Through analyzing the relevant regulations of organ transplantation in China, we identified the problems in the regulations of organ transplantation in China, including more strict limitation of the living organ donors resulting in a serious shortage of organ supply, difficulties in preventing the hidden organ trading, and opaque process of organ allocation resulting in unfair distribution. We also put forward the solutions to address above problems, including the improvement of organ transplantation regulations, establishment of the reimbursement mechanism for organ donation, rational mechanism of organ allocation and the brain death criteria, so as to promote more comprehensive sources of organ donation for the patients with end-stage organ failure.
Objective To explore the donor maintenance points of donor donation after brain death （DBD）. Methods From December 2011 to January 2012，two cases of organ DBD in our hospital were performed. After diagnosis of brain death，mechanical ventilation，fluid resuscitation，vasoactive drugs，inotropic drugs，and so on were used，and invasive arterial pressure， central venous pressure，heart rate，blood gas exchange，urine output，electrolyte and acid-base balance，body temperature， hematocrit，albumin level were monitored，the donors vital organ perfusion were successfully kept at acceptable level. Results The vital signs of two cases of DBD donors were stable. The livers，kidneys，and corneas were donated，and the functions were stable and normal. Case one was diagnosed for brain death 6h after ICU admitted，the period from diagnosis to organ procurement was 33h. Case two was diagnosed for brain death 8h after ICU admitted，the period from diagnosis to organ procurement was 31h. All transplanted organs，livers，kidneys，and corneas，were working well after operation. Conclusions Donor maintenance process of DBD is the cornerstone to ensuring successfully organ donation and transplantation，which is important to improve the utilization rate of donated organs，and release the severely shortage of organ.
ObjectiveAfter establishing the rabbit brain death model, TUNEL, western blotting, and immuno-histochemical methods were used to detect hepatocyte apoptosis to study hepatocyte apoptosis level from rabbit donors after brain death. MethodsSixty healthy male New Zealand rabbits were divided into brain death group (n=30) and sham group (n=30). The rabbits of brain death group were established by increasing intracranial pressure in a modified, slow, and intermittent way, collecting liver tissues after corresponding treatment respectively, using TUNEL to detect apoptosis rate, western blotting and immunohistochemical methods to detect the expression of Cleaved-caspase 3. ResultsThe hepatocyte apoptosis rate at each time point of brain death group were higher than those of the corresponding time point of sham group (P<0.05), and the rate of hepatocyte apoptosis increased gradually with the extension of brain death time (P<0.05). The results of Western blot assay and immunohistochemistry assay showed that the relative expression amount of Cleaved-caspase 3 protein increased gradually with the extension of brain death time (P<0.05), and relative expression amount of Cleaved-caspase 3 protein at each time point of brain death group were higher than those of the corresponding time point of sham group (P<0.05). ConclusionsThe relationship between brain death donor liver and cell apoptosis is closely related. Along with the extension of the brain death time in rabbits, the level of apoptosis of liver cells gradually increased, which affects the quality of liver donors after brain death.
Objective To investigate present status of health care in peri-brain-death and analyze its effectiveness and health economic characteristics. Method Retrospective analysis of case series was conducted and a total of 940 patients from surgical intensive care unit (SICU) were reviewed on treatment and part of direct medical expenditure. The patients admitted from Jun. 1999 to Dec. 2000 and Nov. 2001 to Jun. 2002 were included in this study. Data were processed by SPSS 10.0. Results Patients were included if they had two of the three symptoms for at least one hour: deep coma, pupillar light reflex disappear, and no autonomic respiratory. Ultimately 115 patients were included, with a total cost of ￥2 515.9 per day for each case, whereas mortality was 99.10%. Mortality increased with the state of peri-brain-death prolonged. Eighty percent of patients included were dead within 72 hours after admission. Conclusions Attempts to resuscitate patients of peri-brain-death have been the most widely applied in China, however, it resulted in great unnecessary consumption of health resources. It is of great importance to promote legislation of brain death in China.
Background and Objective Organ transplantation has become an essential and irreplaceable treatment for patients with organ failure. Although organ transplantation was introduced to China in the 1960s, it has witnessed rapid development in recent years. However, problems have been identified in the course of its development. We aim to present both medical and legal points of view on organ transplantation, to compare the current status of organ transplantation in China with that in developed countries, and discuss the challenges China faces in developing its own legislation for organ transplantation. Methods We searched the websites of WHO, NIH, AST, UNOS, and governments, as well as relevant conference proceedings and expert consensus documents. Articles or documents involving organ transplantation legislation were identified. Results We included 10 legal documents, 1 regulation, 9 government documents, and 4 expert consensus documents. Organ transplantation legislation started in the 1960s in the United Kingdom, and was soon followed by New Zealand and the United States. The first law on brain death was enacted in the United States in 1978. Since 1991, the World Health Assembly (WHA) and other non-governmental organizations have issued 7 consensus documents in order to regulate behaviors related to organ transplantation. China including Hong Kong, Macau and Chinese Taipei has not yet formulated any law on organ transplantation. Conclusion At least six challenges about organ transplantation and brain death legislation in China are identified: ① death definition and source of organ donors; ② prevention of organ transplant tourism; ③ risk assessment and insurance for living donors; ④ defining who has the right to choose about potential organ donation for an individual: whether spouses, parents, or children; ⑤ whether an organ donor should receive compensation; ⑥ whether brain death and organ transplant laws should be formulated separately.
Objective To investigate development and perspectives of brain death donation and transplantation. Methods The related literatures about the research of brain dead donors were reviewed. Results Brain death effects hemodynamic stability， hormonal changes， neuroimmunologic effects，and unleashes a cascade of inflammatory events， which may affect quality of graft， graft survival， and patient outcome. Moreover， the exact mechanism linked to brain death is incompletely understood. Conclusions The pathological physiology changes of brain dead donors has important impact on graft outcomes. However， subsequent work remains to be done.
Objective We investigated the effectiveness of legislation in developed countries by analyzingtheir legislation, and produced ideas and strategies for organ transplantation and brain death legislation in China.Methods Official websites were searched as follows: UNOS, TCE, CLTR, ANZDATA, and SRTR through December6, 2008. We included statistical reports and data analysis of organ donations and transplants, and excluded literatureabout non-solid organs. The absolute transplantation numbers were standardized to per one million people. Results 1.The following data was retrieved: The number of eight kinds of organ transplants and organ donations in Britain, the United States, New Zealand, Spain, France, Italy, Germany, and Australia from 2003 to 2005; the number of deceased donors in the United States and Spain from 1988 to 2007; the total number of organ transplants in Australia from 2002 to 2006; the amount of organ transplants in the United States from 1993 to 2006; liver and kidney transplant totals in the United States from 1988 through March, 2008; liver transplants number of China from 1993 through March, 2008; and the number of kidney transplants in some provinces and cities in China. 2. Transplant totals were greatest in the United States; in Spain, after ONT was founded in 1990, the rate of donation from the deceased was the most in theworld. 3. Spain had the best rate of donation with 34.5 pmp, 10.9 pmp higher than in the United States with separate legislation from 2003 to 2005. There was a rate difference of 0.98 pmp between Germany and the United Kingdomwhich implemented separated legislation nine years earlier. 4. Southern Australia had a maximum rate of average kidneytransplant in the country from 2002 to 2006. 5. Live donor kidney transplants accounted for 31.2~44% compared to4.3% and 4.1% for liver transplants in 2006 and 2007 respectively in the United States. 6. The following have been appliedglobally to regulate organ transplantation and brain death: 1) International or multilateral treaties; 2) Regulation ofNGOs; 3) Self-discipline in the field of organ transplantation; 4) Expert consensus; 5) Establishment of patient’s alliance.Conclusion Countries that have implemented organ transplantation and brain death laws have developed successfulmeasures to improve and support insurance and follow-up information for donors and recipients, however, legislation isstill urgently needed in China. As long as brain death and organ transplant laws are reasonably developed and legislatorsresolve to deal with the difficult issues, then the legislation and its subsequent enforcement will reflect the interests of the people and improve health quality for all.
Objective To explore the protective effect and mechanism of Astragalus polysaccharides (APS) on liver injury in the state of brain death in New Zealand rabbits. Methods Twenty-four New Zealand rabbits were randomly divided into 3 groups (n=8): the blank control group, the brain death group, and the APS group. We obtained blood and liver tissue specimens from rabbits of three groups at 4 h and 8 h after treatment respectively (n=4). The rabbits of blank control group simulated the procedures of anesthesia and surgery of the brain death, without the Foley balloon catheter being pressurized, and maintained anesthesia. The brain death group: brain-dead models were established. The APS group: injection of APS (12 mg/kg) via the femoral vein bolus immediately after anesthesia, brain-dead models were established as same as rabbits of brain death group. The blood and liver tissue samples were taken at 4 h and 8 h after treatment to detect aminotrans-ferase (AST), alanine amino-transferase (ALT) and tumor necrosis factor α (TNF-α), and to observe the change of liver tissue by HE staining and immunohistochemical staining〔expression level of nuclear transcription factor p65 protein (NF-κB p65) could be detected by immunohistochemical staining〕. Results ① ALT and AST. Compare with the blank control group at the same time (4 h and 8 h), levels of ALT and AST in brain death group and APS group were significantly increased (P<0.05), and the levels of ALT and AST in brain death group were higher than those of APS group at each time point (P<0.05). In the same group, compared with 4 h, there was no significant difference in the levels of ALT and AST in blank control group at 8 h (P>0.05); the levels of ALT and AST in brain death group at 8 h were both higher than those of 4 h (P<0.05); the levels of ALT at 8 h in APS group was higher than that of 4 h, but there was no significant difference in the level of AST between 4 h and 8 h (P>0.05). ② TNF-α. Compare with the blank control groups at same time (4 h and 8 h), levels of TNF-α in brain death group and APS group were significantly increased(P<0.05), and level of TNF-α in brain death group was higher than that of APS group at 4 h and 8 h (P<0.05). ③ The HE results. The liver tissue structure of blank control group, brain death group, and APS group at 4 h had no obvious change. The liver tissue structure of brain death group at 8 h showed the evident tissue damage: liver cells showed the balloon samples, disordered arrangement, cytoplasmic loose light dye net-like, and inflammatory cells infiltrated in portal area. The liver tissue structure of APS group at 8 h showed that, liver cells showed mild edema, normal arrangement, and a small amount of inflammatory cells infiltrated in portal area. The liver tissue structure damage of APS group at 8 h was milder than that of brain death group. ④ Immunohistochemical staining results. There was no significant difference in expression levels of NF-κB p65 protein among blank control group, brain death group, and APS group at 4 h (P>0.05). But at 8 h, the expression levels of NF-κB p65 protein in brain death group and APS group were higher than that of blank control group (P<0.05), and the expression level of NF-κB p65 protein in brain death group was higher than that of APS group (P<0.05). The expression levels of NF-κB p65 protein in brain death group and APS group at 8 h was higher than that of 4 h in the same group (P<0.05), but there was no significant difference between 4 h and 8 h in blank control group (P>0.05). Conclusions Brain death will cause liver damage and the injury degree may be related to the continuous time. The damage at 8 h was more serious than that of 4 h. APS has a protective effect on liver of brain-dead rabbits' and its mechanism may be closely related to inhibit TNF-α and NF-κB by diverse ways to reduce the inflammation of the liver injury.
Heart transplantation remains the most effective treatment for patients with end-stage heart failure. Over the past decade, significant advancements have been made in the field of heart transplant surgery. However, the enormous demand from heart failure patients and the severe shortage of available donor hearts continue to be major obstacles to the widespread application of heart transplantation. With the development of donor heart recovery, preservation, and evaluation techniques, the use of extended criteria donors and donation after circulatory death has increased. These technological advancements have expanded the safe ischemic time and geographic range for donor heart procurement, significantly enlarging the donor pool and driving a rapid increase in heart transplant cases. Concurrently, many new techniques have emerged in heart transplant surgery and perioperative management, particularly the rapid advancements in mechanical circulatory support and artificial intelligence, which hold the potential to revolutionize the field. This article reviews and discusses the current status and major surgical advancements in adult heart transplantation in the United States, aiming to provide insights and stimulate ongoing exploration and innovation in this field.