'As a surgeon, I am obliged to every single patient': evaluation of focus group discussions with transplantation physicians on the allocation of donor organs

Macrophage membrane coated nanoscale coordination polymers promote graft survival in allogeneic transplantation

Organ transplantation is a crucial life-saving procedure for patients suffering from end-stage organ failure, yet it faces a global shortage. This scarcity not only impacts individual patients but also places strain on healthcare systems worldwide. However, the risk of rejection adds another layer of difficulty to this already intricate medical procedure. Herein, we present the design and synthesis of graft-targeting macrophage membrane coated nanoscale coordination polymers (dNCPs@MM), in which dexamethasone sodium phosphate (DEXp) serves as an effective immunosuppressive drug, Fe3+ acts as bridging ligands for coordination-driven self-assembly with cargo molecules, and macrophage membranes are utilized to reduce uptake by the immune system as well as a retarder to enhance the blood circulation time. The high drug loading, responsive release behavior and targeting capability of the obtained dNCPs@MM promote their biological performance. In a murine allogeneic heart transplantation model, dNCPs@MM exhibited remarkable efficacy in attenuating acute rejection at a low dosage, with a mean survival time of 14.7 days compared to 8.6 days for DEXp and 9.3 days for dNCPs treatment. At a high dosage, dNCPs@MM exhibited the ability to control established rejection by inducing exhaustion in both CD4+ and CD8+ T cell and preventing of alloreactive T cells from acquiring effector (CD44hiCD62L-) functions. Moreover, while high doses of DEXp or dNCPs treatment led to significant adverse effects, the administration of dNCPs@MM demonstrates tolerable adverse effects even at high dosage levels. Therefore, dNCPs@MM exhibits promising potential for clinical application in addressing rejections in allografts and xenografts.

Ethics of allocation of donor organs

PURPOSE OF REVIEW

There is no widely accepted single ethical principle for the fair allocation of scarce donor organs for transplantation. Although most allocation systems use combinations of allocation principles, there is a particular tension between 'prioritizing the worst-off' and 'maximizing total benefits'. It is often suggested that empirical research on public preferences should help solve the dilemma between equity and efficiency in allocation policy-making.

RECENT FINDINGS

This review shows that the evidence on public preferences for allocation principles is limited, and that the normative role of public preferences in donor organ allocation policy making is unclear. The review seeks to clarify the ethical dilemma to the transplant community, and draws attention to recent attempts at balancing and rank-ordering of allocation principles.

SUMMARY

This review suggests that policy makers should make explicit the relative weights attributed to equity and efficiency considerations in allocation policies, and monitor the effects of policy changes on important ethics outcomes, including equitable access among patient groups. Also, it draws attention to wider justice issues associated not with the distribution of donor organs among patients on waiting lists, but with barriers in referral for transplant evaluation and disparities among patient groups in access to waiting lists.

How Should Deceased Donor Organs Be Allocated? The Patient's Perspective Derived from Semi-Structured Interviews

PURPOSE

The gap between the supply and demand for deceased donor organs is increasing worldwide, while patients on waiting lists for organ transplantation die. This situation requires ethical donor organ allocation rules. The patients' perspective on donor organ allocation rules offers a highly relevant and unique perspective that may differ from the perspectives of physicians and the general public.

PATIENTS AND METHODS

Semi-structured telephone interviews were conducted with the regional group coordinators of the federal self-help organization for organ transplanted patients and their relatives in Germany in early 2021. Twelve interviews were conducted with patients and relatives of transplantation patients who received transplants for the affected organs including the lungs, heart, kidney, and liver. Transcripts were analyzed using the deductive framework method which was based on an earlier study. All criteria were reported following the COREQ statement.

RESULTS

Participants emphasized aspects of "medical urgency" and "effectiveness/benefit" of transplantation and associated trade-offs as well as the recipient's responsibility for organ failure ("own fault"), the appreciation for the gifted graft and the patient's capability of taking care of it ("appreciation/responsibility"). Patients acknowledged that urgent patients should be prioritized and they showed a clear preference toward allocation rules that strive to maximize both the life years and quality of life gained by transplantation.

CONCLUSION

The patients' perspective is unique in that patients agree on certain rules for allocation and share many preferences, but also have a hard time finding clear cutoff points when considering selecting a participant for allocation. Patient representatives should therefore be consulted in the debate on donor organ allocation rules.