Search

In the seven years since the HIV Organ Policy Equity (HOPE) Act made HIV-positive organ donation to HIV-positive recipients legally permissible in the United States, there have been fewer HIV-positive organ donations than expected. Organ procurement organizations (OPOs) play a key role in the transplant system and barriers at OPOs may be partly responsible for the relatively low number of HIV-positive donors. To understand potential OPO barriers, we conducted semi-structured interviews with 20 OPO staff members. Interviews were recorded, transcribed, and analyzed using a conventional content analytic approach with two coders. OPO staff had high levels of knowledge about HOPE. Many had evaluated referrals of HIV-positive donors and approached families for authorization. Barriers to HIV-positive organ recovery identified included obtaining authorization for donation, potentially disclosing HIV status to next-of-kin, and fear of HIV infection among those engaged in organ recovery. Strategies to overcome these barriers include providing continuing education about the specific tasks required to procure organs from HIV-positive donors, implementing targeted interventions to reduce fear of infection, and developing partnerships with HIV advocacy and care organizations. Given the central role OPOs play, HIV-positive donations are unlikely to occur in significant numbers unless these barriers can be overcome.

With the rapid and massive vaccination campaign against coronavirus disease 2019 (COVID-19) taking place across the globe, there are increasing reports of thrombotic complications with various COVID-19 vaccines such as the Pfizer-BioNTech mRNA, Moderna mRNA, AstraZeneca Oxford (serum institute), and JohnsonJohnson/Janssen vaccines. We report a case of successful organ donation from an 18-year-old woman who presented with cerebral venous thrombosis caused by vaccine-induced thrombotic thrombocytopenia following the first dose of the COVID-19 vaccine (AstraZeneca, University of Oxford, and Serum Institute of India), which caused brain death. Four recipients received 5 organs, kidneys (2), liver (1), and combined heart and lung (1). All 4 recipients had normal graft function without any thrombotic complications after 16 weeks of transplantation. This is first such case being reported from Asian countries.

Coronavirus disease (COVID-19) vaccine and its utility in solid organ transplantation (SOT) needs to be revised timely and updated. These guidelines have been formalized by the experts -the apex technical committee members of the National Organ and Tissue Transplant Organization (NOTTO), and the heads of transplant societies for the guidance of transplant communities. In our general recommendations, we recommend that all personnel involved in organ transplantation should get vaccinated as early as possible and continue COVID-19 appropriate behaviour, despite a full course of vaccination. For specific guidelines of recipients, we suggest completing the full schedule before transplantation whenever the clinical condition permits. We also suggest a single dose, rather than proceeding unvaccinated for transplant, in case a complete course is not feasible. In case, vaccination is planned before surgery, we recommend a gap of at least 2 weeks between the last dose of vaccine and surgery. For those not vaccinated prior to transplant, we suggest waiting for 4-12 weeks after transplant. For the potential living donors, we recommend the complete vaccination schedule before transplant. However, if not feasible, we suggest getting at least a single dose of vaccine, 2 weeks prior to donation. We suggest that suitable transplant patients and those on the waiting list should accept a third dose of the vaccine when one is offered to them. In the context of Vaccine-induced thrombotic thrombocytopenia (VITT), we recommend organs from a deceased donor with suspected/proven VITT should be notified and best avoided and are justified only in case of emergency situations with informed consent and counselling.

Objective: Despite concerted and directed efforts to increase organ donation, the gap between the need for organs for transplantation and the lack of donors has been increasing globally. Studies have shown that donor rates in countries in the Middle East, such as Saudi Arabia, are particularly low despite a relatively advanced healthcare system and supportive government policies. There are multiple psychosocial, cultural, religious, and structural factors, that influence the increase in the organ donation rate, and some of them may be unique to a country such as Saudi Arabia. The theory of planned behaviour (TPB) is an important theory utilised to study how various types of attitudes, beliefs, and norms, influence organ donation intention and practice. In this study, we aimed to explore the normative, behavioural, and control beliefs, among residents of Saudi Arabia. Methods: The current study was a cross-sectional online survey performed from 6 June 2021 to 31 December 2021, using a questionnaire prepared in GoogleTM form among the residents of Saudi Arabia. The questionnaire asked demographic factors and questions to explore the normative, behavioural, and control beliefs, regarding organ donation. Results: This study received 1245 valid responses. Among the study participants, only 19.6% were willing to register as an Organ/Tissue donors. The intention for organ donation showed a statistically significant positive association with beliefs that organ donation is a good thing (123.51, df 4, p < 0.001), could save somebody’s life (81.38, df 4, p < 0.001), could have a positive impact on life after death (114, df 4, p < 0.001), and provision of better social support to family (of the deceased) can increase organ donation (68.43, df 4, p < 0.001). Those who expressed normative beliefs that their intention to donate organs strongly depend upon their family’s lack of objection to allowing the donation of organs at the time of death (190.76, df 4, p < 0.001), their knowledge about the organ transplantation process (179.35, df 4, p < 0.001), their knowledge about the viewpoint of their religion regarding organ donation (120.345, df 4, p < 0.001), and their knowledge about the registration facilities (241.64, df 4, p < 0.001), were more willing for donating their organs. Perception of worry about the likelihood of getting lesser care from doctors in an emergency if registered as an organ donor (OR = 4.25, 95% CI 1.57–11.51), beliefs that provision of better social support to family (of the deceased) can increase organ donation (OR = 10.49, 95% CI 1.56–70.43), and concern for the emotions of their family members while organ are being taken (OR = 4.37, CI 1.57–12.23), were the strongest predictors influencing a definite intention for organ donation. Conclusion: This study found that most of the components under normative and behavioural beliefs showed positive correlation with a definite intention for organ donation, whereas most of the components under control beliefs showed negative correlation with a definite intention for organ donation, among Saudi population. Based on the study results, there is a need to promote awareness regarding the organ donation process, especially the religious permissibility of organ donation, among general public in order to promote organ donation.

As the incidence of fatal drug overdose has quadrupled in the U.S. in the past two decades, patients awaiting organ transplants may be unintended beneficiaries. We use Vital Statistics mortality data, merged with data on the universe of transplant candidates and recipients in the U.S. from the Scientific Registry of Transplant Recipients, to study the extent to which the growth in opioid-related deaths affects the supply of deceased organ donors and transplants. Using two separate identification strategies, we find that opioid-related deaths led to more than 22,000 organ transplants in the U.S. between 2008 and 2018. Although we detect little evidence of demand responses to opioid-induced organ supply shocks, we find that transplant centers are increasingly recovering organs from overdose victims for transplant, with the association between opioid-related deaths and organ donors more than doubling between 2008 and 2018. We also present evidence that transplant candidates appear to be more willing to use organs from those who died of opioid-related causes when organ shortages are relatively severe.

Objectives The Kidney Team at Home program is an educational intervention aimed at patients with chronic kidney disease to assist them in their choice for kidney replacement therapy. Previous studies have shown that the intervention results in an increase in knowledge and communication on kidney replacement therapy, and eventually in an increase in the number of living donor kidney transplantations. The study assesses the cost-effectiveness of the intervention compared to standard care. Methods A dynamic probabilistic Markov model was used to estimate the monetary and health benefits of the intervention in The Netherlands over 10 years. Data on costs and health-related quality of life were derived from the literature. Transition probabilities, prevalence, and incidence rates were calculated using a large national database. An optimistic and a pessimistic implementation scenario were compared to a base case scenario with standard care. Results In both the optimistic and pessimistic scenario, the intervention is cost-effective and dominant compared to standard care: savings were €108,681,985 and €51,770,060 and the benefits were 1382 and 695 QALYs, respectively. Conclusions The superior cost-effectiveness of the intervention is caused by the superior health effects and the reduction of costs associated with transplantation, and the relatively small incremental costs of the intervention. The favorable findings of this implementation project resulted in national uptake of the intervention in The Netherlands as of 2021. This is the first time a psychosocial intervention has been implemented as part of standard care in a kidney replacement therapy program worldwide.

Organ donation after euthanasia is performed in the Netherlands, Belgium, Spain and Canada. In these countries, altruistic patients, who often suffer from a neurodegenerative or psychiatric disease, are able to donate their lungs, liver, kidneys and pancreas. In the Netherlands, they even have the possibility to donate their heart. Research demonstrates that about 10% of all patients who undergo euthanasia might be medically eligible for organ donation. Preliminary short-term outcomes of transplants from these donors demonstrate good results. Intensive care physicians and nurses play an important supportive role in this combined procedure because of their expertise in end-of-life care and organ donation, and because these procedures are often performed in the intensive care unit. This article provides a practical summary of the various steps that need to be fulfilled to facilitate organ donation after a legal and ethical aspects of organ donation after euthanasia, meaningful procedure.

The use of hemadsorption has been purposed to reduce cytokine levels during the reperfusion phase during donation after circulatory death (DCD) programs. This paper aims to describe a cases series of the inflammatory cytokine levels before and after hemadsorption during normothermic reperfusion in DCD donors of liver and kidneys. In this observational pilot paper, we describe 8 DCD donors of liver or kidneys in our center from the year 2018 to 2019. All DCD donor subjects had similar age, were younger than 60 years, without evident critical conditions, no liver or kidney dysfunction known, and they presented with poor neurological outcomes instrumentally and clinically documented. We observed in our patients an interesting reduction of IL-10 and TNF-α levels during the normothermic reperfusion with hemadsorption. We transplanted all livers and kidneys from DCD donors without significant compliances.

Objectives In Switzerland, in spite of a positive attitude towards organ donation, the population seems to overlook the public health messages about it. Based on a qualitative study on campaigns about organ donation, the article aims to give practical suggestions to prevent undesirable effects in public health communication. Methods The study provides a linguistic analysis of the messages about organ donation produced by the Swiss Federal Office of Public Health. Such a method enables us to understand who communicates what, to whom, how and what for, and gives us empirical data to discuss ethical concerns in relation to the effects of public health messages. Results The analysis shows that the messages, apart from those relying on the expertise of healthcare professionals, are based on the representation of lay persons. The latter strategy generates the depiction of imagined communities. Conclusions Beyond the usual concerns relating to organ donation (e.g., consent, altruism), the analysis of FOPH messages indicates that ethical issues in public health communication are grounded on three relational dimensions (intersubjectivity, cooperation and equity). Practice implications A procedure assessing the ethical concerns of public health communication in terms of social identities and relational consequences could identify and prevent problems relating to the undesirable effects of messages. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author upon reasonable request

Improving public willingness toward organ donation is an important solution to the low organ donation rate. This study aimed to explore factors impacting public willingness for organ donation in China from a multi-agent perspective and further explore the impact of these factors on high or low willingness, using a social–ecological framework. Data from a total of 11,028 (effective rate, 94.18%) participants were analysed. Generalised linear model (GLM) and quantile regression were used to explore factors associated with willingness and high/low willingness toward organ donation, respectively. The mean willingness toward organ donation was 56.9 (range, 0–100) points. GLM regression revealed that age, family health, males, lower educational levels, and agricultural hukou were negatively associated with willingness. For personality, conscientiousness was negatively associated with willingness, whereas openness was positively associated with willingness. Health literacy perceived social support, and media utilisation were positively associated with willingness. Quantile regression further indicated that educational levels of college, bachelor, master’s, and PhD, openness, health literacy, perceived social support, and media utilisation were positively associated with organ donation willingness at all percentiles. It is necessary to adopt more targeted and diversified publicity, education, and guidance for different types of individuals. Meanwhile, social support needs to be strengthened. To enhance the willingness of the residents to donate organs, media publicity should be strengthened, particularly by using modern ways to improve their health literacy.

Le processus du don d’organes, crucial pour la survie de nombreux patients, ne répond pas à la demande croissante. Il dépend d’une identification, par les cliniciens, des potentiels donneurs d’organes. Cette étape est imparfaite et manque entre 30% et 60% des potentiels donneurs d’organes et ce indépendamment des pays étudiés. Améliorer ce processus est un impératif à la fois moral et économique. L’objectif de ce mémoire était de développer et valider un modèle afin de détecter automatiquement les potentiels donneurs d’organes. Pour ce faire, les données cliniques de l’ensemble des patients adultes hospitalisés aux soins intensifs du CHUM entre 2012 et 2019 ont été utilisées. 103 valeurs de laboratoires temporelles différentes et 2 valeurs statiques ont été utilisées pour développer un modèle de réseaux de neurones convolutifs entrainé à prédire les potentiels donneurs d’organes. Ce modèle a été comparé à un modèle fréquentiste linéaire non temporel. Le modèle a par la suite été validé dans une population externe cliniquement distincte. Différentes stratégies ont été comparées pour peaufiner le modèle dans cette population externe et améliorer les performances. Un total de 19 463 patients, dont 397 donneurs potentiels, ont été utilisés pour développer le modèle et 4 669, dont 36 donneurs potentiels, ont été utilisés pour la validation externe. Le modèle démontrait une aire sous la courbe ROC (AUROC) de 0.966 (IC95% 0.9490.981), supérieure au modèle fréquentiste linéaire (AUROC de 0.940 IC95% 0.908-0.969, p=0.014). Le modèle était aussi supérieur dans certaines sous populations d’intérêt clinique. Dans le groupe de validation externe, l’AUROC du modèle de réseaux de neurones était de 0.820 (0.682-0.948) augmentant à 0.874 (0.731-0.974) à l’aide d’un ré-entrainement. Ce modèle prometteur a le potentiel de modifier et d’améliorer la détection des potentiels donneurs d’organes. D’autres étapes de validation prospectives et d’amélioration du modèle, notamment l’ajout de données spécifiques, sont nécessaires avant une utilisation clinique de routine., The organ donation process, however crucial for many patients’ survival, is not enough to address the increasing demand. Its efficiency depends on potential organ donors’ identification by clinicians. This imperfect step misses between 30%–60% of potential organ donor. Improving that process is a moral and economic imperative. The main goal of this work was to address that liming step by developing and validating a predictive model that could automatically detect potential organ donors. The clinical data from all patients hospitalized, between 2012 and 2019 to the CHUM critical care units were extracted. The temporal evolution of 103 types of laboratory analysis and 2 static clinical data was used to develop and test a convolutive neural network (CNN), trained to predict potential organ donors. This model was compared to a non-temporal logistical model as a baseline. The CNN model was validated in a clinically distinct external population. To improve the performance in this external cohort, strategies to fine-tune the network were compared. 19 463 patients, including 397 potential organ donors, were used to create the model and 4 669 patients, including 36 potential organ donors, served as the external validation cohort. The CNN model performed better with an AUROC of 0.966 (IC95% 0.949-0.981), compared to the logistical model (AUROC de 0.940 IC95% 0.908-0.969, p=0.014). The CNN model was also superior in specific subpopulation of increased clinical interest. In the external validation cohort, the CNN model’s AUROC was 0.820 (0.682-0.948) and could be improved to 0.874 (0.731-0.974) after fine tuning. This promising model could change potential organ donors' detection for the better. More studies are however required to improve the model, by adding more types of data, and to validate prospectively the mode before routine clinical usage.

Background: Globally, there is an overwhelming increase in the number of patients waiting for donated organs for transplantation, with a gross shortage of available organs. Lack of clear practice guidelines and the knowledge and attitudes of health care providers were hypothesized as possible reasons. We aimed to determine the attitudes, level of knowledge, and practices of professional nurses working in critical care units in public and private hospitals in Eastern Cape Province regarding organ donation. Method: The study used a quantitative, non-experimental, descriptive design to investigate the current knowledge, attitude, and practice of organ donation in critical care among 108 professional nurses working in public and private critical care units in Eastern cape. Data were collected between 26 February 2017 until 27 June 2017 using anonymous, self-administered, pretested questionnaires. The means of knowledge, and practice scores were estimated among participants, and their associated categorical explanatory variables were ascertained. Results: A total of 108 nurses participated in the study. Of these, 94 (87.0%) were female, 78 (72.2%) were black, 104 (96.3%) were Christians, 79 (73.2%) worked in an ICU, 79 (73.2%) had a diploma qualification, and 67 (62.0%) worked in a tertiary hospital. About 67% of the respondents had good knowledge, 53% had a positive attitude, and 50.4% had poor practice readiness toward organ donation. Working in renal units (p < 0.001) and practicing in tertiary hospitals (p < 0.001) were significantly associated with a high organ donation knowledge score while being a female nurse (p = 0.036), working in renal units (p < 0.001), and practicing in tertiary hospitals (p < 0.001) were significantly associated with a high organ donation practice score. Conclusion: Differences in organ donation knowledge and practices were noted between the different levels of health care services as the tertiary level outperformed the secondary level institutions. Nurses play a major role in critical and end-of-life care and are closer to patients and relatives. Hence, pre- and in-service education and promotional campaigns among nurses at all levels of care would be a strategic step to scale availability of donated organs and would meet the needs of thousands of individuals who need them to survive.

INTRODUCTION: In healthcare settings where potential organ donors could be identified, the importance of suitably trained nursing staff to support even complex organizational processes aimed at optimizing the availability of human organs and tissues has been proven. However, this importance is only sometimes fully perceived as strategic. OBJECTIVE: to investigate the perception of the role of the nurse in organ and tissue donation. MATERIAL AND METHODS: a survey was conducted by administering an online questionnaire found in the literature. A convenience sample was recruited from the entire nursing staff with at least one year of previous work experience. Descriptive analyzes were conducted using Microsoft® Excel 2010. RESULTS: 82% of nurses in a transplant coordination role know that their unit focuses on organ donation; among other nurses, only 69% are aware of it. 83% of healthcare professionals who treated at least one donation encountered difficulties during the entire process, citing the bureaucratic aspects as the greatest fear to face, followed by the relationship with family members and patient maintenance. The majority of nurses are in favor of transplantation (90%), but only 17% believe they are sufficiently trained, including all of the transplant coordinators. CONCLUSIONS: There is some evidence that it is still difficult for nurses to know and apply the different phases of the donation process. This fact could be attributed to an incomplete perception of the peculiarities of the role they may play in identifying, maintaining, and respecting the ethical principles and wishes of the donor., Introduzione: La donazione degli organi è una decisione difficile, quanto importante. Nel lungo e complesso procedimento che porta alla donazione e quindi al trapianto d’organo gli infermieri giocano un ruolo fondamentale, per questo è importante comprendere quanto questi siano preparati al loro ruolo. Materiale e metodi: indagine quantitativa consistente nella somministrazione di un questionario mediante online rivolta a tutti gli infermieri di qualsiasi Unità Operativa con unico limite l'esperienza lavorativa di almeno un anno. Inoltre, veniva richiesto agli infermieri di specificare se fossero coordinatori di trapianto o se avevano ricevuto una formazione specifica in merito. Per i calcoli statistici è stato utilizzato il programma Excel 2010 di Microsoft®. Risultati: l’83% dei coordinatori è al corrente che la loro unità operativa ha come obiettivo la donazione d’organo e tra gli infermieri solo il 69% ne è a conoscenza. Tra chi ha seguito almeno una donazione, l’83% ha riscontrato difficoltà durante il processo, il maggior timore espresso è quello della burocrazia, a seguire il rapporto con i famigliari e il mantenimento del paziente. La maggioranza degli infermieri è favorevole al trapianto (93,3%). Solo il 17% ritiene di essere sufficientemente formato, tra questi la totalità dei coordinatori dei trapianti. Discussione: da questo studio emerge che per gli infermieri è ancora difficile conoscere e applicare le diverse fasi del percorso di donazione. Forse gli infermieri non hanno completa percezione del ruolo fondamentale che hanno nell’identificazione, nel mantenimento e nel rispetto dei principi etici e delle volontà del donatore.&nbsp

Einleitung: Das Intensivpflegepersonal spielt eine essenzielle Rolle bei der Pflege hirntoter Patient*innen und derer Angehörigen, welche ein hohes Maß an Verantwortung, Wissen und Kompetenz seitens der Pflegekräfte benötigt. Der Betreuungsprozess hirntoter Patient*innen ist für einige Intensivpflegepersonen anstrengend, emotional belastend und herausfordernd. Daher ist die Anwendung von Bewältigungsstrategien für Stress- und Belastungssituationen hilfreich, um einerseits die Gesundheit der Intensivpfleger*innen aufrechtzuerhalten und andererseits die höchste Qualität bei der Versorgung potenziell hirntoter Organspender*innen gewährleisten zu können. Methodik: Für diese wissenschaftliche Arbeit wurde eine systematische Literaturrecherche nach Kleibel & Mayer (2011) durchgeführt. Die Literaturrecherche erfolgte in fünf unterschiedlichen wissenschaftlichen Datenbanken, in der Onlinebibliothek des FH Campus Wiens und der Universität Wiens sowie mithilfe des Schneeballverfahrens. Die Qualität der identifizierten Literatur wurde anhand der Bewertungsinstrumente von Brandenburg, Panfil und Mayer (2018) kritisch bewertet. Infolgedessen wurden zur weiteren Bearbeitung der Forschungsfrage zehn qualitative Studien und zwei systematische Reviews herangezogen. Ergebnisse: Aus den Ergebnissen der miteingeschlossenen Literatur konnten drei Hauptkategorien und sechs Subkategorien gebildet werden, welche pflegerische Belastungsfaktoren bei der Betreuung hirntoter Patient*innen bis zur Organexplantation beschreiben sollen: „Belastungserleben“, „Angehörigenbetreuung“ und „Bewältigungsstrategien“. Viele Intensivpflegekräfte erleben einige belastende und stressige Situationen während des Betreuungsprozesses potenziell hirntoter Organspender*innen und derer Angehörigen, wobei sich die Anwendung von Bewältigungsstrategien positiv auf die Vermeidung deren Belastungserlebens auswirken kann. Schlussfolgerung: Psychologische und soziale Unterstützungsmöglichkeiten, Schulungen sowie Fort- und Weiterbildungen im Bereich der Ethik, des Organspendeprozesses und dem Hirntod müssen optimiert werden, um das Belastungserleben des Intensivpflegepersonals während der Pflege hirntoter Patient*innen minimieren beziehungsweise vermeiden und um deren emotionale Stabilität dabei steigern zu können. Es erscheint als nützlich Intensivpflegepersonen erweiterte und angemessene Kompetenzen und Kenntnisse über den Betreuungsprozess potenziell hirntoter Organspender*innen zu übermitteln und zu lehren, um die bestmögliche pflegerische Versorgung hirntoter Patient*innen gewährleisten zu können. Introduction: Intensive care staff plays an essential role in the care of brain-dead patients and their families which requires a high level of responsibility, knowledge and competence from the nurses. The process of caring for brain dead patients is stressful, emotionally draining and challenging for many intensive care nurses. Therefore, the use of coping strategies for stressful nursing situations is helpful in order to maintain the health of the intensive care staff on the one hand and on the other hand to be able to ensure the highest quality of care for potentially brain-dead organ donors. Methodology: For this scientific work a systematic literature search was conducted according to Kleibel & Mayer (2011). The literature search was carried out in five different scientific databases, in the online library of the FH Campus Wien and the University of Vienna and through the snowball method. The quality of the identified literature was critically evaluated using the assessment tool of Brandenburg et al. (2018). As a result, ten qualitative studies and two systematic reviews were used to further address the research question. Results: From the results of the included literature three main categories and six subcategories could be formed to describe nursing stress factors during the care of brain-dead patients until organ explantation: "Experience of stress", "Care of relatives" and "Coping strategies". Many intensive care nurses experienced some distressing and stressful situations during the process of caring for potentially brain-dead organ donors and their families and the use of coping strategies could have a positive impact on avoiding these stressful experiences. Conclusion: Psychological and social support, training and education about ethic, the organ donation process and brain death need to be optimised in order to minimise or avoid stressful experience of intensive care staff during the care of brain-dead patients and to increase their emotional stability. It seems useful to provide and teach intensive care nurses advanced and appropriate competencies and knowledge about the care process of potentially brain-dead organ donors to provide the best possible nursing care for brain-dead patients.

Veselības komunikācija Informācijas un komunikācijas zinātnes Health Communication Information and Communication Sciences Maģistra darba tēma: “Orgānu ziedošanu ietekmējošie faktori un to nozīme orgānu ziedošanas veicināšanā”. Tēma izvēlēta, jo, ņemot vērā straujo transplantācijas nozares attīstību, pēdējo 50 gadu laikā medicīniskā donēšana ir kļuvusi par nozīmīgu veselības aprūpes un pētniecības jomu. Tēmas nozīmību nosaka nozares lielākā problemātika – orgānu trūkums, jo vajadzība pēc orgānu donoriem ir daudz lielāka nekā to pieejamība. Orgānu ziedošana sniedz iespēju izglābt dzīvību situācijās, kad nepastāv citas līdzvērtīgas efektivitātes alternatīvas, tādējādi uzlabojot recipienta dzīves kvalitāti un dzīvildzi. Vienlaikus jāmin orgānu ziedošanas nozīmīgā ekonomiskā ietekme – samazinot veselības aprūpes izmaksas, kā arī sniedzot iespēju recipientam atgriezties ekonomiski aktīvā dzīvesveidā. Tomēr jāatzīst, ka indivīdu iesaiste orgānu ziedošanā var būt sarežģīta, tādēļ nepieciešams noskaidrot faktorus, kas ietekmē indivīda lēmumu reģistrēt piekrišanu orgānu ziedošanas reģistrā. Pētījuma mērķis ir noteikt, kuros C4D modeļa līmeņos un ar kādu uzdevumu nepieciešams īstenot intervences, kas balstās uz Latvijas iedzīvotāju lēmumu ietekmējošajiem faktoriem, lai veicinātu orgānu ziedošanas piekrišanas atzīmes veikšanu. Darba teorētiskā bāze balstīta uz orgānu ziedošanas modeļiem un to attīstību, vienlīdz aplūkota teorētiskā literatūra par sociāli ekoloģisko modeli un tā līmeņiem atbilstošajām C4D pieejām, kā arī aprakstīta uzvedības ekonomikas loma uzvedības maiņas intervencēs un tehnikās. Darba pētnieciskajā daļā izmantots jaukts pētījuma dizains. Pirmajā pētījuma posmā veiktas 10 daļēji strukturētās padziļinātās intervijas, kas analizētas, izmantojot tematisko analīzi, lai noskaidrotu nozīmīgākos orgānu ziedošanas lēmumu ietekmējošos faktorus. Otrajā posmā izmantotas aprakstošās un slēdzienstatistikas metodes un veikta izpētošā faktoranalīze, analizējot kvantitatīvos datus, kas iegūti elektroniskā aptaujā, ar mērķi noskaidrot pastāvošās sakarības starp orgānu ziedošanu ietekmējošajiem faktoriem un uzvedības nodomu. Nozīmīgākais darbā iegūtais secinājums – uzvedības nodomu ietekmē gan kognitīvie, gan nekognitīvie faktori, kas savstarpēji mijiedarbojas. Būtiska ir nekognitīvo faktoru loma orgānu ziedošanas lēmuma pieņemšanas procesā. Būtiskākie secinājumi pēc pētnieciskās daļas – lai gan trūkst zināšanu par orgānu ziedošanu, attieksme pret orgānu ziedošanu ir pozitīva. Tomēr tikai pozitīva attieksme pret orgānu ziedošanu nenosaka uzvedības nodomu. Pamatā orgānu ziedošanu ietekmē altruistiskās un garīgās vērtības, izteiktākie faktori: augsts altruisma līmenis, augsta uzticība informācijas drošībai, nozīmīgs emocionālais atbalsts orgānu ziedošanas lēmuma pieņemšanā. Nepieciešamas visaptverošas C4D intervences visos piecos SEM modeļa līmeņos, sākot ar intervenču ieviešanu politikas līmenī. Master's thesis topic: “Factors influencing organ donation and their importance in promoting organ donation”. The topic was chosen because the rapid growth in the field of organ transplantation has driven advances in health care practice and research into medical donation over the past 50 years. The topic is important because of a growing mismatch between the demand for organs donors and their availability. Organ donation provides an opportunity to save lives in situations where there are no other equally effective alternatives, additionally improving the recipient’s quality of life. Also, the positive economic impact of organ donation is significant – contributing to reduced health care costs, as well as giving the recipient the opportunity to return to an economically productive lifestyle. However, successfully engaging individuals in organ donation has been challenging, and there is a need to identify factors that influence an individual’s decision to consent to register as an organ donor. The aim of the research is to determine at which levels of the C4D model and with which task it is necessary to implement interventions based on the factors influencing the decision of Latvian citizens to influence the decision to consent to organ donation. The theory of the work is based on models of organ donation and the scientific literature on the socio-ecological model and C4D approaches. The role of behavioral economics in determining interventions and techniques that result in behavioral change is also examined. A mixed research design was applied. In the first stage of the research, 10 adults participated in semi-structured in-depth interviews, which were subsequently analyzed to identify common themes regarding the factors influencing the decision to donate organs. In the second stage, descriptive and inferential statistical methods and exploratory factor analysis was performed, analyzing the quantitative data obtained in an electronic survey, with the aim to clarify the existing relationships between the factors influencing the decision to donate and the intention to donate. The major conclusion is that both cognitive and non-cognitive factors interact to influence the intention to donate. The role of non-cognitive factors in the decision-making process of organ donation is important. While there is an apparent lack of knowledge about organ donation, the attitude towards organ donation is positive. However, positive attitudes toward organ donation alone do not determine behavioral intention. The decision to donate is influenced by altruistic and spiritual values, particularly by a high level of altruism, high trust in information security, and significant need for emotional support in making the decision to donate. Comprehensive C4D interventions are needed at all five levels of the SEM model, starting with the implementation of interventions at the policy level.

This scoping review aims to investigate the current state of evidence on the identification of potential organ donors in prehospital settings by healthcare professionals. The success of organ and tissue transplantation largely depends on timely identification, making it crucial for prehospital healthcare providers to identify potential donors in a time-sensitive context. However, the lack of guidance and evidence in this area can lead to missed opportunities for organ donation, ultimately exacerbating the organ scarcity problem and negatively impacting patients on transplant waiting lists. Therefore, this review will explore the ability of healthcare professionals to identify potential donors and any potential obstacles they may face in this process.

Euthanasia based on psychiatric suffering, followed by subsequent organ donation, is considered medically and legally permissible in the Netherlands. Although organ donation after euthanasia (ODE) in patients suffering from unbearable psychiatric illness is performed, it is not specifically addressed in the Dutch guideline on organ donation after euthanasia, and national data on ODE in psychiatric patients have not yet been published. In this article, the preliminary results of the 10-year Dutch case series of psychiatric patients who choose ODE are presented and potential factors influencing opportunities for donation in this population are discussed. We conclude that further future in-depth qualitative exploration of ODE in patients suffering from psychiatric illness and its associated ethical and practical dilemmas, including the consequences for the patient and their family and healthcare professionals, will be important to help make sense of potential barriers to donation for people undergoing euthanasia as a result of psychiatric suffering.

Bakgrund: Varje år dör folk i väntan på organ- och vävnadsdonation. När en person avlider av total hjärninfarkt blir denne under rätt förutsättningar en möjlig donator. Organ- och vävnadsdonationsprocessen är en process som oftast ses som plötslig och främmande för de närstående. Närstående är involverade under hela donationsprocessen och de blir en del av omvårdnaden, något sjuksköterskan måste ta i beaktande. Syfte: Att belysa närståendes upplevelser av donationsprocessen. Metod: En litteraturöversikt baserad på kvalitativa artiklar där tio vetenskapliga originalartiklar analyserades. Resultat: Resultatet presenteras i två huvudteman: Yttre faktorer och Inre faktorer med två subteman tillhörande vardera huvudtema: vårdmiljö och tid, socialt stöd, bristande förståelse och att känna sig bortglömd. Konklusion: Närstående upplevde donationsprocessen som en svår tid med både positiva och negativa känslor. Yttre och inre faktorer präglar de närståendes upplevelser. Behovet av utveckling av vårdandet för de närstående kvarstår och behöver förbättras. Background: Every year people die waiting for organ and tissue donation. When a person dies of a total cerebral infarction, he becomes a possible donor under the right conditions. The organ and tissue donation process is a process that often is seen as sudden and foreign to the relatives. Relatives are involved throughout the donation process and they become part of the care, something the nurses must take into account. Aim: To shed light on relatives’ experiences of the donation process. Method: A literature review based on ten qualitative original articles were analysed. Findings: The results revealed two main themes: External factors and Internal factors with two subthemes belonging to each main theme: care environment and time, social support, lack of understanding and to feel forgotten. Conclusion: Relatives experienced the donation process as a difficult time with both positive and negative emotions. External and internal factors shape the experiences of those close to you. The need for development of care for the next of kin remains and needs to be improved.

Tanto los trasplantes como los alotrasplantes compuestos vascularizados, al depender de donaciones, obedecen a factores psicosociales que conociéndolos permiten tomar actitudes educacionales acordes. Objetivo: explorar los conocimientos, creencias y actitudes de estudiantes de enfermería e informática respecto a la donación y trasplante de órganos y alotrasplantes compuestos vascularizados. Material y métodos: estudio exploratorio desde una aproximación cualitativa. Entrevistas semiestructuradas a 10 estudiantes de enfermería e informática. Resultados: tres categorías: conocimientos, mostrando desinformación; creencias como que no hay nada después de morir, que la donación es altruista y que sus profesiones ayudan a concienciar; y actitudes como que suelen hablar de la muerte de forma abierta, pero no de donación. Discusión: los universitarios están concienciados, pero no están bien informados, encontrando evidencias como que la religión o donar sangre o médula no influyen para ser donante de órganos y conocer receptores o alguien con alguna desfiguración y hablar de la muerte sí influye. Conclusiones: existen creencias que favorecen la do-nación de órganos y tejido compuesto vascularizado en los universitarios, pero también una desinformación importante y una falta de diálogo sobre hacerse donante que perjudica dicha donación y la función educadora en este aspecto a nivel profesional. Both vascularized composite transplants and allogeneic transplants, as they depend on donations, are due to psychosocial factors that, knowing them, allow us to take appropriate educational attitudes. Objective: to explore the knowledge, beliefs and attitudes of nursing and computer science students regarding the donation and transplantation of organs and vascularized compound allogeneic transplants. Material and methods: exploratory research with qualitative approach. Semi-structured interviews with 10 nursing and computer science students. Results: three categories: knowledge, showing disinformation; beliefs such as that there is nothing after death, that donation is altruistic and that their professions help raise awareness; and attitudes such as that they tend to talk about death openly, but not about donation. Discussion: university students are aware, but they are not well informed, finding evidence such as that religion or donating blood or marrow does not influence to be an organ donor and knowing recipients or someone with some disfigurement and talking about death does influence. Conclusions: there are beliefs that favor the donation of organs and vascularized composite tissue in university students, but also a significant misinformation and a lack of dialogue about becoming a donor that damages said donation and the educational role in this regard at a professional level. Tanto os transplantes como os alotransplantes compostos vascularizados, por dependerem de doações, devem-se a fatores psicossociais que, conhecendo-os, nos permitem tomar atitudes educativas adequadas. Objetivo: explorar os conhecimentos, crenças e atitudes dos estudantes de enfermagem e computação em relação à doação e transplante de órgãos e aos alotransplantes compostos vascularizados. Material e métodos: Estudo exploratório a partir de uma exploração qualitativa. Entrevistas semiestruturadas com 10 estudantes de enfermagem e informática. Resultados: três categorias: conhecimento, mostrando desinformação; crenças como que não há nada depois da morte, que a doação é altruísta e que suas profissões ajudam a aumentar a consciência; e atitudes tais como falar sobre a morte abertamente, mas não sobre doação. Discussão: os universitários estão cientes, mas não estão bem informados, encontrando evidências como a religião ou a doação de sangue ou medula óssea não influenciam ser um doador de órgãos, mas conhecer os destinatários ou alguém com uma desfiguração e falar sobre a morte, sim. Conclusões: existem crenças que favorecem a doação de órgãos e tecidos compostos vascularizados em universitários, porém há também uma desinformação significativa e uma falta de diálogo sobre como tornar-se doador, o que é prejudicial para esta doação e à educação sobre este assunto como futuros profissionais.

African Americans comprise approximately 13% of the U.S. population, 6% of missing persons, and 51% of homicide victims (Kochanek et al. 2019; National Crime Information Center [NCIC] 2018; U.S. Census Bureau 2010). However, African American remains are underrepresented in the documented skeletal samples resulting from body donations to U.S. taphonomic research facilities. If forensic anthropologists are to rise to the challenge of identifying remains from this segment of the U.S. population, and if heritable differences among human populations are to be distinguished from the embodied differences acquired by marginalized individuals, a deeper understanding of African American skeletal biology is essential. This understanding is contingent on Black donors participating in whole-body donation to anthropological research facilities—participation that may be undermined by a legacy of mistrust between Black communities and the traditionally White-dominated scientific and medical establishments. This review paper synthesizes data from medical research on cadaver and organ donation, as well as anthropological literature on structural violence, embodiment, and the collection and curation of human remains, to present multiple perspectives on increasing African American body donation to anthropological research. We focus on historical, structural, and cultural factors potentially contributing to Black donor reluctance, providing a perspective often lacking in discussions of skeletal curation. We aim to generate debate and discussion within the field of forensic anthropologyand among community stakeholders about how skeletal research can better serve Black communities.

Objectives Organ donation is the driving force for transplant. Awareness about donation and transplant is invaluable for improved transplant services in any country. Our objective was to assess the knowledge and attitude toward organ donation and transplant among medically educated adult Iraqis versus adult Iraqis who were not medically educated, in Baghdad, Iraq. Materials and methods For this study, we recruited 400 Iraqi residents of Baghdad city from December 1, 2018, to March 1, 2019. We used an interviewer-adm-inistered questionnaire to survey 200 health care professionals and 200 adults who lacked medical education, and then we analyzed the responses from the 2 groups. Results The study included 165 males and 235 females (mean age 33.73 ± 10.38 years). Most participants (60%) were aware of organ donation, and a health care provider was the main source of their knowledge. Only 11.25% were aware of Iraqi legislation that permits donation after brain death. Nearly 50% of the participants volunteered to be living donors, and 229/400 (57.25%%) volunteered to donate after death. About 50% accepted the idea of organ donation as an act to save life, whomever the donor. The most important barrier was the fear of future risks to health after living donation and body disfigurement after death. There was a statistically significant difference in the knowledge and attitude scores between the 2 groups. From the study sample, 46.5% accepted the concept of incenting living donors or families of deceased donors. Conclusions Iraqi people are moderately informed about organ donation and transplant. Medically educated people demonstrated an attitude of greater acceptance. Religion and social beliefs were not barriers to organ donation in the study sample. Regulated governmental application of incentive programs may be a useful strategy at present.

Objective: To evaluate the educational impact of a pilot MOOC (Massive Open Online Course), validated by the French College of Urology Teachers (FCUT), on the surgical technique of kidney transplantation.Materials and methods: We developed a MOOC on the surgical technique of kidney transplantation, based on a video of a surgical procedure, performed by an expert surgeon. The MOOC has been validated by the FCUT. We have created 2 student groups: 1) MOOC-pre-QCM group: visualization of the MOOC then answer to the MCQs and satisfaction questions; 2) MOOC-post-QCM group: answer to the MCQs then visualization of the MOOC then answers to the satisfaction questions. In total, 20 MCQs on the kidney transplantation technique were completed by the 2 groups. The answers were anonymous.Results: A total of 142 people answered the MCQs (MOOC-pre-QCM group (n=66) and MOOC-post-QCM group (n=76)). Twenty-nine percent (41/142) of the participants were fellows and 71 % (101/142) were residents. The proportion of fellows and residents was identical between the 2 groups. The rate of correct answers to the 20 MCQs was statistically higher in the MOOC-pre-QCM group, compared to the MOOC-post-QCM group (88.6 % versus 73.3 %, P, ObjectifÉvaluer l’impact pédagogique d’un MOOC (Massive Open Online Course) pilote, validé par le Collège français des enseignants en urologie (CFEU), sur la technique chirurgicale de transplantation rénale.Matériel et méthodesNous avons réalisé un MOOC sur la technique chirurgicale de transplantation rénale, à partir d’une vidéo d’une intervention chirurgicale, réalisée par un chirurgien expert. Le MOOC a été validé par le CFEU. Nous avons créé 2 groupes d’étudiants : 1) groupe MOOC-pré-QCM : visualisation du MOOC, puis réponse aux QCM et aux questions de satisfaction ; 2) groupe MOOC-post-QCM : réponse aux QCM, puis visualisation du MOOC, puis réponse aux questions de satisfaction. Au total, 20 QCM sur la technique transplantation rénale ont été remplis par les 2 groupes. Les réponses étaient anonymes.RésultatsAu total, 142 personnes ont répondu aux QCM (groupe MOOC-pré-QCM (n = 66) et groupe MOOC-post-QCM (n = 76)). 29 % (41/142) des participants étaient des CCA ou assistants et 71 % (101/142) étaient des internes. La proportion de CCA/assistants et d’internes était identique entre les 2 groupes. Le taux de réponses correctes aux 20 QCM était statistiquement supérieur dans le groupe MOOC-pré-QCM, en comparaison au groupe MOOC post-QCM (88,6 % contre 73,3 %, p < 0,0001). Au total, 91 % des étudiants ont trouvé le MOOC « Très Utile » ou « Utile ». La médiane de la note du MOOC, donnée par les étudiants, était de 8/10.ConclusionCette étude a montré un impact positif du MOOC sur les connaissances théoriques de la technique chirurgicale de transplantation rénale. Ce MOOC pourrait servir de projet pilote pour le développement d’autres MOOC sur la chirurgie urologique.Niveau3.

Organ donation (OD) following circulatory determination of death (DCDD) is an increasing source of transplant organs but little is known about community opinions on treatment withdrawal, death determination death and acceptance of OD in DCDD. To determine attitudes on death determination, the importance of patient choice in treatment withdrawal and OD agreement, and the importance of the 'Dead Donor Rule', we undertook a scenario-based online survey of 1017 members of the Australian general public. Mean levels of agreement across respondent's responses to statements were compared by repeated measures ANOVA. 54% (548) of respondents agreed that a DCDD scenario patient could be declared dead 2 minutes after circulatory standstill, however over 80% nonetheless agreed OD would be appropriate, including 77% (136/176) of those disagreeing with 2-minute death declaration. 48% (484) supported OD even if it caused the patient's death. 75% (766) accepted relatively benign ante-mortem treatments administered to improve transplant outcomes. Over 70% supported a high quadriplegic patient's request to be allowed to die, with 61% (622) agreeing that he should be allowed to donate his organs under anaesthesia, but 60% (610) also agreed that he should first be declared dead. In conclusion, we found high levels of support for treatment withdrawal in severe brain injury and when requested by a quadriplegic patient. While there was variable agreement with the timing of death determination and with OD under anaesthesia, support for OD was high in both scenarios. For many people death determination prior to OD may not be of paramount importance. This article is protected by copyright. All rights reserved.

Background and Aims The global impact of SARS-CoV-2 on liver transplantation (LT) practices across the world is unknown. The goal of this survey was to assess the impact of the pandemic on global LT practices. Method A prospective web-based survey (available online from 7th September 2020 to 31st December 2020) was proposed to the active members of the EASL-ESOT/ELITA-ILTS in the Americas (including North, Central, and South America) (R1), Europe (R2), and the rest of the world (R3). The survey comprised four parts concerning the transplant processes, therapy, living donor, and organ procurement. Results Of the 470 transplant centers reached, 128 answered each part of the survey, 29 centers (23%), 64 centers (50%), and 35 centers (27%) from R1, R2, and R3, respectively. When we compared the practices during the first six months of the pandemic in 2020 with that a year earlier in 2019, statistically significant differences were found in the number of patients added to the waiting list (WL), the number of WL mortality, and the number of transplantations. At the regional level, we found that in R2 the number of LTs was significantly higher in 2019 (p < 0.01), while R3 had more patients listed, higher WL mortality, and more LTs performed before the pandemic. Countries severely affected by the pandemic (“hit” countries) had a lower number of WL patients (p = 0.009) and LT (p = 0.002) during the pandemic. Interestingly, WL mortality was higher in the pandemic in “non-hit” countries (p = 0.022) compared to 2019. Conclusion The first wave of the pandemic differentially impacted LT across the world, especially with detrimental effects on the “hit” countries. The modifications in the policies for recipient and donor selection, organ retrieval, and postoperative recipient management were adopted at a regional or national level. Lay summary The health emergency caused by the Coronavirus has dramatically changed clinical practice during the pandemic. The first wave of pandemic impacted Liver Transplantation across the world differently, especially with detrimental effects on the hit countries. The resilience of the entire transplant network has enabled the support of organ donations and transplants to ultimately improve the lives of patients with end-stage liver disease., Graphical abstract

This review compiles and contextualizes the available empirical literature on natural occurrences of high-stakes altruism among nonrelatives, i.e., behaviors often called ‘heroic’. Four domains are covered: exceptional bravery and self-sacrifice in war, heroism in civilian life, undirected organ donations, and rescues of persecuted persons during mass violence and genocides. The diversity of strategies used to identify instances of heroic behavior and the multiplicity of data collection methods employed in this relatively sparse literature currently preclude a systematic comparison of results. Therefore, the aim of this overview is to provide an exhaustive point of entry to a fascinating field of research with much untapped potential for testing theories about prosocial behavior.

There is a worldwide shortage of organs for transplantation. One method to increase the number of organs available for transplant is to increase the number of registered organ donors. The emergency department (ED) may be a suitable venue to disseminate knowledge to patients about organ donation, and to offer an immediate or future opportunity to register as an organ donor. This study aimed to assess emergency physicians' attitudes and acceptability of an ED-based organ donation registration initiative.We developed and distributed a national postal survey using a modified Dillman's tailored design technique to a random sample of emergency physicians selected from the Canadian Medical Directory.From a total of 474 delivered surveys, we received 228 responses (48.1%). 98.5% of emergency physicians support the concept of deceased organ donation. 85.1% felt that the emergency department is an appropriate setting to disseminate information regarding organ donation and 77.6% felt that it is an appropriate location to offer an immediate opportunity to register as an organ donor. 74.1% of physicians who responded report to be personally registered as an organ donor.Most emergency physicians are supportive of organ donation promotion in the ED, including offering an immediate opportunity to register.RéSUMé: OBJECTIF: Il y a une pénurie mondiale d'organes destinés à la transplantation. Une méthode pour augmenter le nombre d'organes disponibles pour la transplantation est d'augmenter le nombre de donneurs d'organes enregistrés. Le service des urgences (SU) peut être un lieu approprié pour informer les patients sur le don d'organes et leur offrir la possibilité, immédiate ou future, de s'inscrire comme donneur d'organes. Cette étude visait à évaluer les attitudes des médecins urgentistes et l'acceptabilité d'une initiative d'enregistrement des dons d'organes aux urgences. MéTHODES: Nous avons élaboré et distribué une enquête postale nationale en utilisant une technique modifiée de conception sur mesure de Dillman à un échantillon aléatoire de médecins urgentistes sélectionnés à partir de l'annuaire médical canadien. RéSULTATS: Sur un total de 474 questionnaires remis, nous avons reçu 228 réponses (48,1%). 98,5 % des médecins urgentistes soutiennent le concept du don d'organes de personnes décédées. 85,1 % ont estimé que le service des urgences est un lieu approprié pour diffuser des informations sur le don d'organes et 77,6 % ont estimé que c'est un lieu approprié pour offrir une possibilité immédiate de s'inscrire comme donneur d'organes. 74,1 % des médecins qui ont répondu déclarent être personnellement inscrits comme donneurs d'organes. CONCLUSION: La plupart des médecins urgentistes sont favorables à la promotion du don d'organes dans les urgences, notamment en offrant la possibilité de s'inscrire immédiatement.

Objective Organ donation after circulatory death (DCD) is a potential solution for the shortage of suitable organs for transplant. Heart transplantation using DCD donors is not frequently performed due to the potential myocardial damage following warm ischemia. Heat shock protein (HSP) 90 has recently been investigated as a novel target to reduce ischemia/reperfusion injury. The objective of this study is to evaluate an innovative HSP90 inhibitor (HSP90i) as a cardioprotective agent in a model of DCD heart. Methods A DCD protocol was initiated in anesthetized Lewis rats by discontinuation of ventilation and confirmation of circulatory death by invasive monitoring. Following 15 minutes of warm ischemia, cardioplegia was perfused for 5 minutes at physiological pressure. DCD hearts were mounted on a Langendorff ex vivo heart perfusion system for reconditioning and functional assessment (60 minutes). HSP90i (0.01 μmol/L) or vehicle was perfused in the cardioplegia and during the first 10 minutes of ex vivo heart perfusion reperfusion. Following assessment, pro-survival pathway signaling was evaluated by western blot or polymerase chain reaction. Results Treatment with HSP90i preserved left ventricular contractility (maximum + dP/dt, 2385 ± 249 vs 1745 ± 150 mm Hg/s), relaxation (minimum –dP/dt, –1437 ± 97 vs 1125 ± 85 mm Hg/s), and developed pressure (60.7 ± 5.6 vs 43.9 ± 4.0 mm Hg), when compared with control DCD hearts (All P = .001). Treatment abrogates ischemic injury as demonstrated by a significant reduction of infarct size (2,3,5-triphenyl-tetrazolium chloride staining) of 7 ± 3% versus 19 ± 4% (P = .03), troponin T release, and mRNA expression of Bax/Bcl-2 (P Conclusions The cardioprotective effects of HSP90i when used following circulatory death might improve transplant organ availability by expanding the use of DCD hearts.

INTRODUCTION Safely increasing organ donation to meet need is a priority. Potential donors may be declined due to perceived blood borne virus (BBV) transmission risk. With hepatitis C (HCV) curative therapy, more potential donors may now be suitable. We sought to describe potential deceased donors with increased BBV transmission risk. METHODS We conducted a cohort study of all potential organ donors referred in New South Wales, Australia, 2010-2018. We compared baseline risk potential donors to potential donors with increased BBV transmission risk, due to history of HIV, HCV or hepatitis B and/or behavioural risk factors. RESULTS There were 624/5749 potential donors (10.9%) perceived to have increased BBV transmission risk. This included 298/5749 (5.2%) with HCV (including HBV co-infections) and 239/5749 (4.2%) with increased risk behaviours (no known BBV). Potential donors with HCV and those with increased risk behaviours were younger and had fewer comorbidities than baseline risk potential donors (p

BACKGROUND Audiovisual creation allows teachers and students to become consumers and producers of information, creating collaborative environments. In the field of organ donation and transplantation (ODT), most of the educational proposals analyzed to date consist of presentations. The teacher does not usually have a decisive role in this type of methodologies, in addition to not having the appropriate training to be able to participate actively. OBJECTIVES To analyze the change in teachers' attitudes towards ODT after participating in an educational proposal based on the creation of short films. METHODS Teachers of secondary education in ten schools in southeastern Spain. The proposal consisted in the creation of short films based on topics related to ODT by the students. A validated ODT attitude form was administered to teachers at the beginning of the proposal and at the end of the proposal. A descriptive analysis was carried out together with McNemar test was used to compare the pre and post test results of the teacher. P < .05 was considered statiscally significant. RESULTS The favorable attitude towards organ donation at death increased after the proposal (64% vs 88%; P = .008). Favorable attitude towards organ donation from a relative also improved (52% vs 76%; P = .008), as did favorable attitude towards living kidney donation (52% vs 88%; P < .001), living liver donation (36% vs 85%; P = .008) and xenotransplantation (45% vs 82%; P < .001). CONCLUSIONS The teachers improves after an educational proposal based on the creation of short films related to ODT.

Li He,1,&ast; Zhi Fu,2,&ast; Menglong Wang,2 Xin Wang,1 Lu Wang,1 Guangming Li,2 Dongdong Lin2 1Department of Intensive Care Unit, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China; 2Department of General Surgery Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guangming Li; Dongdong LinDepartment of General Surgery Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of ChinaTel +86 10 83997733; Tel/Fax +86 10 83997733Email gm_drli@163.com; dongdlin01@163.comObjective: To evaluate and explore the effectiveness of the new prevention and control measures for the donor-derived infection (DDI) associated with CRO after liver transplantation.Methods: The data of 120 organ donors and recipients from January 2018 to May 2020 were retrospectively analyzed at The Liver Transplantation Center of Beijing Youan Hospital, Capital Medical University, to investigate the epidemiological status of CRO in donors. The cases were divided into two groups. The implemented group was treated according to the execution of a clustered CRO prevention and control measure based on active screening combined with early initiation of prophylactic/therapeutic administration of antibiotics. The effectiveness of the prevention and control measures was evaluated by comparing the length of postoperative ICU stay, total postoperative length of hospital stay, duration of ventilator use, duration of restricted antibiotics use, the incidence of DDI, incidence and composition distribution of DDI-related CRO, and incidence of severe DDI-relevant adverse events between the two groups.Results: There was a high detection rate of 39.32% (105 strains) of drug-resistant bacteria in the donors. Fifty-six strains of CRO were detected. Participants in group B, which implemented the new prevention and control measures, were transferred out of the ICU sooner (P = 0.023), used fewer restrictive antibiotics (P = 0.003), and were discharged more quickly (P = 0.013) than those in group A. Postoperative DDI incidences (P = 0.113) and severe DDI-related adverse events were not statistically different between the two groups (P = 0.062). CR-Kp-related DDI was less common in group B (P = 0.021).Conclusion: The situation of donor-derived drug-resistant bacterial infections remains critical. The clustered prevention and control measures for CRO based on active screening combined with early initiation of prophylactic/therapeutic application of antibiotics would be beneficial.Keywords: organ donation, liver transplantation, drug-resistant bacteria, epidemiology, carbapenem-resistant Enterobacteriaceae, active screening, novel β-lactamase inhibitors

Background Access to forms of dialysis, kidney transplantation (Tx) and comprehensive conservative management (CCM) for patients with end-stage kidney disease (ESKD) varies across European countries. Attitudes of nephrologists, information provision and decision-making may influence this access and nephrologists may experience several barriers when providing treatments for ESKD. Methods We surveyed European nephrologists and kidney transplant surgeons treating adults with ESKD about factors influencing modality choice. Descriptive statistics were used to compare the opinions of professionals from European countries with low–, middle– and high–gross domestic product purchasing power parity (GDP PPP). Results In total, 681 professionals from 33 European countries participated. Respondents from all GDP categories indicated that ∼10% of patients received no information before the start of renal replacement therapy (RRT) (P = 0.106). Early information provision and more involvement of patients in decision-making were more frequently reported in middle- and high-GDP countries (P Conclusions Differences in factors influencing modality choice when providing RRT or CCM to adults with ESKD were found among low-, middle- and high-GDP countries in Europe. Therefore a unique pan-European policy to improve access to treatments may be inefficient. Different policies for clusters of countries could be more useful.

This study examines different types of organ donation public service announcement appeal messages (narrative, counter argument, and statistical) in relation to their effectiveness on the African American community. Previous studies on public service announcements aimed at African Americans and how effective the different message appeals are examined along with issues effecting the likelihood of African Americans consenting to be organ donors. African American participants were recruited using the Qualtrics survey company. Analysis of survey data suggest that narrative appeals are more effective than statistical and counter argument appeals but statistical and counter argument did not differ from each other. Implications of this finding along with directions for future research is included.

To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 hours.A retrospective cohort study was made covering the period 2015-2017.An adult Intensive Care Unit (ICU).Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD.A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD 24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD 24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD 24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups.Early BD (24 h) was associated to GCS 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.

Introduction: Organ shortage is a global issue. As future doctors, role of medical students becomes important in promoting organ donation. Objectives: 1. To study the knowledge of medical students regarding organ donation 2. To study the beliefs of medical students regarding various aspects of organ donation 3.To study their perceptions about the need to have a training on this topic. Method: The study design was cross sectional involving undergraduate medical students from a teaching institute of Delhi. Sample size of 296 was calculated and 60 students were randomly recruited from each year by using random number tables. Data collection was done by using a pre designed pre tested semi structured questionnaire. Data entry and analysis was done by using Microsoft Excel and SPSS version 20 software. Results: A large proportion of 95.3% (286) had heard of ‘organ donation’ but correct knowledge regarding ideal age for donation and brain dead people for donation was very poor. It was significantly poorer in males and those studying in earlier years of graduation (p

People easily agree with the principle of organ donation; nevertheless, when a person dies, their relatives often refuse to honour this agreement. Because of this persistent social conduct, organ shortage is responsible for the rising mortality of patients on organ waiting lists. This sad reality continues despite the ongoing education effort with the enduring slogan: “Organ donation is a gift of life”.

In 2020 England moved to an opt-out deceased donation law. We aimed to investigate the views of a mixed stakeholder group comprising people with kidney disease, family members and healthcare practitioners towards the change in legislation. We investigated the expected impacts of the new legislation on deceased-donor and living-donor transplantation, and views on media campaigns regarding the law change.We undertook in-depth qualitative interviews with people with kidney disease (n = 13), their family members (n = 4) and healthcare practitioners (n = 15). Purposive sampling was used to ensure diversity for patients and healthcare practitioners. Family members were recruited through snowball sampling and posters. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed using thematic analysis.Three themes with six subthemes were identified: (i) Expectations of impact (Hopeful patients; Cautious healthcare professionals), (ii) Living-donor transplantation (Divergent views; Unchanged clinical recommendations), (iii) Media campaigns (Single message; Highlighting recipient benefits). Patients expected the law change would result in more deceased-donor transplant opportunities.Clinicians should ensure patients and families are aware of the current evidence regarding the impact of opt-out consent: expectations of an increased likelihood of receiving a deceased-donor transplant are not currently supported by the evidence. This may help to prevent a decline in living-donor transplantation seen in other countries with similar legislation. Media campaigns should include a focus on the impact of organ receipt.Two patient representatives from the Kidney Disease Health Integration Team, Primrose Granville and Soumeya Bouacida, contributed to the content and design of the study documents.

OBJECTIVES: In India, organ donation and transplant activities are managed under the National Organ and Tissue Transplant Organisation, established per the mandate of the Transplantation of Human Organs and Tissues Act 1994, as stipulated by World Health Organization guidelines. MATERIALS AND METHODS: The National Organ and Tissue Transplant Organisation reached out to various hospitals and concerned authorities at national, regional, and local levels through E-mails and telephone calls to gather and to analyze 2019 data regarding the World Health Organization-Global Observatory on Donation and Transplantation questionnaire. RESULTS: In 2019, India had 550 transplant centers registered with state-appropriate authorities and 140 nontransplant organ retrieval centers. Most living donors were kidney donors (8613) or liver donors (1993). Of all solid-organ transplants, most were kidney transplants, followed by liver, heart, lung, and pancreas. There were few heart and pancreas transplants in 2019, with higher percentage of female donors (65.4% and 54.3%, respectively, n = 5633 and 1084). Of transplant procedures, there were more living donor transplants (84%, n = 10 600) than deceased donor transplants (16%, n = 2023). Among all organs, wait lists for kidney transplants were higher than for other organs. CONCLUSIONS: Reporting on organ donation and transplant of 2019 from the National Organ and Tissue Transplant Organisation, India's national registry, continued in 2020 despite the challenges of COVID-19. India has been submitting organ donation and transplant data at the national level to the Global Observatory on Donation and Transplantation consistently from 2013 to 2019 and is the only country in the World Health Organization South-East Asia Region to have done so, providing information from all states and union territories in India.

Introduction There is variation in exposure to transplantation in undergraduate medical education. We created a program pairing medical students with transplant patients for semi-structured, virtual encounters and studied the impact on both students and patients using qualitative content analysis. Methods Fifty medical students were paired with transplant recipients and donors for non-medical virtual encounters. Separate focus groups were conducted, deidentified, and analyzed using a constant comparative method. Results Three themes related to the student experience emerged: transplant-related relationships, a deeper understanding of the patient's journey to transplant, and alterations of their personal view of organ donation and transplantation. Three themes emerged from the patient's experiences: the benefits of conversations, the patient as a teacher, and spreading the message of organ donation and transplantation. Conclusions This novel program demonstrates that virtual student-patient interactions are a useful approach to engage patients and a unique way to teach medical students about transplantation and donation.

INTRODUCTION Les décès de nourrissons par traumatisme crânien non accidentel s’inscrivent dans une procédure médico-judicaire pouvant compliquer les démarches de prélèvement multi-organes. L’objectif de cette étude est de décrire les pratiques du prélèvement d’organes chez ces nourrissons en état de mort encéphalique en France. METHODES Une enquête nationale rétrospective a été menée d’Avril à Décembre 2018 auprès des 33 coordinations de prélèvement d’organes pédiatriques et des 28 instituts médico-légaux. Le recueil de données a porté sur les cas recensés entre 2013 et 2017. RESULTATS Seize cas ont été recensés. La prise en charge des traumatismes crâniens non accidentels éligibles au prélèvement d’organes est très hétérogène selon les centres. Les coordinations considèrent que la judiciarisation des dossiers représente le principal obstacle au prélèvement. Seuls 6 des instituts médico-légaux approuvent systématiquement le prélèvement multi-organes dans ce contexte, 11 estimant qu’il pourrait empêcher la mise en évidence de lésions thoraco-abdominales, compromettre l’interprétation de certaines lésions ou encore la détermination des causes de la mort. CONCLUSION Une uniformisation des pratiques du prélèvement multi-organes incluant une collaboration étroite entre réanimateurs, coordinateurs, légistes et magistrats sont indispensables pour faciliter le prélèvement d’organes pédiatriques dans les situations médico-judiciaires le permettant, afin d’augmenter la disponibilité des greffons compatibles aux nourrissons en attente de greffe en France.

OBJECTIVE This scoping review will collate and summarize the current literature on what is known worldwide about organ donation following medical assistance in dying. The information gathered will be used to inform updates of current and future policies on organ donation following medical assistance in dying in Canada. INTRODUCTION Medical assistance in dying is a controversial and contentious issue worldwide. While more countries are legalizing medical assistance in this regard, very few allow organ donation after such assistance has been given. At present, Canada, Belgium, and The Netherlands are the only three countries that permit this procedure. This scoping review will be conducted to summarize the current state of evidence and practices regarding organ donation following medical assistance in dying. INCLUSION CRITERIA This review will consider articles and documents on individuals who choose organ donation following medical assistance in dying. Articles will be considered for inclusion if they explore organ donation following medical assistance in dying at home or in any health care setting in any country. Quantitative and qualitative studies, text and opinion papers, gray literature, and unpublished materials provided by researchers will be considered for inclusion. METHODS This review will be conducted in accordance with the JBI methodology for scoping reviews. Published and unpublished materials will be included. Databases will include MEDLINE, Embase, CINAHL, PsycINFO, Web of Science - Science Citation Index and Social Science Citation Index, and Academic Search Complete. Relevant gray literature and materials from organ donation organizations will be included. Two independent reviewers will screen all material, extract data, and complete the descriptive examination.

Introduction: As many countries change to opt-out systems to address organ shortages, calls for similar reform in Australia persist. Community perspectives on consent systems for donation remain under-researched, therefore Australian perspectives on consent systems and their effectiveness in increasing donation rates were explored. Design: In this descriptive cross-sectional study, participants completed a survey presenting opt-in, soft opt-out, and hard opt-out systems, with corresponding descriptions. Participants chose the system they perceived as most effective and described their reasoning. Results: Participants (N = 509) designated soft opt-out as the most effective system (52.3%; hard opt-out 33.7%; opt-in 13.7%). Those who identified with an ethnic/cultural group or were not registered had greater odds of choosing opt-out. Six themes identified in thematic analysis reflected their reasoning: (1) who decides (individual, shared decision with family); (2) right to choose; (3) acceptability (ethics, fairness); and utility in overcoming barriers for (4) individuals (apathy, awareness, ease of donating, fear/avoidance of death); (5) family (easier family experience, family veto); (6) society (normalizing donation, donation as default, expanding donor pool). Choice and overcoming individual barriers were more frequently endorsed themes for opt-in and opt-out, respectively. Discussion: Results suggested the following insights regarding system effectiveness: uphold/prioritize individual's recorded donation decision above family wishes; involve family in decision making if no donation preference is recorded; retain a register enabling opt-in and opt-out for unequivocal decisions and promoting individual control; and maximize ease of registering. Future research should establish whether systems considered effective are also acceptable to the community to address organ shortages.

Cuban immigrants constitute an important group in both the United States and Spain, with different behaviors toward organ donation having been described among the different Latin American nationalities. We analyzed the attitude toward organ donation among the Cuban populations in Cuba, Spain, and Florida. The study population was Cuban immigrants over 15 years of age residing in Cuba, Spain, and Florida, with samples randomly stratified by age and sex. A validated questionnaire on psychosocial aspects of organ donation (PCID-DTO Rios) was used. Census was used as the sampling base in all 3 countries; however, additionally, in Spain and the United States (Florida), we sought the support of immigration support associations to determine the Cuban population without legal documentation. The questionnaire was completed anonymously and self-administered. The completion rate of the study was 74% (4123/5574) among 424 surveyed in Spain, 1224 in Florida, and 2475 in Cuba. The attitude in favor of donating their own organs upon death was 60.6% of those surveyed in Spain, 37.6% in Florida, and 68.9% in Cuba, or 58% of the global sample. Multivariate analysis showed that country of residence was an independent factor associated with attitude toward organ donation (odds ratio, 1.929). Other factors associated with attitude were sex, educational level, performance of prosocial activities, knowledge of the brain death concept, religion, the couple's opinion toward donation, fear of mutilation after donation, and attitude toward manipulation of the body after death. The attitude toward organ donation among Cubans in their country of origin and immigrants in Spain was similar, being significantly different from those who emigrate to Florida, where the attitude is much less favorable.

Traumatic cardiac arrests (TCAs) are associated with high mortality and the majority of deaths occur at the prehospital scene. The aim of the present study was to assess, in a prehospital physician-led emergency medical system, the factors associated with sustained return of spontaneous circulation (ROSC) in TCA, including advanced life procedures. The secondary objectives were to assess factors associated with 30-day survival in TCA, evaluate neurological recovery in survivors, and describe the frequency of organ donation among patients experiencing a TCA.We conducted a retrospective study of all TCA patients included in the French nationwide cardiac arrest registry from July 2011 to November 2020. Multivariable logistic regression analysis was used to identify factors independently associated with ROSC.A total of 120,045 out-of-hospital cardiac arrests were included in the registry, among which 4,922 TCA were eligible for analysis. Return of spontaneous circulation was sustained on-scene in 21.1% (n = 1,037) patients. Factors significantly associated with sustained ROSC were not-asystolic initial rhythms (pulseless electric activity (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.40-2.35; p0.001), shockable rhythm (OR, 1.83; 95% CI, 1.12-2.98; p = 0.016), spontaneous activity (OR, 3.66; 95% CI, 2.70-4.96; p0.001), and gasping at the mobile medical team (MMT) arrival (OR, 1.40; 95% CI, 1.02-1.94; p = 0.042). The MMT interventions significantly associated with ROSC were as follows: intravenous fluid resuscitation (OR, 3.19; 95% CI, 2.69-3.78; p0.001), packed red cells transfusion (OR, 2.54; 95% CI, 1.84-3.51; p0.001), and external hemorrhage control (OR, 1.74; 95% CI, 1.31-2.30; p0.001). Among patients who survived (n = 67), neurological outcome at Day 30 was favorable (cerebral performance categories 1-2) in 72.2% cases (n = 39/54) and 1.4% (n = 67/4,855) of deceased patients donated one or more organ.Sustained ROSC was frequently achieved in patients not in asystole at MMT arrival, and higher ROSC rates were achieved in patients benefiting from specific advanced life support interventions. Organ donation was somewhat possible in TCA patients undergoing on-scene resuscitation.Prognostic and epidemiologic, Level III.

Background The number of organs donated after brain death in Germany is far lower than the demand. This underlines the importance of providing the brain-dead donor with optimal medical care throughout the donation process to decrease the risk of graft dysfunction. Several international guidelines and national recommendations guide the intensivists in organ-protective intensive care management of the brain-dead donor. Objective The anesthetist is a key member during organ retrieval procedures and plays a crucial role in physiological donor management; however, evidence-based recommendations for the perioperative anesthetic management, drug treatment strategies and target values are lacking. Anesthesia literature about donor management is scarce and predominantly composed of reviews of practice, with little exploration of the scientific foundations. The aim of this review is to guide the anesthetist in the organ-protective perioperative therapy. The pathophysiological changes in patients who progress to brain death are briefly summarized. The available evidence, guidelines and expert opinions regarding medical treatment strategies and therapeutic goals in organ-protective therapy are reviewed. The ethical and pathophysiological considerations regarding the performance of anesthesia during organ retrieval are discussed. Methods This review is based on a selective literature search in PubMed for publications regarding organ donation after brain death (keywords: "brain dead donor", "organ procurement", "organ protective therapy", "donor preconditioning", "perioperative donor management", "ethical considerations of brain dead donor"). International guidelines, national recommendations and expert opinions were given special consideration. Results Overall, the evidence for optimal perioperative organ-protective care of the brain-dead donor is limited. Most elements in the current recommendations and guidelines are based on pathophysiological reasoning, epidemiological observations or extrapolations from general organ-protective management strategies, and not on evidence from randomized controlled trials. National and international recommendations on treatment goals and drug therapy differ considerably in some aspects. The therapy concepts applied are very heterogeneous. Apart from medical challenges, the ethical circumstances are an additional burden for the entire treatment team. Whether anesthesia is reasonable during organ retrieval remains unclear. There is uncertainty about possible organ-protective effects of anesthetic drugs. Furthermore, ethical considerations raise the question of whether the determination of brain death and the use of anesthetic drugs during the procedure of organ retrieval are compatible with each other. Conclusion Due to the lack of evidence, perioperative treatment should be guided by intensive care therapy strategies. The discussion about using anesthetic drugs during organ retrieval remains controversial. Pathophysiological considerations support the use of volatile anesthetics because of possible organ-protective effects. The use of neuromuscular blocking is justified to control any possible motor response resulting from spinal cord reflexes, whereas there is no evidence for a benefit from using opioids. Apart from that, it seems ethically problematic to anesthetise a brain-dead donor. Consequently, knowledge about the pathophysiological processes caused by brain death and about organ-protective therapy concepts are just as much a basic requirement as the consideration of ethical problems in organ donation after brain death. Only then are the caregivers able to do justice to both the organ recipient and the organ donor, as well as their relatives in this challenging situation.

In 2013, Illinois enacted a new law (SB 957) to allow undocumented motorists to acquire Temporary Visitor Driver's Licenses (TVDLs). We explored the impact of this legislation on organ donor registration in the state. Using Freedom of Information Act requests, we obtained the Illinois TVDL and general adult driver's license applicant organ donation statistics for the last 3 years from the Illinois Secretary of State. We found that between 2017 and 2019, TVDLs directly resulted in 91,720 newly registered organ donors. This group registered as organ donors at rates significantly higher (p < 0.0001) than the general population. In the 3 years studied, only 7.3% of general driver's license registrants became new organ donor registrants, while TVDL drivers signed up at an average rate of 44.9%. TVDLs resulted in a significant increase in registered organ donors. Similar policies implemented nationwide could increase donor registrations substantially. In addition, this finding among a population largely of Latin American origin may suggest strategies for future organ donor registration efforts globally.

Purpose of Review To summarize outcomes to date, as well as important considerations and unanswered questions related to the use of hepatitis C virus (HCV) positive donors for heart transplantation. Recent Findings Outcomes from single-center studies and registry data to date suggest that among patients who develop donor-transmitted HCV after heart transplantation, direct-acting antiviral therapies (DAAT) are effective and well-tolerated, and that short-term survival is similar to that of patients transplanted with HCV - donors. Summary In an era marked by increasing numbers of HCV positive deceased donors and a growing imbalance between the demand and supply of donor hearts, utilization of HCV + donors is a feasible strategy to expand the donor pool and reduce waitlist times. Ongoing work is needed to clarify longer-term outcomes with the use of this strategy.

To gather information from stakeholders involved in corneal donation and transplantation to inform discussion at the “National Consensus Forum on Improving Cornea Donation and Transplantation Access in Canada” held in February 2020, survey questions were posed to eye banks, transplanting ophthalmologists and organ donation organizations across Canada to learn more about demand, wait times, and access to tissue for transplant. The survey response rate was one hundred percent (100%) for eye banks and organ donation organizations while 64 percent (64%) of transplant ophthalmologists provided feedback. A number of opportunities for improvement were identified including: demand forecasting; infrastructure and strategies to align supply with demand; data collection and benchmarking of wait times for assessment and transplant to support consistency, equitability and transparency in access; and national collaboration in the development of a data strategy to accurately measure demand and access to cornea transplants in a consistent manner across all provinces to facilitate equity in access nationally.