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Introduction. The goal of the Eurotransplant renal allocation scheme is to provide every patient on the waiting list with a reasonably balanced opportunity for a donor offer. New initiatives were taken in order to maximize donor usage while maintaining a successful transplant outcome.Methods. Two Eurotransplant projects were launched in order to accommodate changes in donor and recipient profiles. A re-addressing of the non-heart-beating donor pool was undertaken and an allocation scheme in which organs from donors aged >65 are allocated to recipients aged >65 [the Eurotransplant Senior Programme (ESP)] was introduced.Results. Especially in The Netherlands, an enormous increase in the number of non-heart-beating donor kidneys has been observed, however with a pace-keeping reduction in heart-beating donors. The organization-wide implementation of the ESP has been successful. The 3 year graft survival rates for these age-matched transplants were as good as the human leukocyte antigen (HLA)-matched transplants (64 vs 67%) (P = 0.4).Conclusion. Within the framework of sound research, the utmost flexibility and creativity is needed to keep or even increase the number of renal transplants when faced with a quantitatively stagnating but qualitatively deteriorating donor pool. Both the non-heart-beating donor protocol and the ESP have proven to be quite successful in achieving this goal without compromising the outcome for the individual end-stage renal disease patient. [ABSTRACT FROM AUTHOR]

Objectives To analyse a potential association between surgical quality and time of day. Design A retrospective analysis of complete sets of quality forms filled out by the procuring and accepting surgeon on organs from deceased donors. Setting Procurement procedures in the Netherlands are organised per region. All procedures are performed by an independent, dedicated procurement team that is associated with an academic medical centre in the region. Participants In 18 months' time, 771 organs were accepted and procured in The Netherlands. Of these, 17 organs were declined before transport and therefore excluded. For the remaining 754 organs, 591 (78%) sets of forms were completed (procurement and transplantation). Baseline characteristics were comparable in both daytime and evening/night-time with the exception of height (p=0.003). Primary outcome measure All complete sets of quality forms were retrospectively analysed for the primary outcome, procurement-related surgical injury. Organs were categorised based on the starting time of the procurement in either daytime (8:00-17:00) or evening/night-time (17:00-8:00). Results Out of 591 procured organs, 129 organs (22%) were procured during daytime and 462 organs (78%) during evening/night-time. The incidence of surgical injury was significantly lower during daytime; 22 organs (17%) compared with 126 organs (27%) procured during evening/night-time (p=0.016). This association persists when adjusted for confounders. Conclusions This study shows an increased incidence of procurement-related surgical injury in evening/night-time procedures as compared with daytime. Time of day might (in)directly influence surgical performance and should be considered a potential risk factor for injury in organ procurement procedures. [ABSTRACT FROM AUTHOR]

Families of organ donors play an important role in the deceased organ donation process. The aim of this study was to gain insight into donor family care by creating an inventory of practice in various European countries. A questionnaire about donor family care and contact between donor families and recipients was developed. Representatives of the organ donor professionals of 15 European countries responded (94%). The donor coordinator plays a key role in care for the donor family. All countries provide information about the donation results to the families, although diminished due to privacy laws. Anonymous written contact between donor families and recipients is possible in almost all countries and direct contact in only a few. Remembrance ceremonies exist in most countries. Half of the respondents thought the aftercare could improve. This first inventory shows that differences exist between countries, depending on the organisation of the donation process, the law and the different role of the professionals. Direct contact between donor families and recipients is rarely supported by the donation organisation. To date there has been limited research about the experience of donor family aftercare and we would urge all donation organisations to consider this as a priority area. [ABSTRACT FROM AUTHOR]

I Transplant International i thanks the following colleagues for their time and effort in reviewing manuscripts during 2021. Their astute assessments along with their productive and often critical comments ensure that only high-quality papers are published in I Transplant International i . [Extracted from the article]

Summary: The access of non‐resident patients to the deceased donor waiting list (DDWL) poses different challenges. The European Committee on Organ Transplantation of the Council of Europe (CD‐P‐TO) has studied this phenomenon in the European setting. A questionnaire was circulated among the Council of Europe member states to inquire about the criteria applied for non‐residents to access their DDWL. Information was compiled from 28 countries. Less than 1% of recipients of deceased donor organs were non‐residents. Two countries never allow non‐residents to access the DDWL, four allow access without restrictions and 22 only under specific conditions. Of those, most give access to non‐resident patients already in their jurisdictions who are in a situation of vulnerability (urgent life‐threatening conditions). In addition, patients may be given access: (i) after assessment by a specific committee (four countries); (ii) within the framework of official cooperation agreements (15 countries); and (iii) after patients have officially lived in the country for a minimum length of time (eight countries). The ethical and legal implications of these policies are discussed. Countries should collect accurate information about residency status of waitlisted patients. Transparent criteria for the access of non‐residents to DDWL should be clearly defined at national level. [ABSTRACT FROM AUTHOR]

Deemed consent for organ donation has long been discussed as a potential solution to the shortage of organs for transplantation, with several countries having implemented it. In Great Britain, Wales was the first nation to introduce such a system, having done so in 2015. Now, the other two nations are following suit. In this paper, I compare the approaches of England and Scotland in moving to systems of deemed consent for organ donation. After outlining both sets of legislation, I focus on three points on which the two nations differ. First, the role of those close to the deceased in the consent process and the extent to which clinicians are required to consult them ahead of consent being deemed. Second, the role of government ministers in ensuring widespread public awareness. Third, the ways in which the two nations responded to the challenge of the COVID-19 pandemic in relation to the implementation of deemed consent. I conclude that on all three points, the Scottish approach is preferable. [ABSTRACT FROM AUTHOR]

Summary: This paper addresses ethical, legal, and psychosocial aspects of Global Kidney Exchange (GKE). Concerns have been raised that GKE violates the nonpayment principle, exploits donors in low‐ and middle‐income countries, and detracts from the aim of self‐sufficiency. We review the arguments for and against GKE. We argue that while some concerns about GKE are justified based on the available evidence, others are speculative and do not apply exclusively to GKE but to living donation more generally. We posit that concerns can be mitigated by implementing safeguards, by developing minimum quality criteria and by establishing an international committee that independently monitors and evaluates GKE's procedures and outcomes. Several questions remain however that warrant further clarification. What are the experiences and views of recipients and donors participating in GKE? Who manages the escrow funds that have been put in place for donor and recipients? What procedures and safeguards have been put in place to prevent corruption of these funds? What are the inclusion criteria for participating GKE centers? GKE provides opportunity to promote access to donation and transplantation but can only be conducted with the appropriate safeguards. Patients' and donors' voices are missing in this debate. [ABSTRACT FROM AUTHOR]

Summary: Donation after circulatory death (DCD) has become an accepted practice in many countries and remains a focus of intense interest in the transplant community. The present study is aimed at providing a description of the current situation of DCD in European countries. Specific questionnaires were developed to compile information on DCD practices, activities and post‐transplant outcomes. Thirty‐five countries completed the survey. DCD is practiced in 18 countries: eight have both controlled DCD (cDCD) and uncontrolled DCD (uDCD) programs, 4 only cDCD and 6 only uDCD. All these countries have legally binding and/or nonbinding texts to regulate the practice of DCD. The no‐touch period ranges from 5 to 30 min. There are variations in ante and post mortem interventions used for the practice of cDCD. During 2008–2016, the highest DCD activity was described in the United Kingdom, Spain, Russia, the Netherlands, Belgium and France. Data on post‐transplant outcomes of patients who receive DCD donor kidneys show better results with grafts obtained from cDCD versus uDCD donors. In conclusion, DCD is becoming increasingly accepted and performed in Europe, importantly contributing to the number of organs available and providing acceptable post‐transplantation outcomes. [ABSTRACT FROM AUTHOR]

This report deals with organ retrieval procedures in both controlled and uncontrolled DCD, looking at the ethical, legal, and psychosocial aspects during the different phases of the process. A recently published report by the UK Donation Ethics Committee ( UKDEC) has served as an important reference document to outline the steps in the controlled DCD patient-donor pathway (Academy of Medical Royal Colleges. UK Donation Ethics Committee. An ethical framework for controlled donation after circulatory death. December 2011). For uncontrolled DCD, the UKDEC pathway description was adapted. At the 6th International Conference in Organ Donation held in Paris in 2013, an established expert European Working Group reviewed the UKDEC reports, which were then considered along with the available published literature. Along this pathway, the crucial ethical, legal, and psychosocial aspects have been flagged, and relevant recommendations have been formulated based on a consensus of the working group. [ABSTRACT FROM AUTHOR]

The article presents abstracts on organ transplantation including kidney transplantation of patients from deceased donors, use of Edinburgh Liver Function (ELF) score for identification of graft dysfunction after liver transplantation and graft failure after liver allograft dysfunction.

Living donor kidney transplantation is the preferred treatment for patients suffering from end-stage renal disease. To alleviate the shortage of kidney donors, many advances have been made to improve the utilization of living donors deemed incompatible with their intended recipient. The most prominent of these advances is kidney paired donation ( KPD), which matches incompatible patient-donor pairs to facilitate a kidney exchange. This review discusses the various approaches to matching and allocation in KPD. In particular, it focuses on the underlying principles of matching and allocation approaches, the combination of KPD with other strategies such as ABO incompatible transplantation, the organization of KPD, and important future challenges. As the transplant community strives to balance quantity and equity of transplants to achieve the best possible outcomes, determining the right long-term allocation strategy becomes increasingly important. In this light, challenges include making full use of the various modalities that are now available through integrated and optimized matching software, encouragement of transplant centers to fully participate, improving transplant rates by focusing on the expected long-run number of transplants, and selecting uniform allocation criteria to facilitate international pools. [ABSTRACT FROM AUTHOR]

The article presents abstracts on organ transplantation and medical topics, which include liver transplantation for incidental cholangiocarcinoma, liver transplantation for hepatocellular carcinoma, and the immunogenicity of pluripotent stem cells and their derivatives.

A European patient registry to track the outcomes of organ transplant recipients does not exist. As knowledge gleaned from large registries has already led to the creation of standards of care that gained widespread support from patients and healthcare providers, the European Union initiated a project that would enable the creation of a European Registry linking currently existing national databases. This report contains a description of all functional, technical, and legal prerequisites, which upon fulfillment should allow for the seamless sharing of national longitudinal data across temporal, geographical, and subspecialty boundaries. To create a platform that can effortlessly link multiple databases and maintain the integrity of the existing national databases crucial elements were described during the project. These elements are: (i) use of a common dictionary, (ii) use of a common database and refined data uploading technology, (iii) use of standard methodology to allow uniform protocol driven and meaningful long-term follow-up analyses, (iv) use of a quality assurance mechanism to guarantee completeness and accuracy of the data collected, and (v) establishment of a solid legal framework that allows for safe data exchange. [ABSTRACT FROM AUTHOR]

The article presents abstracts of medical research. They include "Preemptive Kidney Transplantation - More Than 700 Cases Revisited at a Single Center," "Human Leukocyte Antigen-G Predicts Allograft Tolerance in Heart Transplant Patients," and "Living Donor Living Transplantation: A European Liver Transplant Registry (ELTR) Report on 1942 Cases."

Presents several abstracts. "Adult Human Exocrine Pancreas Contains Mesenchymal Stem Cells," by Reto M. Baertschiger and colleagues; "Hepatocyte Transplantation in Gunn Rats: Improvement in Bilirubin Metabolism," by Silvia Tomat and colleagues; "Risk Factors for Malignancies in Renal Transplant Recipients," by Tetsuya Imao.

Presents several abstracts. "Expanded Criteria Donor (ECD): Is a Cluster Definition for the Liver Beneficial?," by Carl-Ludwig Fischer-Froehlich and Werner Lauchart; "Efficacy of Organ Recipients Back Screening," by Olivier Cornu, Christian Delloye, Beatrice Pelleriaux, Vincent Lambert and Katy Unger; "Profile of Australian Donors: A 10 Year Comparison," by Tina A. Coco.

The transplantation of human cells and tissues has become a global enterprise for both life-saving and life-enhancing purposes. Yet current practices raise numerous ethical and policy issues relating to informed consent for donation, profit-making, and quality and safety in the procurement, processing, distribution, and international circulation of human cells and tissues. This paper reports on recent developments in the international debate surrounding these issues, and in particular on the attention cell and tissue transplantation has received in WHO&apos;s ongoing process of updating its 1991 Guiding principles on human organ transplantation. Several of the organizers of an international working group of stakeholders from a wide range of backgrounds that convened in Zurich in July 2006 summarize the areas of normative agreement and disagreement, and identify open questions regarding facts and fundamental concepts of potential normative significance. These issues must be addressed through development of common medical, scientific, legal and ethical requirements for human cell and tissue transplantation on a global basis. While guidance must accommodate the distinct ethical issues raised by activities involving human cells and tissues, consistency with normative frameworks for organ transplantation remains a prime objective. La transplantation de cellules et de tissus humains est devenue une entreprise d&apos;ampleur mondiale, visant a sauver des vies et a ameliorer des existences. Bien que les pratiques actuelles soulevent de nombreuses questions ethiques et politiques concernant le consentement informe au don, ainsi que la rentabilite, la qualite et la securite des processus d&apos;acquisition, de traitement, de distribution et de circulation internationale des cellules et tissus humains. Le present article rapporte les faits marquants recents dans le debat international autour de ces questions et notamment l&apos;attention accordee a la transplantation de cellules et de tissus dans le cadre du processus actuellement mene par l&apos;OMS d&apos;actualisation des <>. Plusieurs des organisateurs d&apos;un groupe de travail international ayant reuni des participants issus d&apos;horizons tres divers en juillet 2006 a Zurich resument les domaines d&apos;accord et de desaccord sur le plan normatif et identifient les questions restant ouvertes concernant les faits et concepts fondamentaux pouvant avoir une importance dans la normalisation. Il faut traiter ces questions en developpant des exigences mondiales communes sur les plans medical, scientifique, juridique et ethique pour la transplantation de cellules et de tissus humains. Meme si les recommandations doivent prendre en compte les differentes questions ethiques soulevees par les activites faisant appel a des cellules et tissus humains, la coherence avec les cadres normatifs de la transplantation d&apos;organes reste un objectif primordial. El trasplante de celulas y tejidos humanos se ha convertido en una gran empresa mundial que aspira tanto a salvar vidas como a mejorar la calidad de vida. Sin embargo, las practicas actuales suscitan numerosas cuestiones eticas y normativas en relacion con el consentimiento informado para las donaciones, la obtencion de lucro, y la calidad y seguridad en materia de adquisicion, procesamiento, distribucion y circulacion internacional de celulas y tejidos humanos. En este articulo se informa sobre las ultimas novedades registradas en el debate internacional sobre estas cuestiones, y en particular sobre la atencion que ha suscitado el trasplante de celulas y tejidos en el proceso seguido actualmente por la OMS para actualizar sus Principios rectores sobre el trasplante de organos humanos, de 1991. Varios de los organizadores de un grupo de trabajo internacional de interesados directos con muy diversas experiencias que se reunio en Zurich en julio de 2006 resumen aqui las areas de acuerdo y desacuerdo normativo y plantean interrogantes por resolver sobre hechos y conceptos fundamentales de eventual trascendencia normativa. Estos temas deberan abordarse formulando requisitos medicos, cientificos, legales y eticos comunes para el trasplante de celulas y tejidos humanos a nivel mundial. Si bien las indicaciones deben tener en cuenta los aspectos eticos peculiares que plantean las actividades en que se manejan celulas y tejidos humanos, la coherencia con los marcos normativos para el trasplante de organos sigue siendo un objetivo primordial., Introduction From its origins with the first successful transplant of banked cadaveric tissue in the first half of the 20th century, the transplantation of human tissues (HTs) has become a [...]