept an organ from a donor if they needed one. Among the individuals surveyed, 67% were willing to donate an organ to a close relative, while 26.8% would donate an organ to an unrelated person. Only 47.2% said they had adequate information about brain death, and 85.2% refused to consent to donating organs of family members declared brain dead. Only 33.9% thought they had adequate information about organ donation. The main source of information was the television. The two main reasons for refusing organ donation were that it was too soon to think about organ donation and the importance of retaining the integrity of the dead person’s body.CONCLUSION This study showed that Turkey’s adult population has inadequate knowledge about organ donation. The study advocates for public education programs to increase awareness among the general population about legislation related to organ donation.
文摘AIM: To analyze the attitude of Spanish medical students toward living liver donation(LLD) and to establish which factors have an influence on this attitude.METHODS: Study type: A sociological, interdisciplinary, multicenter and observational study. Study population: Medical students enrolled in Spain(n = 34000) in the university academic year 2010-2011. Sample size: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire(PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions. Statistical analysis: Student′s t test, χ^(2 )test and logistic regression analysis.RESULTS: The completion rate was 95.7%(n = 9275). 89%(n = 8258) were in favor of related LLD, and 32%(n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude:(1) age(P = 0.008);(2) sex(P < 0.001);(3) academic year(P < 0.001);(4) geographical area(P = 0.013);(5) believing in the possibility of needing a transplant oneself in the future(P < 0.001);(6) attitude toward deceased donation(P < 0.001);(7) attitude toward living kidney donation(P < 0.001);(8) acceptance of a donated liver segment from a family member if one were needed(P < 0.001);(9) having discussed the subject with one's family(P < 0.001) and friends(P < 0.001);(10) a partner's opinion about the subject(P < 0.001);(11) carrying out activities of an altruistic nature; and(12) fear of the possible mutilation of the body after donation(P < 0.001).CONCLUSION: Spanish medical students have a favorable attitude toward LLD.
