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Background: The demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA's impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors. Methods: We conducted a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1–4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation. Results: Of the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09–12.12), with non-medical aetiology as associated factors. Conclusion: The enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions. [ABSTRACT FROM AUTHOR]

Abstract Background The demand for organ transplants, both globally and in South Korea, substantially exceeds the supply, a situation that might have been aggravated by the enactment of the Life-Sustaining Treatment Decision Act (LSTDA) in February 2018. This legislation may influence emergency medical procedures and the availability of organs from brain-dead donors. This study aimed to assess LSTDA’s impact, introduced in February 2018, on organ donation status in out-of-hospital cardiac arrest (OHCA) patients in a metropolitan city and identified related factors. Methods We conducted a retrospective analysis of a regional cardiac arrest registry. This study included patients aged 16 or older with cardiac arrest and a cerebral performance category (CPC) score of 5 from January 2015 to December 2022. The exclusion criteria were CPC scores of 1–4, patients under 16 years, and patients declared dead or transferred from emergency departments. Logistic regression analysis was used to analyse factors affecting organ donation. Results Of the 751 patients included in this study, 47 were organ donors, with a median age of 47 years. Before the LSTDA, there were 30 organ donations, which declined to 17 after its implementation. In the organ donation group, the causes of cardiac arrest included medical (34%), hanging (46.8%), and trauma (19.2%). The adjusted odds ratio for organ donation before the LSTDA implementation was 6.12 (95% CI 3.09–12.12), with non-medical aetiology as associated factors. Conclusion The enactment of the LSTDA in 2018 in South Korea may be linked to reduced organ donations among patients with OHCA, underscoring the need to re-evaluate the medical and legal aspects of organ donation, especially considering end-of-life care decisions.

The article discusses the early experience of controlled donation after circulatory death (cDCD) heart transplantation in Italy, where a 20-minute no-touch period is required for circulatory death declaration. Despite initial concerns, the first cDCD heart transplant in Italy was successfully performed in May 2023. The study analyzed 21 cDCD heart transplants performed between April 2023 and March 2024, showing a 100% 30-day organ survival rate and a 90.5% 30-day patient survival rate. The results suggest that cDCD heart transplantation is a feasible procedure in Italy, even with older donors and longer donor asystolic times. [Extracted from the article]

Objective. To obtain a comprehensive overview of organ donation, organ utilization, and discard in the entire donation process in Colombia. Methods. A retrospective study of 1 451 possible donors, distributed in three regions of Colombia, evaluated in 2022. The general characteristics, diagnosis, and causes of contraindication for potential donors were described. Results. Among the 1 451 possible donors, 441 (30.4%) fulfilled brain death criteria, constituting the potential donor pool. Families consented to organ donation in 141 medically suitable cases, while 60 instances utilized legal presumption, leading to 201 eligible donors (13.9%). Of those, 160 (11.0%) were actual donors (in whom operative incision was made with the intent of organ recovery or who had at least one organ recovered). Finally, we identified 147 utilized donors (10.1%) (from whom at least one organ was transplanted). Statistically significant differences were found between age, sex, diagnosis of brain death, and donor critical pathway between regions. A total of 411 organs were transplanted from 147 utilized donors, with kidneys being the most frequently procured and transplanted organs, accounting for 280 (68.1%) of the total. This was followed by 85 livers (20.7%), 31 hearts (7.5%), 14 lungs (3.4%), and 1 pancreas (0.2%). The discard rate of procured deceased donors was 8.1%. Conclusions. About one-tenth of donors are effectively used for transplantation purposes. Our findings highlight areas of success and challenges, providing a basis for future improvements in Colombia.

Amygdalin is an aromatic cyanogenic glycoside, and available in tablet form as amygdalin, vitamin B17 or laetrile. We describe an intentional amygdalin drug overdose resulting in fatal cyanide poisoning which eventuated into tissue and organ procurement with successful organ transplantation. Because measured cyanide concentrations were not immediately available, the ICU adopted a 48-hour observation period to monitor organ function and lactate concentrations to determine suitability for organ tissue donation. This led to the acceptance of the heart, liver and one kidney. All three transplant recipients were doing well in the 12 months following donation.

Background: Limited data are available on organ donation practices and recipient outcomes, particularly when comparing donors who experienced cardiac arrest and received extracorporeal cardiopulmonary resuscitation (ECPR) followed by veno-arterial extracorporeal membrane oxygenation (ECMO) decannulation, versus those who experienced cardiac arrest without receiving ECPR. This study aims to explore organ donation practices and outcomes post-ECPR to enhance our understanding of the donation potential after cardiac arrest. Methods: We conducted a nationwide retrospective cohort study using data from the Japan Organ Transplant Network database, covering all deceased organ donors between July 17, 2010, and August 31, 2022. We included donors who experienced at least one episode of cardiac arrest. During the study period, patients undergoing ECMO treatment were not eligible for a legal diagnosis of brain death. We compared the timeframes associated with each donor's management and the long-term graft outcomes of recipients between ECPR and non-ECPR groups. Results: Among 370 brain death donors with an episode of cardiac arrest, 26 (7.0%) received ECPR and 344 (93.0%) did not; the majority were due to out-of-hospital cardiac arrests. The median duration of veno-arterial ECMO support after ECPR was 3 days. Patients in the ECPR group had significantly longer intervals from admission to organ procurement compared to those not receiving ECPR (13 vs. 9 days, P = 0.005). Lung graft survival rates were significantly lower in the ECPR group (log-rank test P = 0.009), with no significant differences in other organ graft survival rates. Of 160 circulatory death donors with an episode of cardiac arrest, 27 (16.9%) received ECPR and 133 (83.1%) did not. Time intervals from admission to organ procurement following circulatory death and graft survival showed no significant differences between ECPR and non-ECPR groups. The number of organs donated was similar between the ECPR and non-ECPR groups, regardless of brain or circulatory death. Conclusions: This nationwide study reveals that lung graft survival was lower in recipients from ECPR-treated donors, highlighting the need for targeted research and protocol adjustments in post-ECPR organ donation. [ABSTRACT FROM AUTHOR]

Introduction. The critical pathway for deceased donation offers a methodical framework for guiding the donation process. It not only serves to assess performance but also to identify areas of potential improvement. Therefore, the identification and selection of potential organ donors (POD) is a key process. This study aims to describe the critical pathway for deceased donation in a cohort of POD in three regions (CRT1, CRT2, and CRT5) of Colombia. Methods. We retrospectively reviewed data of POD assessed from January 2022 to December 2022. General characteristics of POD, diagnosis, contraindication causes, and organ procurement were described. Analysis was conducted using the Chi-squared test for categorical variables and the Mann-Whitney test for quantitative variables. Results. Within the cohort of 1451 assessed POD, 441 (30.3%) were diagnosed with brain death. Among potential donors after brain death, 198 (44.9%) were eligible donors (medically suitable). Of these, 157 donors (79.3%) became actual donors (undergoing operative incision for organ recovery), with 147 (93,6 %) having at least one organ recovered (actual donors with organ recovery). Ultimately, 411 utilized organs were utilized. Additionally, there were observed differences in the characteristics of donors from different regions. Conclusion. This study reports the critical pathway for deceased donation in a cohort of POD in three regions of Colombia. This provides useful information and helps to gain insight and understanding into the process of organ donation and organ procurement in order to take actions that could improve the donation rates. [ABSTRACT FROM AUTHOR]

Introduction: Thoracoabdominal normothermic regional perfusion (TA‐NRP) following cardiac death is an emerging multivisceral organ procurement technique. Recent national studies on outcomes of presumptive TA‐NRP‐procured organs are limited by potential misclassification since TA‐NRP is not differentiated from donation after cardiac death (DCD) in registry data. Methods: We studied 22 donors whose designees consented to TA‐NRP and organ procurement performed at our institution between January 20, 2020 and July 3, 2022. We identified these donors in SRTR to describe organ utilization and recipient outcomes and compared them to recipients of traditional DCD (tDCD) and donation after brain death (DBD) organs during the same timeframe. Results: All 22 donors progressed to cardiac arrest and underwent TA‐NRP followed by heart, lung, kidney, and/or liver procurement. Median donor age was 41 years, 55% had anoxic brain injury, 45% were hypertensive, 0% were diabetic, and median kidney donor profile index was 40%. TA‐NRP utilization was high across all organ types (88%–100%), with a higher percentage of kidneys procured via TA‐NRP compared to tDCD (88% vs. 72%, p =.02). Recipient and graft survival ranged from 89% to 100% and were comparable to tDCD and DBD recipients (p ≥.2). Delayed graft function was lower for kidneys procured from TA‐NRP compared to tDCD donors (27% vs. 44%, p =.045). Conclusion: Procurement from TA‐NRP donors yielded high organ utilization, with outcomes comparable to tDCD and DBD recipients across organ types. Further large‐scale study of TA‐NRP donors, facilitated by its capture in the national registry, will be critical to fully understand its impact as an organ procurement technique. [ABSTRACT FROM AUTHOR]

Background: Prolonged ischemic times (IT) for transplant hearts transported under cold storage conditions are associated with an increased risk of mortality; however, the impact of IT on functional outcomes, such as exercise capacity (EC), is not fully understood. This prospective, observational cohort study aimed to determine the association between EC, a strong predictor for post-transplant survival, and relatively longer IT. Methods: Thirty heart transplant recipients were grouped dichotomously according to relatively longer (>180 minutes) or shorter (≤180 minutes) IT. A cardiopulmonary exercise test (CPET) was performed post-transplant upon cardiac rehabilitation admission, during which EC [peak volume of oxygen consumption (VO2)] and CPET duration were measured and compared between groups. Results: This cohort was predominantly male (n = 22, 73%) with a median age of 57.5 years [Q1-Q3: 54.0-65.0]. Baseline demographics and characteristics were similar between groups aside from United Network for Organ Sharing listing status, in which patients listed as status 1 or 2 were more likely to have long IT. Twelve (40%) participants received a donor heart with long IT. Surprisingly, higher peak VO2 was observed in those with long (15.0±2.8) than short (13.1±3.7) IT (p = 0.009). However, CPET duration was significantly shorter in recipients with a long IT (6.3 vs 7.7 minutes, p = 0.048) despite similar time since transplant, ratings of perceived exertion, protocol performed, and EC. Conclusions: In this modest-sized cohort, EC was higher in heart transplant recipients with donor IT >180 minutes compared with those with IT ≤180 minutes. However, CPET duration was significantly shorter in those with relatively longer IT.

Objective: to describe Biovigilance Systems and their associated management tools among member countries of the World Health Organization. Method: overview conducted following the population, concept, and context strategy to develop the research question and objective. Structured searches were conducted in PubMed, CINAHL, Embase, and Scopus. Snowballing procedure in Google Scholar and health authorities’ websites as World Health Organization and Pan American Health Organization during the first semester of 2023. Language and time restrictions were not applied. Results: we examined more than 70 studies and non-scientific works. Biovigilance systems were identified in 12 countries members of WHO in 3 of 6 regions: Pan-American Region (Brazil and Colombia, Canada), Europe (England, France, Germany, Italy, Netherlands, Poland, Portugal, and Spain), and Western Pacific Region (Australia). Conclusion: This overview achieved its objective by describing biovigilance systems and their management tools among World Health Organization member countries. This research, designed as an overview, refrains from generalizing results but holds significance for countries and health authorities developing biovigilance systems, offering benchmark opportunities and supporting system improvement. The study contributes directly to the biovigilance discourse, guiding efforts to enhance safety and quality globally.

Objective: To analyze family refusals to donate a cornea for transplantation in an Organ Procurement Organization. Methods: This was a quantitative cross-sectional study on corneal donation refusals from potential brain-dead donors. The data source was based on the Terms of Authorization for Donation of Organs and Tissues signed from January 2001 to December 2020 in an Organ Procurement Organization. Data were collected, tabulated, and analyzed in a descriptive and inferential manner. The present study was approved by the Research Ethics Committee. Results: Of the 2,447 Terms of Authorization for Donation of Organs and Tissues signed in the above period, 620 (25.34%) of them refused to donate a cornea. Regarding the time trend of corneal donation refusals, the period 2001-2009 was the only one that showed significance, when the 0-11 and 12-19 age groups showed a decreasing trend and that of 60 years or older showed an increasing trend. In the period 2001-2020, the age groups of 20-40, 41-59, and 60 years or older had lower rates of refusal to donate a cornea (48%, 59%, and 73%, respectively). Conclusion: The age group is associated with refusal because older individuals had the highest refusal rates. [ABSTRACT FROM AUTHOR]

Copyright of Gümüshane Üniversitesi Saglik Bilimleri Dergisi is the property of Gumushane University, Faculty of Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Rationale & Objective: A high level of cooperation between organ procurement organizations and transplant programs may help maximize use of deceased donor kidneys. The practices that are essential for a high functioning organ donation and transplant system remain uncertain. We sought to report metrics of organ donation and transplant performance in British Columbia, Canada, and to assess the association of specific policies and practices that contribute to the system’s performance. Study Design: A retrospective observational study. Setting & Participants: Referred deceased organ donors in British Columbia were used in the study from January 1, 2016, to December 31 2019. Exposures: Provincial, organ procurement organization, and center level policies were implemented to improve donor referral and organ utilization. Outcomes: Assessment of donor and kidney utilization along steps of the critical pathway for organ donation. Analytical Approach: Deceased donors were classified according to the critical pathway for organ donation and key donation and transplant metrics were identified. Results: There were 1,948 possible donors referred. Of 1,948, 754 (39%) were potential donors. Of 754 potential donors, 587 (78%) were consented donors. Of 587 consented donors, 480 (82%) were eligible kidney donors. Of 480 eligible kidney donors, 438 (91%) were actual kidney donors. And of 438 actual kidney donors, 432 (99%) were utilized kidney donors. One-year all-cause allograft survival was 95%. Practices implemented to improve the system’s performance included hospital donor coordinators, early communication between the organ procurement organization and transplant nephrologists, dedicated organ recovery and implant surgeons, aged-based kidney allocation, and hospital admission of recipients before kidney recovery. Limitations: Assignment of causality between individual policies and practices and organ donation and utilization is limited in this observational study. Conclusions: In British Columbia, consent for donation, utilization of donated kidneys, and transplant survival are exceptionally high, suggesting the importance of an integrated deceased donor and kidney transplant service. Plain-Language Summary: Optimization of all possible opportunities for deceased donor kidney donation and transplantation is essential to meet the need for transplantation. We examined the performance of organ procurement and transplant in a deceased organ donor system in British Columbia, Canada, and reviewed policies and practices that may contribute to the system’s performance. We found a high level of donation, transplantation, and survival of donated kidneys and identified policies and practices that likely contribute to the system’s performance.

We present a summary of the evidence on testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and organ procurement from deceased donors and provide recommendations based on current clinical data and the guidelines from major transplant organizations. Because of the limited historical experience with coronavirus disease 2019 (COVID-19), certain recommendations in this document are based on theoretical rationales rather than clinical data. The recommendations in this manuscript may be subject to revision as subsequent clinical studies provide definitive evidence regarding COVID-19 in organ procurement.

Background : Improving organ donation rates requires better detection of possible organ donors, which in turn necessitates identifying barriers preventing the identification of possible organ donors. The objectives of this study were to determine the actual rate of possible deceased organ donors among nonreferred cases and to identify barriers to their identification as possible donors. Methods : This retrospective observational study used 6 months of data collected from two intensive care units (ICUs). Possible organ donors were defined as patients with a Glasgow Coma Scale score

Introduction: Organ transplantation is one of the most successful advances in modern medicine. However, a legal system is necessary for its practice to be free from ethical flaws and to respect donors, recipients, and family members. Objective: To map the global legislation regulating the donation, capture and distribution processes of organs and tissues from deceased donors for transplants. Method: A scoping review according to the Joanna Briggs Institute was conducted in the following databases: Medline, CINAHL, Virtual Health Library, SCOPUS, Web of Science, Science Direct, and EMBASE, as well as gray literature, and reported according to the PRISMA extension for scoping reviews. Results: We identified 3302 records, of which 77 were analyzed which enabled mapping the type of consent adopted and the existence of current legislation for harvesting organs and tissues after circulatory and brain death. Conclusion: Opt-out consent predominates in Europe, and there is harvesting after brain and circulatory death. Opt-out predominates in the Americas, while Opt-in and harvesting of organs and tissues after brain death predominate in Asia and Oceania. The procurement of organs and tissues from deceased donors is practically non-existent in Africa.

AIM OF THE REVIEW: Improving rates of organ donation among patients with out-of-hospital cardiac arrest who do not survive is an opportunity to save countless lives. The objectives of this scientific statement were to do the following: define the opportunity for organ donation among patients with out-of-hospital cardiac arrest; identify challenges and opportunities associated with organ donation by patients with cardiac arrest; identify strategies, including a generic protocol for organ donation after cardiac arrest, to increase the rate and consistency of organ donation from this population; and provide rationale for including organ donation as a key clinical outcome for all future cardiac arrest clinical trials and registries. METHODS: The scope of this International Liaison Committee on Resuscitation scientific statement was approved by the International Liaison Committee on Resuscitation board and the American Heart Association, posted on ILCOR.org for public comment, and then assigned by section to primary and secondary authors. A unique literature search was completed and updated for each section. RESULTS: There are a number of defining pathways for patients with out-of-hospital cardiac arrest to become organ donors; however, modifications in the Maastricht classification system need to be made to correctly identify these donors and to report outcomes with consistency. Suggested modifications to the minimum data set for reporting cardiac arrests will increase reporting of organ donation as an important resuscitation outcome. There are a number of challenges with implementing uncontrolled donation after cardiac death protocols, and the greatest impediment is the lack of legislation in most countries to mandate organ donation as the default option. Extracorporeal cardiopulmonary resuscitation has the potential to increase organ donation rates, but more research is needed to derive neuroprognostication rules to guide clinical decision-making about when to stop extracorporeal cardiopulmonary resuscitation and to evaluate cost-effectiveness. CONCLUSIONS: All health systems should develop, implement, and evaluate protocols designed to optimize organ donation opportunities for patients who have an out-of-hospital cardiac arrest and failed attempts at resuscitation. [ABSTRACT FROM AUTHOR]

For example, in Belgium and the Netherlands, both euthanasia and DCD procedures need to be strictly separated, to prevent a patient choosing euthanasia because they can then donate organs. Keywords: Death; Euthanasia, active; Tissue and organ procurement; Transplantation EN Death Euthanasia, active Tissue and organ procurement Transplantation 202 205 4 09/05/23 20230904 NES 230904 All Australian states have passed voluntary assisted dying (VAD) legislation. Organ donation following euthanasia: international practice Organ donation after euthanasia is currently performed in Belgium, the Netherlands, Spain and Canada. Statistics from international jurisdictions From 2012 to January 2022, organ donation after euthanasia in the Netherlands was performed 85 times.[13] In Spain in 2021, organ donation after euthanasia was only performed in seven cases from 656 DCD donors. [Extracted from the article]

Objective: To identify the nursing diagnoses of potential organ donors in brain death according to the NANDA-I Taxonomy. Method: Observational, cross-sectional study conducted in a public hospital in the interior of Ceará, Brazil. Data collection was realized in October and November 2021 in 23 medical records of potential organ donors. Descriptive statistics analyzed data. Results: Twenty-two diagnoses were identified in five of the 13 domains of the NANDA-I taxonomy. The following were prevalent: risk of unstable blood glucose; risk of impaired liver function; impaired gas exchange; impaired bed mobility; ineffective breathing pattern; risk of infection; risk of pressure injury; risk of aspiration; risk of decreased cardiac output; risk of falls, impaired urinary elimination; risk of electrolyte imbalance and risk of unstable blood pressure. Conclusion: The identification of diagnoses may favor the improvement of practice and the application of the nursing process in the care of potential organ donors.

Background: Organ donation and transplantation can save or improve the quality of life of people worldwide. However, there are many challenges associated with organ donation, as the demand for organs greatly outstrips supply. Additionally, there are brain-dead patients who could be potential organ donors. It is thus important to determine the attitudes affecting organ donation and transplantation in intensive care unit settings. Aim: this study aimed to identify attitudes that might affect organ donation and transplantation in intensive care unit settings. Methodology: Five electronic databases (CINAHL, Medline, PsycINFO, Scopus, and EMBASE) were searched systematically. A systematic search strategy was formulated. The quality of each study was assessed using the MMAT quality appraisal tool. Results: A total of seven studies were included. The findings of this systematic review demonstrate that education, policy, and continuing professional development could help to address barriers to donation. Conclusions: therefore, to influence organ donation and transplantation positively, the main themes evaluated in this systematic review provide an opportunity to influence organ donation and transplantation attitudes in intensive care unit settings. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of the 2009 National Reform Program for organ donation in Australia on the number and characteristics of organ donors under 16 years of age. Design, setting, participants: Retrospective observational time series study; analysis of Australia and New Zealand Organ Donation (ANZOD) registry data for all consented potential deceased organ donors under 16 years of age during 2000–2019, and of numbers of donors aged 16 years or more reported in ANZOD annual reports. Main outcome measures: Difference between 2000–2008 (pre‐reform) and 2009–2019 (reform period) in annual organ donor rates (donors per million population), by age group (under 16 years, 16 years or more), reported as incidence rate ratio (IRR). Secondary outcomes: Differences in child donor characteristics during 2000–2008 and 2009–2019. Results: During 2000–2019, 400 children under 16 years of age were consented potential deceased organ donors, of whom 374 were actual deceased donors (94%): 146 during 2000–2008, 228 during 2009–2019. The median annual rate was 3.3 (interquartile range [IQR], 3.0–4.3) actual donors per million population during 2000–2008 and 4.2 (IQR, 3.6–5.2) donors per million population during 2009–2019 (IRR, 1.15; 95% confidence interval [CI], 0.93–1.42). In contrast, the difference between the two periods was statistically significant for donors aged 16 years or more, rising from 11.7 (IQR, 11.2–11.8) to 19.9 (IQR, 18.3–24.4) actual donors per million population (IRR, 1.75; 95% CI, 1.66–1.85). The median age of actual organ donors under 16 was similar during 2000–2008 (11 years; IQR, 7–14 years) and 2009–2019 (10 years; IQR, 4–14 years), as was the proportion of donors in this age group under 10 kg (2000–2008: four of 146, 3%; 2009–2019: 14 of 228, 6%). Conclusions: Despite its overall effect on organ donation rates, the National Reform Program was not effective in increasing the numbers of donors under 16 years of age. Relying on broad initiatives for adult donors may not be appropriate for achieving this aim. [ABSTRACT FROM AUTHOR]

Health data science aims to extract knowledge from data allowing better decision-making, using multidisciplinary approaches from fields such as computation, statistics, epidemiology, and several medical knowledge domains. We live in the ‘big data’ era, with a growing availability of health data, in volume, variety, and velocity, also for tasks such as kidney transplantation. Hereby, secondary use of this health data must be encouraged to improve patient care planning, disease research, and policymaking around transplantation. This article presents the Transplant Open Registry (TxOR) website where some health data science applications on kidney transplantation are available. With it, we try to answer, some of the remaining questions on kidney transplantation in Portugal, with a new approach.

Background : A family approach and obtaining consent from the families of potential brain-dead donors is the most important step of organ procurement in countries where an opt-in policy applies to organ donation. Health care staff’s communication skills and ability to have conversations about donation under circumstances of grief and emotion play a crucial role in families’ decision-making process and, consequently, the consent rate. Methods : A new training course, called the Iranian family approach-specific course (IrFASC), was designed with the aim of improving interviewers’ skills and knowledge, sharing experiences, and increasing coordinators’ confidence. The IrFASC was administered to three groups of coordinators. The family consent rate of participants in the same intervals (12 months for group 1, 6 months for group 2, and 3 months for group 3) was measured before and after the training course. The Wilcoxon signed-rank test was used to make comparisons. Results : The family consent rate was significantly different for all participants before and after the training, increasing from 50.0% to 62.5% (P=0.037). Furthermore, sex (P=0.005), previous training (P=0.090), education (P=0.068), and duration of work as a coordinator (P=0.008) had significant effects on the difference in families’ consent rates before and after IrFASC. Conclusions: This study showed that the IrFASC training method could improve the success of coordinators in obtaining family consent.

Deceased donor liver transplantation (DDLT) using donations after brain death (DBDs) has been widely performed in Korea. However, to date, there is no report regarding donation after circulatory death (DCD) category III. A 56-year-old male patient diagnosed with hepatitis B virus-associated liver cirrhosis underwent DDLT using DCD category III. The recipient’s recovery was uneventful, and he was discharged on postoperative day 37. Currently, the patient is alive, with no complications 20 months after transplantation. This case suggests that DCD with LT is both feasible and safe. Further studies are required to validate this finding.

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There is a global shortage of organs for transplantation and despite many governments making significant changes to their organ donation systems, there are not enough kidneys available to meet the demand. This has led scientists and clinicians to explore alternative means of meeting this organ shortfall. One of the alternatives to human organ transplantation is xenotransplantation, which is the transplantation of organs, tissues, or cells between different species. The resurgence of interest in xenotransplantation and recent scientific breakthroughs suggest that genetically engineered pigs may soon present a realistic alternative as sources of kidneys for clinical transplantation. It is therefore important for healthcare professionals to understand what is involved in xenotransplantation and its future implications for their clinical practices. First, we explore the insufficiency of different organ donation systems to meet the kidney shortage. Second, we provide a background and a summary of the progress made so far in xenotransplantation research. Third, we discuss some of the scientific, technological, ethical, and public health issues associated with xenotransplantation. Finally, we summarize the literature on the attitudes of healthcare professionals toward xenotransplantation. [ABSTRACT FROM AUTHOR]

Direct‐acting antiviral drugs (DAA) are safe and effective in the HCV population. However, in patients with decompensated cirrhosis and/or active hepatocellular carcinoma or relapse to NS5A inhibitors, response rates are lower and DAA therapy must be postponed until after liver transplant in an era of organ shortage and suboptimal donors. We aimed to assess the prevalence of patients still HCV infected at time of transplantation over the last 3 years in our Center and describe the safety and efficacy of DAA therapy started as soon as possible after surgery. We enrolled all HCV viraemic patients transplanted in our Centre from January 2019 to March 2022. The follow‐up was closed in July 2022. Among 490 liver transplants, 49 (10%) patients were still HCV viraemic at operation, 43 naive to DAA and 6 were NS5A‐experienced. Median donor age was 64 years; donor risk index was 1.8. In naive patients, sofosbuvir/velpatasvir was started after a median time of 1 day from surgery, while in NS5A‐experienced sofosbuvir/velpatasvir/voxilaprevir after 14.5 days (p =.001). Response rate was 98%. 1 NS5A‐experienced patient experienced acute cholestatic hepatitis which promptly reverted after permanent DAA discontinuation. Hence, very early post‐liver transplant HCV eradication was safe and effective thanks to a close teamwork which involved anaesthesiologists, transplant surgeons and hepatologists. [ABSTRACT FROM AUTHOR]

Frederick D’Aragon,1,2 Olivier Lachance,1 Vincent Lafleur,1 Ivan Ortega-Deballon,3,4 Marie-Helene Masse,5 Gabrielle Trepanier,6 Daphnee Lamarche,1 Marie-Claude Battista5 1Department of Anesthesiology, Faculty of Medicine and Health Sciences Université de Sherbrooke, Sherbrooke, Quebec, Canada; 2Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; 3Nursing Department, Faculty of Medicine and Health Sciences, Universidad de Alcalá, Madrid, Spain; 4Helicopter & Nursing Care Unit, Emergency Medical Service SUMMA 112, Madrid, Spain; 5Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada; 6Department of Family Medicine and Emergency, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, CanadaCorrespondence: Frederick D’Aragon, 3001 12e Avenue N, Sherbrooke, PQ, J1H 5N4, Canada, Tel +1 819 821-8000 ext. 70103, Email Frederick.D’Aragon@USherbrooke.caPurpose: Worldwide, the number of patients waiting for organ transplantation exceeds the number of organs available. Program for uncontrolled donation after circulatory death (uDCD) implemented in Europe has resulted in a 10– 15% expansion of the donor pool. We aimed to describe the number of patients eligible for an uDCD program in a regional tertiary care center.Methods: We conducted a retrospective cohort study in a Canadian tertiary academic center located in a rural area including all adults who received cardiopulmonary resuscitation in 2016 and died in the emergency department (ED) or during their hospitalization. The primary outcome was the number of patients eligible for uDCD defined as aged between 18 and 60 years old whose collapse was witnessed and where the time between cardiac arrest to cardiopulmonary resuscitation and ED arrival was, respectively, less than 30 and 120 minutes. As a secondary outcome, we determined the number of patients eligible for controlled donation after circulatory death.Results: Of the 130 patients included, 84 did not return to spontaneous circulation. We identified 15 potential uDCD candidates, with a mean age of 46.6 (95% Confidence Interval [CI] 41.3 to 52) years. Twelve had an out-of-hospital cardiac arrest with a mean time between collapse and arrival to the ED of 43.2 (29.8 to 56.6) minutes. Among the 46 patients who died after a return of spontaneous circulation, 10 (21.7%) were eligible for organ donation after circulatory death.Conclusion: Implementing an uDCD program in a tertiary hospital covering a rural area could increase the number of donors.Keywords: tissue and organ procurement, out-of-hospital cardiac arrest, donor selection, death, uncontrolled donation after circulatory death

Introduction. The critical pathway for deceased donation offers a methodical framework for guiding the donation process. It not only serves to assess performance but also to identify areas of potential improvement. Therefore, the identification and selection of potential organ donors (POD) is a key process. This study aims to describe the critical pathway for deceased donation in a cohort of POD in three regions (CRT1, CRT2, and CRT5) of Colombia. Methods. We retrospectively reviewed data of POD assessed from January 2022 to December 2022. General characteristics of POD, diagnosis, contraindication causes, and organ procurement were described. Analysis was conducted using the Chi-squared test for categorical variables and the Mann-Whitney test for quantitative variables. Results. Within the cohort of 1451 assessed POD, 441 (30.3%) were diagnosed with brain death. Among potential donors after brain death, 198 (44.9%) were eligible donors (medically suitable). Of these, 157 donors (79.3%) became actual donors (undergoing operative incision for organ recovery), with 147 (96.3%) having at least one organ recovered (actual donors with organ recovery). Ultimately, 411 utilized organs were utilized. Additionally, there were observed differences in the characteristics of donors from different regions. Conclusion. This study reports the critical pathway for deceased donation in a cohort of POD in three regions of Colombia. This provides useful information and helps to gain insight and understanding into the process of organ donation and organ procurement in order to take actions that could improve the donation rates.

Objective: To identify the nursing diagnoses of potential organ donors in brain death according to the NANDA-I Taxonomy. Method: Observational, cross-sectional study conducted in a public hospital in the interior of Ceará, Brazil. Data collection was realized in October and November 2021 in 23 medical records of potential organ donors. Descriptive statistics analyzed data. Results: Twenty-two diagnoses were identified in five of the 13 domains of the NANDA-I taxonomy. The following were prevalent: risk of unstable blood glucose; risk of impaired liver function; impaired gas exchange; impaired bed mobility; ineffective breathing pattern; risk of infection; risk of pressure injury; risk of aspiration; risk of decreased cardiac output; risk of falls, impaired urinary elimination; risk of electrolyte imbalance and risk of unstable blood pressure. Conclusion: The identification of diagnoses may favor the improvement of practice and the application of the nursing process in the care of potential organ donors. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To synthesize and critically evaluate the scientific evidence from observational studies on biosurveillance systems and adverse event reporting in organ donation and transplantation. Methods: Systematic review of observational studies following the recommendations of the Methodological Guidelines (REBRATS) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Primary studies and case reports on biosurveillance and/or adverse events in organ donation and/or transplantation, without restriction of publication date or language were included. Six electronic databases were used in the scientific literature search: Medical Literature Analysis and Retrieval System Online (MEDLINE) (via PubMed), Excerpta Medica Database (Embase), Web of Science, LILACS, Scopus and the electronic library Scielo. A data search was also performed in the following secondary databases: Notify - World Health Organization (WHO), Pan American Health Organization (PAHO) and Google Scholar. The MINORS tool was used to assess the quality of studies. Results: 551 studies were identified, and after the evaluation steps, eight of them were included in the systematic review. These were divided into results, processes and strategies for preventing adverse events. Regarding the classification of the quality of studies, two obtained a good classification. Conclusion: The results indicate the occurrence of adverse events at some stage of the organ and tissue donation and transplantation process, such as: adverse drug-related reactions; neurotoxicity; longer length of hospital stay; surgical reinterventions; falls; coma; death; graft failure or loss. The fact that adverse events are possibly still underreported is noteworthy. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Transplantation is the property of Brazilian Journal of Transplantation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Transplantation is the property of Brazilian Journal of Transplantation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Transplantation is the property of Brazilian Journal of Transplantation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Texto & Contexto Enfermagem is the property of Universidade Federal de Santa Catarina, Programa de Pos-Graduacao de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Organ transplantation is a treatment for patients with end-stage organ failure limited by the number of organs. The aims of this article are: to compare the relevance of the indicated systems for the number of donated organs, to analyze the status of organ donation, to identify current issues and possible measures in order to increase the number of donations from deceased donors in Poland. Design/methodology/approach: The paper refers to theories from behavioral economics: status quo bias, human tendency to procrastinate, aversion to changes. It also analyzes statistical data of donated organs and the number of objections raised in Poland. Findings: There is a widespread public approval for organ donation in Poland, however most people do not state their decisions. Countries with an opt-out system have a higher rate of organ donations. In Poland in 2020 less than 0,1% of population objected to donate organs, yet 12% of potential donors were disqualified due to record in the Central Register of Objections or family’s statement. In 2016 only 20% of population was aware that presumed consent is legally binding. Moreover, 75% have never talked with their relatives about donating their organs. Research limitations/implications: The article relies on general data from statistical databases and population-based survey studies, which do not include detailed information on the subject described, and thus do not provide data for reliable in-depth statistical analysis. Due to unavailability of numeric data on the reasons for abandoning the organ procurement, the article relied on the available general statistical classification. The authors find an qualitative research to be worth considering in the studied area in order to identify profound causes of the problem and to find a target group for future experimental research. Practical implications: As majority of Polish population is pro-donation the presumed consent for organ donation is preferable to increase the number of donors. Social implications: Profound ignorance of the legislations and broad unawareness of the family's preference is the foundation of public fear and uncertainty towards organ donation. Originality/value: As the social factor appears to be the limiting factor for organ procurement it is fundamental to educate the society about transplantation in a relevant way in order to increase the number of donations in Poland. [ABSTRACT FROM AUTHOR]

Introduction: Donation after circulatory death (DCD) is rapidly increasing in the United States. Detailed data outlining the process from referral to organ transplantation is lacking. Project Aims: We sought to quantify differences at each stage along the referral to donation pathway by donor type. Additionally, we examined factors associated with successful DCD organ utilization. Design: This program evaluation analyzed data from a single organ procurement organization in 2018 to assess demographic and clinical predictors of progression through the donation process, including the role of first-person authorization in DCD. Descriptive statistics were examined by donation stage for demographic characteristics using chi-square; univariate and multivariate logistic regression was used to model predictors of utilization and authorization by organ type, respectively. Results: There were 2466 organ donation referrals during 2018, including 575 donations after brainstem death (DBD), 1890 controlled DCD referrals, and 1 uncontrolled DCD referral. Univariate and multivariate logistic regression models highlighted differences in authorization rates by donor type (DCD vs DBD) and by age, race, and ethnicity. Next-of-kin authorization was declined in 23% of first-person authorized potential DCD, highlighting issues related to the role of donor registration in DCD. Pre-mortem heparin administration was predictive of DCD organ utilization; donor age and warm ischemia time of less than 30 min was statistically significantly associated with DCD extra-renal organ utilization. Conclusion: These results provided insight into strategies for increasing authorization and transplantation of organs from DCD donors and identified areas of improvement for process standardization and policy development. [ABSTRACT FROM AUTHOR]

Background : This study explored emergency physicians’ experiences and perspectives related to brain death organ tissue donation (OTD) after the enforcement of the Life-Sustaining Treatment (LST) Decision Act in Korea. Methods : Using the Braun and Clarke thematic analysis method, this qualitative study analyzed interview data—comprising experiences and perspectives of brain death OTD since the LST Decision Act—of 10 emergency physicians who specialized in targeted temperature management (TTM) and cared for post-cardiac arrest patients. Results : Data analysis revealed 13 subthemes and 5 themes: the LST Decision Act is easier to explain to family members than brain death OTD, but it does not fit well in an emergency medical setting; many family members decide to stop LST even before physicians mention brain death or OTD; family members view stopping LST as being about comforting patients without bothering them, and decision-makers are therefore no longer willing to choose OTD; stopping LST does not always result in brain death, but cases of brain death are preceded by stopping LST; and since the LST Decision Act, the number of TTM cases and potential brain death donors has decreased. Conclusions: Unless a supplementary policy that connects stopping LST to brain death OTD is prepared, the withdrawal of LST in patients resuscitated after cardiac arrest is expected to continue, and brain death OTD is expected to decrease.

Objective: To know the perception of deceased donors’ relatives about consent to organ donation and the factors that influence the decision to donate. Methods: Exploratory and descriptive research with a qualitative approach. We interviewed seven relatives of organ donors, notified by the Organ Procurement Organization of Petrolina-PE. The interviews occurred between January and February 2018, through a semi-structured questionnaire, were recorded and transcribed in full, and subjected to thematic content analysis. Results: Family members’ perceptions of donation were tied to feelings of sadness and joy. The factors related to the consent process were understanding of the death of the loved one; a decision shared by the family; care provided by health professionals to the family and the donor, and knowledge of the relative’s willingness to donate. Final considerations: The health professionals’ understanding of the decision-making process can support more qualified assistance.

Objective: To evaluate medical students’ perception about organ and tissue donation and transplantation. Methods: This is a cross-sectional study, with quantitative analysis, which evaluated students from the 1st to the 12th semester of the Bahia Medical School of the Bahia Federal University (FMB/UFBA), grouped by year of graduation (1st to 6th year), through a questionnaire. Data were statistically analyzed using R for Windows, considering significant values of p ≤ 0.05. Results: Of the 393 participants, 207 (52.7%) were female, 250 (63.3%) were between 21 to 25 years old, 144 (36.6%) had no religion, and 80 (20.3%) were boarding students. Of all the interviewees, 159 (40.5%) self-assessed their knowledge as regular and 153 (38.8%) as bad and terrible. About the exposure to the subject, 222 (56.6%) had never attended a class and, among those who had, 187 (60.1%) evaluated the information as insufficient. A total of 324 students (82.4%) would have the intention of being a post-mortem donor and 42 (61.6%) would accept to participate in a living donor transplantation, although 245 (62.3%) said they did not know the risks. Among the students, 327 (83.2%) said they knew the concept of brain death, 119 (30.3%) the legal terms of donation, and 105 (26.7%) the donor maintenance measures. However, 72 (18.3%) said they had a good knowledge of how to diagnose brain death. A total of 275 (70%) got right what is needed to declare a donor. There were 359 answers that would exclude alcoholics, smokers and users of illicit drugs from the transplant list, and 363 (92.7%) considered that the severity of the problem is the most appropriate criterion for priority on the waiting list. Conclusion: Students perceive their level of knowledge as unsatisfactory and understanding about specific issues is still low. No significant influence of sociodemographic aspects was observed regarding the desire to be a donor. [ABSTRACT FROM AUTHOR]

How important is it, morally speaking, that banning the sale of organs removes the best option available to would-be organ sellers? According to a widespread argument called the best option argument, this is very important. In a recent article I criticised such reasoning, drawing on considerations of distributive justice. Luke Semrau has argued that I have misunderstood the best option argument. In this article, I respond to Semrau's criticism and elaborate on my original argument., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Although India's organ donation rate is less than 1 per million population, significant disparities exist between the regions and centres within the country, leading to varying consent rates among different organ donation centres. Therefore, this study aimed to understand the experience of transplant coordinators and their barriers and facilitators in the deceased organ donation process across various organ donation centres in India. A phenomenological study using interviews was conducted among fourteen transplant coordinators purposefully recruited from public and private organ donation centres in India, with experience between six years and more than a decade. Audio recordings were transcribed and analysed using framework analysis. Five themes were identified namely: (1) supportive management policies, (2) infrastructure for the deceased organ donation process, (3) delays in the processing time, (4) active involvement in the identification process, and (5) explaining the concept of brain death. The study identifies that implementation priorities include strengthening teamwork, streamlining processes, optimising infrastructure for sensitive discussions, efficient donor identification, and empathetic handling of donor families' grief stages. Collaborating with law enforcement, applying successful medico-legal strategies, improving family communication, and clarifying brain death concepts ethically and legally can boost consent rates, fostering informed decisions and possibly achieving self-sufficiency in deceased organ donation., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval: The Institute for Health Research Ethics Committee (IHREC952), University of Bedfordshire, United Kingdom approved the present study. All participants provided informed consent and permission to record the interviews. Consent for publication: All study participants consented to publication of anonymised data via the ethics approval. All authors have contributed to publication and consented to publication., (© 2024. The Author(s).)

Background: The transplantation of human organs, and some human tissues, is often the only life-saving therapy available for serious and life-threatening congenital, inherited or acquired diseases. However, it is associated with a risk of transmission of communicable diseases from donor to recipient. It is imperative to understand the characteristics of the donor population (including both potential and actual donors) to inform policies that protect recipient safety. The Tissue and Organ Donor Epidemiology Study (TODES) was a pilot project designed to identify and collect standardized information on deceased persons referred for organ, tissue and/or eye donation, and to estimate (to the extent possible) infectious disease prevalence and incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in this population. TODES is summarized here to shed light on addressable limitations on accessing data needed for transplant recipient safety. Limitations, future research needs and potential pathways to solve the remaining data needs are explored., Methods: Retrospective data for all deceased donors during a 5-year period from 2009 to 2013 were obtained from participating organ procurement organizations (OPOs), tissue establishments and eye banks. These decedent data were used to ascertain whether the available real-world data (RWD) could be used to inform donor screening and testing policy., Results: The TODES database contains 291 848 records received from nine OPOs and 42 451 records received from four eye banks. Data were analysed from deceased donors with at least one organ, tissue or ocular tissue recovered with the intent to transplant. Results for potential donors were not analysed. Available RWD at the time of the TODES study were not fit-for-purpose to help characterize the organ, tissue and eye donor populations and/or to inform donor screening policy., Conclusions: Recent advances in electronic data collection systems make it more realistic to now collect fit-for-purpose RWD that address the research needed to improve transplant safety., Competing Interests: Declarations Ethics approval and consent to participate All TODES data were collected on deceased donors, who are not included in the definition of human subjects (45 CFR §46.102(e)). Additionally, OPTN data are collected with the intention of making data available for public and scientific uses [31]. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Background: In organ donation from deceased donors, the interaction between the donor's relatives and intensive care personnel is an important factor. The organ donation (OD) process is complex, and patients' relatives play a vital role. Intensive care professionals need knowledge about how relatives perceive and experience the process to create a caring environment and support them throughout. Therefore, this collaborative project aims to explore both relatives' and intensive care personnel's perspectives of care in deceased organ donation in Scandinavia., Objective: This study aims to (1) investigate donor relatives' satisfaction and ICU personnel's perception of their own professional competence and (2) explore donor relatives' and ICU personnel's experiences in the OD process to design for care and support in OD., Methods: This protocol outlines a Scandinavian (Norway, Sweden, and Denmark) project, including 4 work packages. Work package 1 started in 2023 with the translation and validation of the Family Satisfaction in the Intensive Care Unit questionnaire into a Danish version and the translation of the Professional Competence in Organ Donation Questionnaire into a Swedish and Danish version. A cross-sectional survey measuring Scandinavian relatives' perception of support in and satisfaction with the organ donation process and a cross-sectional survey measuring Scandinavian intensive care personnel's competence in organ donation are the foundation for work package 2 (2024). The data from both surveys will be analyzed using descriptive and comparative analysis. The results will inform the interview guides in qualitative studies (work packages 3 and 4). Participants in the quantitative study will be invited to participate in in-depth interviews. In work package 3, in-depth interviews will be conducted to illuminate relatives' experiences in the organ donation process. The interviews will be analyzed using thematic analysis, according to Braun and Clarke. In work package 4 (2025-2026), 1 qualitative design study will be conducted to illuminate ICU personnel's experiences. Furthermore, the results from work packages 2 and 3 will inform the development of specific programs for care, support, and communication in the organ donation process., Results: The project was funded by the Norwegian Organ Donor Foundation in 2022 and Scandiatransplant in 2023. The Norwegian Nurses Organisation supports the project by funding a PhD student. The PhD student was employed by the University in Agder in May 2024., Conclusions: This project will provide new knowledge that will assist us in designing and establishing programs for care, support, and donor relatives' involvement in OD processes., International Registered Report Identifier (irrid): PRR1-10.2196/55643., (©Kathe B Meyer, Gudrun Rohde, Gro Frivold. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 11.11.2024.)

As transplant programmes have evolved to allow a wider donor pool, organ acceptance decisions have become increasingly complex and lack transparency and equality. Clinical scoring tools exist but there is limited consensus on their use. From a prospective observation of consecutive deceased-donor kidney offers in a large urban transplant centre, a simple score was developed based on donor age and other risk characteristics, excluding ischemia time and graft histology. The score was validated in subsequent cohorts of consecutive offers in the United Kingdom and Germany. In the development cohort of 389 kidney offers, 110 (28%) were transplanted and 175 (45%) declined. Nine risk factors were incorporated into a score based on age, but adjusted for the number of risk factors present, making an "adjusted donor age," with offers separated into equal quintiles by decade. The score was validated in a UK cohort of 380 subsequent offers, and a German cohort of 431 offers. In both cohorts adjusted donor age discriminated between favourable and poor post-transplant outcomes (C-statistic 0.77 in the United Kingdom, 95% CI 0.65-0.88, and 0.71 in Germany, 95% CI 0.64-0.77). Adjusted donor age is a simple score quantifying deceased donor kidney quality, which is consistent with current practice and predicts post-transplant outcome., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Bright, Mahler, Adwaney, Dosani, Morganti, Friedl, Nusshag, Speer, Benning, Göth, Schaier, Sommerer, Mieth, Mehrabi, Zeier, Morath, Dor, Kälble and Ashby.)