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The article presents the main principles of dialoguing with the family of a transplant donor; attention is paid to the key points that ensure the highest number of consents to the explantation of organs and tissues., В статье представлены основные принципы ведения диалога с семьей трансплантат-донора, уделяется внимание ключевым моментам, обеспечивающим наиболее высокое количество согласий на эксплантацию органов и тканей., У статті надані основні принципи ведення діалогу з сім’єю трансплантат-донора, приділяється увага ключовим моментам, що забезпечують найбільш високу кількість згод на експлантацію органів і тканин.

Objetivo: analisar o conhecimento da equipe de saúde da Unidade de Terapia Intensiva de adulto sobre protocolo de morte encefálica e manutenção do potencial doador de órgãos e tecidos para transplantes. Método: estudo transversal, observacional, analítico desenvolvido na unidade de terapia intensiva adulto, de um hospital de alta complexidade do Nordeste brasileiro, no período de julho a setembro de 2019. A amostra foi de conveniência, formada por 22 profissionais, enfermeiros, médicos e fisioterapeutas. Resultados: a maioria apresentou conhecimento adequado sobre os procedimentos necessários para abertura do protocolo de morte encefálica, entretanto, não sabe quais profissionais têm competência para abertura do protocolo, desconhece quando deve ser iniciado o processo de manutenção do potencial doador de órgãos, apresentaram déficit de conhecimentos sobre suas atribuições. Conclusão: identificamos a necessidade de capacitação da equipe de saúde sobre o protocolo de morte encefálica, doação de órgãos e tecidos, com foco na manutenção do potencial doador.

Introducción: a nivel internacional hay una búsqueda de donadores debido a una demanda creciente mientras que éstos son pocos. Dentro de la cultura de la donación existen los factores sociales y psicológicos que influyen directamente en la decisión de la familia de un potencial donador por muerte encefálica. Objetivo: identificar cuáles son las experiencias de la familia ante la condición potencial de donación de órganos en pacientes con muerte encefálica en una institución de tercer nivel. Material y métodos: estudio mixto cuanti-cualitativo retrospectivo, transversal realizado en una institución de tercer nivel, por medio de una familia (el responsable) con un integrante donador por muerte encefálica. Análisis: estadística descriptiva con valores porcentuales, en Spss 23 previo, diseño de base de datos con variables sociodemográficas y de actitud. Resultados: el 51.8 % de la población tuvo el diagnóstico de hemorragia subaracnoidea; seguida del 18.4 % con diagnóstico de tumor cerebral. Y un 9.6% diagnosticados con evento vascular cerebral. Destaca un 1.8 % con diagnóstico de criptocosis cerebral. La investigación revela que el 53.5 % de la población es femenina y el 46.5 % masculina, en la relación con el índice de donación el 43.3 % de los hombres aceptan la donación a diferencia del 23 % de las mujeres que se convierten en donadoras. Conclusiones: las experiencias de los familiares de donadores por muerte encefálica reflejan disposición para donar. Sin embargo, es evidente que se requiere una evaluación de las condiciones emocionales del familiar, en el momento de sugerirle la posibilidad de autorizar la donación.

The implementation of organ transplantation programs in our country is far from perfect. Many regions do not have transplantation centers, in many regions the work on organ donation is not carried out. Intensification of this vital work is of key importance – the need for organ transplantation remains unfulfilled in many regions of the Russian Federation by 70–90 %. The activity on organ donation must be realized with strict administrative control and administrative stimulation. It does not represent the sphere of interests of particular transplantologists. It is a strategically important task, the implementation of which should be carried out at the state level. The key importance in the implementation of organ transplantation program is the hospital where the potential donor is located, identified and accompanied. In the literature and daily practice the outdated term “donor base” is often used, the use of which we consider unacceptable. The donor hospital is a spring, a source of life, the work in which has a key, starting character.

BACKGROUND: Autologous hair transplantation has been the convention in cases of androgenic alopecia. Routinely, the occipital area serves as an ideal donor site. The advent of follicular unit extraction (FUE) has made body and beard hair harvest a possibility. Beard hair, in particular, has been far more sought after than other parts of the body. MATERIALS AND METHODS: A case series of 20 patients have been documented wherein cases with Grade 6 and 7 androgenic alopecia have been treated with beard hair as an adjunct donor site. The local anatomy, procedural technicalities and method of harvesting have been emphasized. The pre, intra and postoperative records have been maintained. DISCUSSION: The advent of FUE paved way for minimal downtime, better cosmesis and less scarring facilitating the possibility of using non-scalp hair in hair restoration, thus increasing the overall donor graft availability. Beard hair has its characteristic differences when compared to the scalp hair. Alongside there exists an array of advantages and disadvantages. CONCLUSION: Minimal complications and potential advantages have encouraged the usage of beard graft in the recent past. In hindsight, beard to scalp transplantation is a worthwhile alternative in cases demanding an expanded source of donor hair which demands further literary contribution.

Serologic testing and Donor Risk Assessment Interview (DRAI) combined have made tissue transplantation a frequent and safe modality for a variety of trauma and disease conditions. Donate Life America reports 30,000 tissue donors providing more than 1,750,000 tissue transplants annually. This study of 188 potential donor cases addresses issues of risk assessment in a medical examiner population in a metropolitan area, where serologic testing of deferred potential donors were compared with the DRAI screening, which determined the suitability or non-suitability for tissue procurement. Such serologic testing of deferred cases is not usually available in evaluating screening processes. This comparison gives insight into the effectiveness of the DRAI screening in deferring potential serology reactive donors. Results show in 65 cases how the DRAI screening eliminates most, but not all of the serologically reactive donors identified post recovery. The result emphasizes the need for the combined process of DRAI screening and testing to assure transplantation safety.

Background: Solid organ donation and transplantation remains grossly underdeveloped in most African countries. The knowledge and attitude of tomorrow’s professionals may be key to the improvement of these services. Methods: A sample of undergraduate medical students from all the medical schools in Kenya offering Bachelor of Medicine and Bachelor of Surgery degrees were surveyed using a self-administered, web-based questionnaire, between July and September 2018. Results: Of the 303 participants, 167 (55.1%) were female. Only 8.9% of the students had read the laws governing transplantation in Kenya. An even lower percentage (3.3%) felt that they had learned enough about solid organ donation and transplantation from their medical curriculum. More than half (53%) of the respondents would subscribe as solid organ donors, which reduced to 47% when it came to consenting to donating their relatives’ organs. Less than half of the students (40%) considered they would be comfortable introducing the topic or confident answering questions (23%) related to organ donation and transplantation. Only 9.9% of the sample had ever spoken to a patient about organ donation. There was no significant association between level of study (preclinical versus clinical) and comfort introducing the topic of organ donation (P = 0.206) or experience talking to a patient about the subject (P = 0.102). Conclusion: Undergraduate medical students have significant knowledge gaps regarding organ donation and transplantation and feel ill-prepared to approach a potential donor or transplant recipient.

Objective. Study the issues of ensuring the vital functions of the organism of a potential donor at the prehospital stage in the structure of transplantology.In our work, an analysis of specialized literature and studies on the functioning of the body of a potential donor at the prehospital stage has been carried out.The complex of measures for the maintenance of the vital functions of the body of a deceased person is a more difficult task compared to carrying out standard intensive care in severely ill patients. At present, this amount of work is poorly studied and often condemned (including by colleagues) the workload for resuscitation department staff and heads of medical institutions.In recent years, experimental and clinical studies have been conducted on new alternative methods that should improve blood flow during cardiopulmonary resuscitation (CPR) and patient survival. Automated systems for compression of the chest, which do not require manual intervention, are developed, as well as the prevention of fatigue in persons who perform CPR. The automation of the execution of the compress allows the personnel to be freed, and helps the honey staff to pay attention to other tasks necessary to maintain the patient’s livelihood.Conclusions. Correct and well-organized organization of aid at the prehospital stage in the event of a sudden death of a person can significantly help not only the development of such a branch of medicine as transplantology, but also increase the percentage of successfully performed resuscitation measures.

Email field experiment varying whether potential donor has matching surname to in-need teacher and quantifying effectiveness of less-exact matches.

Much of the contribution of bivalves to paleoecology is based on the fraction preserved whole. The use of fragments has been limited by the inability to reconstruct the whole shell. For this study, shells of selected species were broken, metrics obtained for shell reconstruction, and a stepwise model developed and tested to evaluate the potential of reconstructing whole shells from fragments. The model is based on the facts that shell thickness is well correlated with shell length, width, and weight, that fragments can be assigned to shell areas, and that each shell area can be matched to a potential donor shell by combinations of length, width, and weight. Simulations using the model show that shell reconstructions are feasible and that the size frequency can be reconstructed more accurately than the number of shells. If all fragments are preserved, shell number tends to be modestly overestimated. Assuming fragment loss, the shell number estimated will be a conservative estimate of original abundance. Reconstructed size frequencies did not differ significantly from the original size frequencies of the whole shells even if 40% of the fragments were not preserved. Biovolume, consequently, may also be estimable. Standardly, bivalve fragments are enumerated by counting intact umbos. If all fragments are preserved, this approach is preferable, as shell model reconstructions overestimate abundance under that circumstance. However, the expectation that fragments with intact umbos are uniquely well preserved is unrealistic and if fragment loss has occurred, relying on all fragments may provide an improved estimate of the original abundance and, in addition, an estimate of the size frequency and the latter proves to be robust even with 40% of the fragments lost.

Novel coronavirus pneumonia (COVID-19) is currently raging worldwide, and the prevention and control situation is very grim. Gratifying achievements of organ donation have been made in China since its implementation. Due to the characteristics of potential donors, such as complicated personnel structure, sudden onset and critical illness, it is necessary for multi-department to contact with the donors and their families during the work link of donor evaluation, family communication, donor transportation, organ function maintenance and organ procurement, which raises higher requirement for the screening and management of potential donors under COVID-19 epidemic. During the outbreak, Beijing Youan Hospital, Capital Medical University has completed 9 cases of organ donation, formulated the relevant screening process, established the prevention and control requirements, and gained certain experience and effects, which benefits the orderly and smooth development of organ donation under the COVID-19 epidemic.

Objective To get a knowledge of the current status of organ donation and utilization after citizen's death in Wuxi District, and thereby provide ideas and basis for further development of organ donation work in local areas. Methods Clinical data from 151 organ donors, included 37 successful donors and 114 potential donors, were retrospectively analyzed. The reasons for donation failure of potential donors were analyzed. The general information for successful donors was collected. And the information on organ donation and organ utilization in successful donors were analyzed. Results Among the 151 organ donors, 37 were successful donors, with the conversion rate reaching 24.5%. For the 114 donors with failed organ donation, the reasons for failure included family disagreement, failure to meet donation status criteria, insufficient evaluation time, and unresolved work injury disputes. The categories for organ donation included 34 cases of donation after brain death followed by cardiac death (DBCD), 3 cases of donation after brain death (DBD), and no case of donation after cardiac death (DCD). The reasons for death of donors includes 19 cases of craniocerebral trauma, 14 cases of stroke and 4 cases of others. Among the 37 cases of successful donors, the majority were floating population. A total of 154 major organs and tissues were donated, of which 124 were major organs. The number of major organs and tissues donated per citizen was (4.2± 1.6) and the number of major organs donated per citizen was (3.4± 1.1). The utilization rate of the 154 donated organs reached 96.7% (149/154), with Nanjing, Wuxi, Suzhou and Changzhou ranking the top 4 of organ distribution. Conclusions The rate for successful organ donation and conversion after citizen's death is low in Wuxi District. The organ donation work networks in local areas should be established. And organ donation promotion efforts and skills training for coordinators should be developed.

Breeding for resistant varieties has been shown to be the most suitable method to control bean anthracnose caused by Colletotrichum lindemuthianum though the method is challenged by the existence of many races of the pathogen. This work focused on characterizing races of C. lindemuthianum from potential bean agro ecological zones of Tanzania using a set of differential bean cultivars. From 144 anthracnose infected bean samples collected, 50 pure isolates were obtained and characterized whereby 42 races were identified. The most virulent race identified was race 3610 from the Southern Highland zone of Tanzania while the least virulent was characterized as race 0. Race 2 was the most widely spread (4.2 %) found in Northern, Southern highland and in Eastern zones of Tanzania. The work confirms that G2333 can still be used as a potential donor of resistant genes to varieties that are to be grown in Northern, Eastern and Lake zones but not for the varieties from Southern Highland and Western zones of Tanzania since isolates from these zones overcame resistant genes Co-42, Co-5, Co-7 in G2333. 95% of all races which were identified are new and were not specific to either Mesoamerican or Andean origin common bean. Key words: Colletotrichum lindemuthianum, races, resistant genes, differential cultivars, Anthracnose.

The thigh region has many perforators when compared to the other areas in the body. Surgeons have disregarded the posterior thigh region as a potential donor site for perforator flap surgeries, presumably owing to the positioning difficulties of the patients during the intervention and inadequate anatomical information. The purpose of this study was to provide comprehensive data concerning the profunda femoris artery. Perforator flaps on an anatomical basis, and to describe anatomical landmarks, easing topographical flap dissection in various combinations. Eleven fresh cadaver thighs were obtained from different individuals using the Willed Body Program. The mean age was 43.5 years (29-63), and the male/female ratio was 7/4. We evaluated each cutaneous perforator for localization, diameter, source artery, numbers, length, and type (musculocutaneous or septocutaneous).We observed at least two perforators in all thighs in the study. Medial perforators consisted of 74.5% musculocutaneous and 25.5% septocutaneous perforators. Lateral perforators consisted of 68.3% septocutaneous perforators and 31.7% musculocutaneous perforators. Positioning difficulties of the patient during surgery and inadequate anatomical information cause surgeons to avoid this area. However, surgeons may easily perform these flaps in reconstructive surgery as a local or free flap with substantial success.

Introduction Living-donor renal transplantation is the optimal treatment for patients with end-stage renal disease. The rate of living donation in the UK is sub-optimal, and potential donor concerns regarding postoperative recovery may be contributory. Enhanced recovery programmes are well described for a number of surgical procedures, but experience in living-donor surgery is sparse. This study reports the impact of introducing an enhanced recovery protocol into a living-donor renal transplant programme. Materials and methods All consecutive patients undergoing laparoscopic living-donor nephrectomy over a 25-month period were included. The principles of enhanced recovery were fluid restriction, morphine sparing and expectation management. Outcome measures were postoperative pain scores and complications for donor and recipients. Results Standard care was provided for 24 (30%) patients and 57 (70%) followed an enhanced recovery pathway. The latter group received significantly less preoperative intravenous fluid (0ml vs 841ml p < 000.1) and opiate medication (14.83mg vs 23.85mg p = 0.001). Pain scores, postoperative complications and recipient transplant outcomes were comparable in both groups. Conclusions Enhanced recovery for living-donor nephrectomy is a safe approach for donors and recipients. Application of these techniques and further refinement should be pursued to enhance the experience of living donors.

Organ transplantation is an effective treatment for end-stage organ failure. However, organ shortage has always been a common problem faced by countries around the world. The recognition and active participation of intensive care unit (ICU) medical staff in organ donation contributes to promoting the development of organ donation, thereby alleviating the shortage of donor organ. In this article, the key strategies of ICU donor management to promote organ donation and the key strategies of ICU medical staff management to promote organ donation were summarized, aiming to provide reference for organ donation practitioners (especially ICU medical staff) and jointly facilitate the professional development of organ donation.

The 2017 version of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines is the most recent international framework for the evaluation and care of living kidneys donors. Along with the call for an integrative approach evaluating the long-term end-stage kidney disease risk for the future potential donor, several recommendations are formulated regarding the pre-donation glomerular filtration rate (GFR) adequacy with no or little consideration for the donor candidate’s age or for the importance of using reference methods of GFR measurements. Herein, we question the position of the KDIGO guidelines and discuss the rationale and modalities for a more basic, but no less demanding GFR evaluation enabling a more efficient selection of potential kidney donors.

Positive anti-human leukocyte antigen (HLA) antibodies are considered a contraindication for cardiac transplantation in India, due to its negative impact on cardiac allograft survival and increased chances of rejection post-transplant. Single antigen bead (SAB) assay helps to further characterize these antibodies. Our case portrays India’s first reported successful cardiac transplant utilizing a virtual crossmatch (VXM)-based approach in a patient with positive anti-HLA antibody screen and SAB assay. We propose that adopting such an approach, in select cases, in India is certainly feasible. This approach would lead to increasing the potential donor pool and mitigate the chances of post-transplant rejection. With increased demands, the SAB assay cost would reduce, further improving its cost-effectiveness.

Introduction: Tests exist for ApoL1 genetic variants to determine whether a potential donor’s kidneys are at increased risk of kidney failure. Variants of the ApoL1 gene associated with increased risk are primarily found in people with West African ancestry. Given uncertainty about clinical implications of ApoL1 test results for living kidney donors and recipients and the lack of uniform guidelines for ApoL1 testing, transplant centers across the United States vary in ApoL1 testing practices. Research Questions: (1) What approach do transplant centers take to determine whether prospective donors are of West African ancestry? (2)How do transplant centers engage potential donors during the ApoL1 testing process? (3) What do transplant centers identify as concerns and barriers to ApoL1 testing? and (4) What actions do transplant centers take when a potential donor has 2 ApoL1 risk variants? Design: We explored the current practices of transplant centers by surveying nephrologists and transplant surgeons at transplant centers evaluating the majority of black living donors in the United States. Results: About half of these transplant centers offered ApoL1 testing. Of those who offered ApoL1 testing, only half involved the donor in decision-making about donation when the donor has 2 risk variants. Discussion: Unaddressed differences in the priorities of transplant centers and black living donors may stigmatize black donors and undermine trust in the health-care and organ donation systems. Variation in transplant center testing practices points to the critical need for further research and community engagement to inform the development of guidelines for ApoL1 testing.

Paediatric organ donors remain a critically scarce and precious resource at a time of ever increasing demand for donor organs. The early recognition and management of the potential paediatric organ donor can increase the number of viable donor organs available. Managing the cardiovascular instability that follows brain death requires a systematic intensive care approach in order to preserve viability of the potential donor organs. Careful consideration of the fluid status and inotrope requirements in addition to supplementation of the hormonal and haematological axes helps to optimize tissue perfusion. This paper seeks to summarize the physiology that occurs following death and review current management strategies within the paediatric intensive care setting.

Background Donation after brain death (DBD) is current praxis in Sweden. Circulatory death is far more common. Donation from patients suffering Out-of-Hospital Cardiac Arrest (OHCA) may have the potential to increase the organ-donor pool. The aim of this study was to describe the potential donor pool and its characteristics if uncontrolled donation after circulatory death (uDCD) were to be implemented in the metropolitan area of Stockholm, Sweden. Methods A retrospective analysis was made using data from the Swedish Register for cardiopulmonary resuscitation (SRCR) between 2006 and 2015. Evaluation of potential organ donors was made using selection criteria from five previously published protocols concerning uDCD. Results When applying different criteria from each of the five studied protocols in a total of 9,793 cases of OHCA, between 7.5% (n = 732) and 1.5% (n = 150) of the patients were found to be potential candidates for uDCD. The median age of the sampled uDCD candidates in each protocol was between 48 and 57 years. Male donors were found in 67–76% of all cases. Conclusion Although not taking important real-life limitations into account, our results indicate that implementation of a uDCD programme may substantially increase the number of potential organ donors in Stockholm.

Cardiac transplantation is an established therapy for end-stage heart failure. The number of heart transplant procedures performed worldwide has remained relatively unchanged in recent years. Although mortality rates on the waiting list have improved due to improved ventricular assist devices and rhythm correction techniques, it remains imperative to maximize use of all potential donor hearts. The recipient now presents with multiple complexities. The continued divergence between the rising number of transplant candidates added to the transplant waiting list and the number of suitable organ donors has increased pressure on clinicians to maximize the use of available thoracic organs for transplantation.

Aims and objectivesTo explore the role that Donor Transplant Co‐ordinators have played and the future potential of Specialist Nurses for Organ Donation (SN‐ODs), within organ donation strategies in the UK and other countries.BackgroundOrgan donation and transplantation rates vary extensively around the world. However, there is a universal shortage of deceased donors, prompting different approaches to increase transplantation rates. Within the UK, the Clinical Lead for Organ Donation and Specialist Nurse in Organ Donation undertake a key role in the implementation of the Organ Donation Strategy. The Human Transplantation (Wales) Act 2015 is a recent development which facilities a deemed (presumed) consent approach to organ donation, the Specialist Nurse in Organ Donation undertakes a major role identifying the potential donor in this situation by confirming the deemed consent status of the donor and supporting bereaved relatives. UK governments in England and Scotland are currently seeking legislative changes to an opt‐out system of organ donation, in line with the Wales change.DesignThis discursive paper explores the role from Donor Transplant Co‐ordinator to Specialist Nurse in Organ Donation (SN‐OD) within organ donation policy in different settings, but with a specific focus on the UK. The paper clarifies the current and future potential of nurses working with bereaved families when requesting authorisation for donation.Implications for nursingThe current scope and future potential of Donor Transplant Co‐ordinator and Specialist Nurse in Organ Donation roles need better recognition. Little empirical data exist about the key role that these nurses play in the organ donation process, especially in relation to gaining authorisation to proceed to donation.ConclusionThere is a need to clarify the role of the Specialist Nurse in Organ Donation and their impact on improving rates of organ donation.

Purpose Evaluating degree of hepatic steatosis is of great value for prognosis of liver transplantation. There is an urgent need for a non-invasive method to assess hepatic steatosis grade of donor livers. Purpose of our study was to evaluate diagnostic accuracy of attenuation coefficient estimation (ACE) by reference frequency method (RFM) in detecting hepatic steatosis of donor livers. Method: We retrospectively enrolled 62 potential liver donors which underwent ACE by RFM ex-vivo, in-vivo or both. We acquired raw data of B-mode images of liver parenchyma and offline-processes for attenuation estimation. Finally, we calculated and compared diagnostic performance of ACEs for steatosis grade detection and used histological results as the gold standard. Results: ACEs with none, mild and moderate hepatic steatosis were 0.57, 0.73 and 0.80 dB/cm/MHz in potential donor livers. The cutoff value to diagnose mild hepatic steatosis was 0.63 dB/cm/MHz and 0.77 dB/cm/MHz for moderate hepatic steatosis, and values for the area under the receiver operating characteristic curve for diagnosis of mild and moderate hepatic steatosis were 0.92 and 0.90, respectively. Conclusions: According to our results, ACE by RFM is an accurate non-invasive method in detecting hepatic steatosis, which may be of great help for clinical evaluation of donor livers before liver transplantation.

Integrative and conjugative elements (ICEs) are mobile genetic elements capable of transferring their own and other DNA. They contribute to the spread of antibiotic resistances and other important traits for bacterial evolution. Exclusion is a mechanism used by many conjugative plasmids and a few ICEs to prevent their host cell from acquiring a second copy of the cognate element. ICEBs1 of Bacillus subtilis has an exclusion mechanism whereby the exclusion protein YddJ in a potential recipient inhibits the activity of the ICEBs1-encoded conjugation machinery in a potential donor. The target of YddJ-mediated exclusion is the conjugation protein ConG (a VirB6 homolog). Here we defined the regions of YddJ and ConG that confer exclusion specificity and determined the importance of exclusion to host cells. Using chimeras that had parts of ConG from ICEBs1 and the closely related ICEBat1 we identified a putative extracellular loop of ConG that conferred specificity for exclusion by the cognate YddJ. Using chimeras of YddJ from ICEBs1 and ICEBat1 we identified two regions in YddJ needed for exclusion specificity. We also found that YddJ-mediated exclusion reduced death of donor cells following conjugation into recipients. Donor death was dependent on the ability of transconjugants to themselves become donors and was reduced under osmo-protective conditions, indicating that death was likely due to alterations in the donor cell envelope caused by excessive conjugation. We postulate that elements that can have high frequencies of transfer likely evolved exclusion mechanisms to protect the host cells from excessive death.ImportanceHorizontal gene transfer is a driving force in bacterial evolution, responsible for the spread of many traits, including antibiotic and heavy metal resistances. Conjugation, one type of horizontal gene transfer, involves DNA transfer from donor to recipient cells through conjugation machinery and direct cell-cell contact. Exclusion mechanisms allow conjugative elements to prevent their host from acquiring additional copies of the element, and are highly specific enabling hosts to acquire heterologous elements. We defined regions of the exclusion protein and its target in the conjugation machinery that convey high specificity of exclusion. We found that exclusion protects donors from cell death during periods of high transfer. This is likely important for the element to enter new populations of cells.

Repetitive ablative surgery, neck dissection and radiation therapy lead to a gradual depletion of cervical vessels. About 7% of oral cancer patients end up with a neck devoid of all potential donor vessels, a so-called frozen or vessel-depleted neck, rendering all future reconstruction endeavours extremely challenging.

New metrics for organ procurement organization (OPO) performance utilize National Center for Health Statistics data to measure cause, age, and location consistent (CALC) deaths. We used this denominator to identify opportunities for improved donor conversion at one OPO, Indiana Donor Network (INOP). We sought to determine whether such analyses are immediately actionable for quality improvement (QI) initiatives directed at increased donor conversion. CALC-based assessment of INOP's performance revealed an opportunity to improve conversion of older donors. Following the QI initiative, INOP donor yield rose by 44%, while organs transplanted rose by 29%. These changes tolerated temporary disruption around the COVID-19 pandemic. Improved donor yield was primarily seen in older groups identified by CALC-based methods. Process changes in resource allocation and monitoring were associated with a 57% increase in the number of potential donors approached in the QI period and a subsequent rise in the number of potential donor referrals, suggesting positive feedback at area hospitals. Post-intervention, INOP's projected donation performance rose from 51st to 18th among all OPOs. OPOs can use CALC death data to accurately assess donor conversion by categories including age and race/ethnicity. These data can be used in real time to inform OPO-level processes to maximize donor recovery.

International audience; The forearm is an interesting donor site for non-vascularized nerve grafts, especially hand surgeons. Very few studies have described the use of the lateral and medial antebrachial cutaneous nerves (LABCN and MABCN, respectively) as vascularized nerve grafts (VNGs). The aim of this anatomical study was to analyze the characteristics and vascularization of these nerves to describe new potential donor sites for VNGs. Twelve forearms were dissected from fresh cadavers injected with red latex. The number of terminal branches, lengths, and proximal and distal diameters of both the LABCN and MABCN were studied. An anatomical description of the cutaneous perforator arteries from the radial and ulnar arteries that vascularized the nerve was also recorded: number of perforators, length, type of perforator (septo- or musculocutaneous), and location within the forearm (proximal, middle, and distal third). In over 80% of the specimens, the cutaneous perforator arteries from the radial and ulnar artery vascularized the LABCN and the MABCN, respectively. These arteries, found mostly in the proximal third of the forearm, had diameters >0.5 mm. Most of them came from the radial and ulnar arteries (for LABCN and MABCN vascularization, respectively). In over 75% of the specimens, the nutrient arteries of both nerves also vascularized the superficial veins and the skin. We found that these nerves are vascularized by perforators arteries, which also participate in vein and skin vascularization. Altogether, this anatomical study shows that reconstructive surgeons could use new VNGs based on the perforator artery of the forearm.; L’avant-bras est un site donneur intéressant de greffe nerveuse non vascularisée. Très peu d’études se sont intéressées à l’utilisation des nerfs cutanés latéral et médial de l’avant-bras (NCLAB et NCMAB) comme potentielle greffe nerveuse vascularisée (GNV). L’objectif de cette étude anatomique était d’analyser les caractéristiques et la vascularisation de ces nerfs afin de décrire de nouveaux sites de GNV. Douze avant-bras ont été disséqués à partir de cadavres fraîchement injectés de latex rouge. Le nombre de branches terminales, la longueur et les diamètres proximaux et distaux des NCLAB et NCMAB ont été étudiés. Les caractéristiques anatomiques des artères perforantes cutanées des artères radiale et ulnaire qui vascularisent ces nerfs sont également rapportées: nombre d’artère perforantes, longueur, type (septo- ou musculo-cutané) et localisation dans la région de l’avant-bras (tiers proximal, moyen et distal). Dans plus de 80% des cas, les artères perforantes cutanées de l’artère radiale ou ulnaire participaient à la vascularization des NCLAB et NCMAB respectivement. Ces artères, situées pour la plupart dans le tiers proximal de l’avant-bras, avaient un diamètre > 0,5 mm et provenaient des artères radiale (NCLAB) et ulnaire (NCMAB). Dans plus de 75% des cas, ces artères vascularisaient également les veines superficielles et la peau. Nous avons observé que ces nerfs sensitifs superficiels de l’avant-bras étaient vascularisés par des artères perforantes cutanées. Ces artères participent également à la vascularization des veines superficielles. Au total, cette étude anatomique indique que les chirurgiens reconstructeurs pourraient utiliser de nouveaux nerfs vascularisés basés sur les artères perforantes de l’avant-bras.