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
Although national transplant organizations share common visions and goals,the creation of a unified global organization remains impractical.Differences in ethnicity,culture,religion,and education shape local practices...Although national transplant organizations share common visions and goals,the creation of a unified global organization remains impractical.Differences in ethnicity,culture,religion,and education shape local practices and infrastructure,making the establishment of a single global entity unfeasible.Even with these social disparities aside,logistical factors such as time and distance between organ procurement and transplantation sites pose significant challenges.While technological advancements have extended organ preservation times,they have yet to support the demands of transcontinental transplantations effectively.This review presents a comparative analysis of the structures,operational frameworks,policies,and legislation governing various transplant organizations around the world.Key differences pertain to the administration of these organizations,trends in organ donation,and organ allocation policies,which reflect the financial,cultural,and religious diversity across different regions.While a global transplant organization may be out of reach,agreeing on best practices for the benefit of patients is essential.展开更多
April 2025 China has over 7 million registered organ donors More than 7.05 million people in China have registered as voluntary organ donors,according to data released during an awareness-raising event for organ donat...April 2025 China has over 7 million registered organ donors More than 7.05 million people in China have registered as voluntary organ donors,according to data released during an awareness-raising event for organ donation held on April 1.To date,58,000 posthumous organ donation surgeries,more than 63,000 body donations and over 110,000 corneal donations have been carried out.These donations have saved the lives of more than 170,000 people experiencing organ failure,and restored sight to over 100,000 individuals.To honor the donors,over 280 memorial sites have been established around China.During the Qingming Festival each year,commemorative events will be held across the country to promote awareness of and encourage greater public participation in this life-saving initiative.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
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
BACKGROUND Liver disease is a major cause of mortality in Mexico.Liver transplantation(LT)remains severely limited,and there are no reports on equity of access.AIM To analyze geographical disparities in LT access in M...BACKGROUND Liver disease is a major cause of mortality in Mexico.Liver transplantation(LT)remains severely limited,and there are no reports on equity of access.AIM To analyze geographical disparities in LT access in Mexico.METHODS LT waitlist registrations and LT rates in Mexico from 2014 to 2023 were assessed.LT listings per million persons(pmp)were calculated.Observed-to-expected listings were calculated by controlling listings pmp and mortality rate per 10000.LT and waitlist mortality was calculated as 90-day rate,overall rate and rate per 100 person-years.We compared access to waitlist,transplantation and mortality between patients living in Mexican States with higher LT activity and those living in other States.RESULTS There were 2600 new waitlist registrations;1572 registrations(60.4%)living in Mexico City and State,Jalisco and Nuevo Leon.There were 1755 LT;92.5%of them performed in States with higher LT activity,and 1101(62.7%vs 37.3%;P<0.001)done in patients living in those States.Listings pmp in the Mexican States with high LT activity were 3.8,1.5 vs 1.2,0.6(P<0.001);observed-to-expected listings were 1.3,0.4 vs 0.4,0.2(P<0.001);LT pmp were 2.7,0.9 vs 0.7,0.5(P<0.001).After controlling for other variables,patients living in high LT activity States had a HR 1.14(95%CI:1.03-1.26;P=0.009)to be a case of transplantation after listing.CONCLUSION Geographic disparities substantially affect LT access in Mexico.The population living near Transplant Centers has a 3.2-fold higher access to the waiting list and a 3.8-fold higher likelihood of LT.Current referral system,and resource allocation need urgent revision to remove the barriers associated with geographic disparity.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
In a crumbling tech hub near the marginal coastline,young Angolan developers,despite the challenges of unreliable Internet and dependence on foreign APIs(application programming interfaces),are tapping on donated lapt...In a crumbling tech hub near the marginal coastline,young Angolan developers,despite the challenges of unreliable Internet and dependence on foreign APIs(application programming interfaces),are tapping on donated laptops,debugging health apps that alert rural clinics of disease outbreaks.Their resilience and determination in the face of such obstacles are not just a source of innovation,but also of inspiration and hope.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
Khan et al’single-centre,retrospective study on the use of right or left kidneys in living-donor renal transplantation,offers the opportunity to further discuss a complex and debated topic in clinical transplantation...Khan et al’single-centre,retrospective study on the use of right or left kidneys in living-donor renal transplantation,offers the opportunity to further discuss a complex and debated topic in clinical transplantation.In brief,the authors confirm that,despite the historical preference for left kidneys,attributed to their anatomical advantages during donor nephrectomy and recipient transplantation,right kidneys can provide excellent outcomes when donors and recipients are carefully selected,and a meticulous surgical technique is applied in every step of the process.Usefully,the article includes some practical tips to help less experienced surgeons address the technical challenges of right kidney transplantation,such as extended renal vein dissection or full mobilization of the iliac vein of the recipient to minimize tension during anastomosis.Although limited by the selective use of minimally invasive(MI)nephrectomy for left kidneys,this work underscores the importance of expanding the living-donor pool,challenging the traditional taboos,and facilitating access to transplantation for a wider population of patients around the globe.Properly designed studies with larger sample size,comparable MI surgical techniques,prospective data collection,and long-term donor and recipient outcomes are warranted.展开更多
Extensive studies have identified potential adverse effects on semen quality of obesity, based on body mass index, but the association between body fat distribution, a more relevant indicator for obesity, and semen qu...Extensive studies have identified potential adverse effects on semen quality of obesity, based on body mass index, but the association between body fat distribution, a more relevant indicator for obesity, and semen quality remains less clear. We conducted a longitudinal study of 4304 sperm donors from the Guangdong Provincial Human Sperm Bank (Guangzhou, China) during 2017–2021. A body composition analyzer was used to measure total and local body fat percentage for each participant. Generalized estimating equations were employed to assess the association between body fat percentage and sperm count, motility, and morphology. We estimated that each 10% increase in total body fat percentage (estimated change [95% confidence interval, 95% CI]) was significantly associated with a 0.18 × 106 (0.09 × 106–0.27 × 106) ml and 12.21 × 106 (4.52 × 106–19.91 × 106) reduction in semen volume and total sperm count, respectively. Categorical analyses and exposure-response curves showed that the association of body fat distribution with semen volume and total sperm count was stronger at higher body fat percentages. In addition, the association still held among normal weight and overweight participants. We observed similar associations for upper limb, trunk, and lower limb body fact distributions. In conclusion, we found that a higher body fat distribution was significantly associated with lower semen quality (especially semen volume) even in men with a normal weight. These findings provide useful clues in exploring body fat as a risk factor for semen quality decline and add to evidence for improving semen quality for those who are expected to conceive.展开更多
Liver transplantation(LT)is the only curative treatment for end-stage liver disease.Although Mexico has made important strides in surgical capacity and institutional development,the country continues to report one of ...Liver transplantation(LT)is the only curative treatment for end-stage liver disease.Although Mexico has made important strides in surgical capacity and institutional development,the country continues to report one of the lowest LT rates in Latin America.Multiple challenges remain,including inequitable access to care,limited organ donation,and structural inefficiencies in allocation systems.To review the current status of LT in Mexico,describe historical trends,highlight significant barriers to progress,and discuss potential opportunities for program expansion.We conducted a narrative review incorporating data from the National Transplant Center(Centro Nacional de Trasplantes in Spanish),relevant peer-reviewed literature,and global benchmarks.The analysis focused on trends in liver transplant volume,donor types,etiology shifts,institutional disparities,and the impact of the coronavirus disease 2019(COVID-19)pandemic.LT activity in Mexico increased from 25 transplants in 1999 to 297 in 2023.However,over 68%of transplants are concentrated in Mexico City,and only eight centers perform more than ten LTs per year.Deceased donors account for most grafts,while living donor transplants remain rare and mostly limited to private institutions.The national waiting list functions primarily as a registry rather than a priority-based allocation system.The COVID-19 pandemic further disrupted transplant programs,particularly in the public sector.Innovative approaches such as donation after circulatory death,hepatitis C virus-positive donor utilization,and advanced perfusion technologies are currently unavailable or underutilized in Mexico.Mexico's LT system faces geographic,regulatory,and resource-related limitations.To improve outcomes and ensure equitable access,strategic reforms focused on donor expansion,centralized allocation,perfusion technologies,and standardization of care are urgently needed.展开更多
BACKGROUND Kidney transplantation is one of the most effective treatments for patients with end-stage renal disease.However,many regions face low deceased donor rates and limited ABO-compatible transplant availability...BACKGROUND Kidney transplantation is one of the most effective treatments for patients with end-stage renal disease.However,many regions face low deceased donor rates and limited ABO-compatible transplant availability,which increases reliance on living donors.These regional challenges necessitate the implementation of kidney paired donation(KPD)programs to overcome incompatibilities such as ABO mismatch or positive cross-matching,even when suitable and willing donors are available.AIM To evaluate the effectiveness of a single-center domino KPD model in both operational planning and clinical management processes and to assess its impact on clinical outcomes.METHODS Between April 2020 and January 2024,we retrospectively evaluated patients enrolled in our center’s domino kidney transplantation program.Donor-recipient pairs unable to proceed due to ABO incompatibility or positive cross-matching with their own living donors were included.Donors and recipients were assessed based on blood group compatibility,HLA tissue typing,and negative cross-match results.A specialized computer algorithm grouped patients into three-way,fourway,and five-way chains.All surgical procedures were performed on the same day at a single center.RESULTS A total of 169 kidney transplants were performed,forming 52 domino chains.These domino KPD transplants accounted for a notable proportion of our center’s overall transplant activity,which included both living donor kidney transplants and deceased donor transplants.Among these chains,the primary reasons for participation were ABO incompatibility(74%),positive cross-matching(10%),and the desire to improve HLA mismatch(16%).Improved HLA mismatch profiles and high graft survival(96%at 1 year,92%at 3 years)and patient survival(98%at 1 year,94%at 3 years)rates were observed,as well as low acute rejection episodes.CONCLUSION The single-center domino KPD model enhanced transplant opportunities for incompatible donor-recipient pairs while maintaining excellent clinical outcomes.By providing a framework that addresses regional challenges,improves operational efficiency,and optimizes clinical management,this model offers actionable insights to reduce waiting lists and improve patient outcomes.展开更多
The adsorption-catalysis ability of metal-based catalysts toward lithium polysulfides(LiPSs)is dominated by the position of their d-/p-band center.An available strategy to strengthen the d-p band center proximity of m...The adsorption-catalysis ability of metal-based catalysts toward lithium polysulfides(LiPSs)is dominated by the position of their d-/p-band center.An available strategy to strengthen the d-p band center proximity of metal-based catalysts is to fabricate a crystalline-amorphous heterointerface,which markedly enhances LiPS conversion.The polyanionic pyrophosphate of TiP_(2)O_(7)serves as an efficient catalyst and ionic conductor for lithium-sulfur(Li-S)batteries.However,TiP_(2)O_(7)does not fully optimize sulfur redox reactivity due to limitations in factors such as the adsorption-catalysis of sulfur species,Li^(+)diffusion,and electron transfer.Herein,we engineer the crystalline-amorphous heterointerface of TiP_(2)O_(7)combined with carbon nanotubes(CNTs)to facilitate electronic donation from C to TiP_(2)O_(7).This interaction results in an upward shift of the Ti d,enhancing the proximity of the d-p band center in TiP_(2)O_(7)/CNTs.By utilizing TiP_(2)O_(7)/CNTs as both electrode and separator modifier,we optimize the LiPS conversion process,showing a comprehensive strategy to mitigate the diffusion of LiPSs and achieve the bidirectional redox reactions in Li-S batteries.Accordingly,the cell assembled by TiP_(2)O_(7)/CNTs delivers a satisfactory capacity of835 mAh g^(-1)after 300 cycles at 4 C and an impressive initial areal capacity of 3.52 mAh cm^(-2)under the sulfur areal loading of 5 mg cm^(-2)at 0.1 C.Additionally,the Li//Li cells utilizing TiP_(2)O_(7)/CNTs present a prolonged cycling life of up to 1800 h without voltage fluctuation and Li dendrite growth.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
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
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Although national transplant organizations share common visions and goals,the creation of a unified global organization remains impractical.Differences in ethnicity,culture,religion,and education shape local practices and infrastructure,making the establishment of a single global entity unfeasible.Even with these social disparities aside,logistical factors such as time and distance between organ procurement and transplantation sites pose significant challenges.While technological advancements have extended organ preservation times,they have yet to support the demands of transcontinental transplantations effectively.This review presents a comparative analysis of the structures,operational frameworks,policies,and legislation governing various transplant organizations around the world.Key differences pertain to the administration of these organizations,trends in organ donation,and organ allocation policies,which reflect the financial,cultural,and religious diversity across different regions.While a global transplant organization may be out of reach,agreeing on best practices for the benefit of patients is essential.
文摘April 2025 China has over 7 million registered organ donors More than 7.05 million people in China have registered as voluntary organ donors,according to data released during an awareness-raising event for organ donation held on April 1.To date,58,000 posthumous organ donation surgeries,more than 63,000 body donations and over 110,000 corneal donations have been carried out.These donations have saved the lives of more than 170,000 people experiencing organ failure,and restored sight to over 100,000 individuals.To honor the donors,over 280 memorial sites have been established around China.During the Qingming Festival each year,commemorative events will be held across the country to promote awareness of and encourage greater public participation in this life-saving initiative.
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BACKGROUND Liver disease is a major cause of mortality in Mexico.Liver transplantation(LT)remains severely limited,and there are no reports on equity of access.AIM To analyze geographical disparities in LT access in Mexico.METHODS LT waitlist registrations and LT rates in Mexico from 2014 to 2023 were assessed.LT listings per million persons(pmp)were calculated.Observed-to-expected listings were calculated by controlling listings pmp and mortality rate per 10000.LT and waitlist mortality was calculated as 90-day rate,overall rate and rate per 100 person-years.We compared access to waitlist,transplantation and mortality between patients living in Mexican States with higher LT activity and those living in other States.RESULTS There were 2600 new waitlist registrations;1572 registrations(60.4%)living in Mexico City and State,Jalisco and Nuevo Leon.There were 1755 LT;92.5%of them performed in States with higher LT activity,and 1101(62.7%vs 37.3%;P<0.001)done in patients living in those States.Listings pmp in the Mexican States with high LT activity were 3.8,1.5 vs 1.2,0.6(P<0.001);observed-to-expected listings were 1.3,0.4 vs 0.4,0.2(P<0.001);LT pmp were 2.7,0.9 vs 0.7,0.5(P<0.001).After controlling for other variables,patients living in high LT activity States had a HR 1.14(95%CI:1.03-1.26;P=0.009)to be a case of transplantation after listing.CONCLUSION Geographic disparities substantially affect LT access in Mexico.The population living near Transplant Centers has a 3.2-fold higher access to the waiting list and a 3.8-fold higher likelihood of LT.Current referral system,and resource allocation need urgent revision to remove the barriers associated with geographic disparity.
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In a crumbling tech hub near the marginal coastline,young Angolan developers,despite the challenges of unreliable Internet and dependence on foreign APIs(application programming interfaces),are tapping on donated laptops,debugging health apps that alert rural clinics of disease outbreaks.Their resilience and determination in the face of such obstacles are not just a source of innovation,but also of inspiration and hope.
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Khan et al’single-centre,retrospective study on the use of right or left kidneys in living-donor renal transplantation,offers the opportunity to further discuss a complex and debated topic in clinical transplantation.In brief,the authors confirm that,despite the historical preference for left kidneys,attributed to their anatomical advantages during donor nephrectomy and recipient transplantation,right kidneys can provide excellent outcomes when donors and recipients are carefully selected,and a meticulous surgical technique is applied in every step of the process.Usefully,the article includes some practical tips to help less experienced surgeons address the technical challenges of right kidney transplantation,such as extended renal vein dissection or full mobilization of the iliac vein of the recipient to minimize tension during anastomosis.Although limited by the selective use of minimally invasive(MI)nephrectomy for left kidneys,this work underscores the importance of expanding the living-donor pool,challenging the traditional taboos,and facilitating access to transplantation for a wider population of patients around the globe.Properly designed studies with larger sample size,comparable MI surgical techniques,prospective data collection,and long-term donor and recipient outcomes are warranted.
基金supported by the Guangdong Natural Science Foundation(No.2022A1515011705).
文摘Extensive studies have identified potential adverse effects on semen quality of obesity, based on body mass index, but the association between body fat distribution, a more relevant indicator for obesity, and semen quality remains less clear. We conducted a longitudinal study of 4304 sperm donors from the Guangdong Provincial Human Sperm Bank (Guangzhou, China) during 2017–2021. A body composition analyzer was used to measure total and local body fat percentage for each participant. Generalized estimating equations were employed to assess the association between body fat percentage and sperm count, motility, and morphology. We estimated that each 10% increase in total body fat percentage (estimated change [95% confidence interval, 95% CI]) was significantly associated with a 0.18 × 106 (0.09 × 106–0.27 × 106) ml and 12.21 × 106 (4.52 × 106–19.91 × 106) reduction in semen volume and total sperm count, respectively. Categorical analyses and exposure-response curves showed that the association of body fat distribution with semen volume and total sperm count was stronger at higher body fat percentages. In addition, the association still held among normal weight and overweight participants. We observed similar associations for upper limb, trunk, and lower limb body fact distributions. In conclusion, we found that a higher body fat distribution was significantly associated with lower semen quality (especially semen volume) even in men with a normal weight. These findings provide useful clues in exploring body fat as a risk factor for semen quality decline and add to evidence for improving semen quality for those who are expected to conceive.
文摘Liver transplantation(LT)is the only curative treatment for end-stage liver disease.Although Mexico has made important strides in surgical capacity and institutional development,the country continues to report one of the lowest LT rates in Latin America.Multiple challenges remain,including inequitable access to care,limited organ donation,and structural inefficiencies in allocation systems.To review the current status of LT in Mexico,describe historical trends,highlight significant barriers to progress,and discuss potential opportunities for program expansion.We conducted a narrative review incorporating data from the National Transplant Center(Centro Nacional de Trasplantes in Spanish),relevant peer-reviewed literature,and global benchmarks.The analysis focused on trends in liver transplant volume,donor types,etiology shifts,institutional disparities,and the impact of the coronavirus disease 2019(COVID-19)pandemic.LT activity in Mexico increased from 25 transplants in 1999 to 297 in 2023.However,over 68%of transplants are concentrated in Mexico City,and only eight centers perform more than ten LTs per year.Deceased donors account for most grafts,while living donor transplants remain rare and mostly limited to private institutions.The national waiting list functions primarily as a registry rather than a priority-based allocation system.The COVID-19 pandemic further disrupted transplant programs,particularly in the public sector.Innovative approaches such as donation after circulatory death,hepatitis C virus-positive donor utilization,and advanced perfusion technologies are currently unavailable or underutilized in Mexico.Mexico's LT system faces geographic,regulatory,and resource-related limitations.To improve outcomes and ensure equitable access,strategic reforms focused on donor expansion,centralized allocation,perfusion technologies,and standardization of care are urgently needed.
文摘BACKGROUND Kidney transplantation is one of the most effective treatments for patients with end-stage renal disease.However,many regions face low deceased donor rates and limited ABO-compatible transplant availability,which increases reliance on living donors.These regional challenges necessitate the implementation of kidney paired donation(KPD)programs to overcome incompatibilities such as ABO mismatch or positive cross-matching,even when suitable and willing donors are available.AIM To evaluate the effectiveness of a single-center domino KPD model in both operational planning and clinical management processes and to assess its impact on clinical outcomes.METHODS Between April 2020 and January 2024,we retrospectively evaluated patients enrolled in our center’s domino kidney transplantation program.Donor-recipient pairs unable to proceed due to ABO incompatibility or positive cross-matching with their own living donors were included.Donors and recipients were assessed based on blood group compatibility,HLA tissue typing,and negative cross-match results.A specialized computer algorithm grouped patients into three-way,fourway,and five-way chains.All surgical procedures were performed on the same day at a single center.RESULTS A total of 169 kidney transplants were performed,forming 52 domino chains.These domino KPD transplants accounted for a notable proportion of our center’s overall transplant activity,which included both living donor kidney transplants and deceased donor transplants.Among these chains,the primary reasons for participation were ABO incompatibility(74%),positive cross-matching(10%),and the desire to improve HLA mismatch(16%).Improved HLA mismatch profiles and high graft survival(96%at 1 year,92%at 3 years)and patient survival(98%at 1 year,94%at 3 years)rates were observed,as well as low acute rejection episodes.CONCLUSION The single-center domino KPD model enhanced transplant opportunities for incompatible donor-recipient pairs while maintaining excellent clinical outcomes.By providing a framework that addresses regional challenges,improves operational efficiency,and optimizes clinical management,this model offers actionable insights to reduce waiting lists and improve patient outcomes.
基金supported by the National Natural Science Foundation of China(22278347)。
文摘The adsorption-catalysis ability of metal-based catalysts toward lithium polysulfides(LiPSs)is dominated by the position of their d-/p-band center.An available strategy to strengthen the d-p band center proximity of metal-based catalysts is to fabricate a crystalline-amorphous heterointerface,which markedly enhances LiPS conversion.The polyanionic pyrophosphate of TiP_(2)O_(7)serves as an efficient catalyst and ionic conductor for lithium-sulfur(Li-S)batteries.However,TiP_(2)O_(7)does not fully optimize sulfur redox reactivity due to limitations in factors such as the adsorption-catalysis of sulfur species,Li^(+)diffusion,and electron transfer.Herein,we engineer the crystalline-amorphous heterointerface of TiP_(2)O_(7)combined with carbon nanotubes(CNTs)to facilitate electronic donation from C to TiP_(2)O_(7).This interaction results in an upward shift of the Ti d,enhancing the proximity of the d-p band center in TiP_(2)O_(7)/CNTs.By utilizing TiP_(2)O_(7)/CNTs as both electrode and separator modifier,we optimize the LiPS conversion process,showing a comprehensive strategy to mitigate the diffusion of LiPSs and achieve the bidirectional redox reactions in Li-S batteries.Accordingly,the cell assembled by TiP_(2)O_(7)/CNTs delivers a satisfactory capacity of835 mAh g^(-1)after 300 cycles at 4 C and an impressive initial areal capacity of 3.52 mAh cm^(-2)under the sulfur areal loading of 5 mg cm^(-2)at 0.1 C.Additionally,the Li//Li cells utilizing TiP_(2)O_(7)/CNTs present a prolonged cycling life of up to 1800 h without voltage fluctuation and Li dendrite growth.
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.
