Healthcare System Impact on Deceased Organ Donation and Transplantation: A Comparison Between the Top 10 Organ Donor Countries With 4 Countries in Southeast Asia

Organ transplantation in Africa: Confronting socioeconomic, cultural, and infrastructural hurdles

BACKGROUND

Organ transplantation is a critical procedure offering life-saving treatment for patients with end-stage organ failure. In Africa, however, the accessibility and development of organ transplantation are severely hampered by numerous barriers. Socioeconomic disparities, inadequate healthcare infrastructure, legal and ethical gaps, cultural resistance, and the dual burden of infectious and non-communicable diseases are among the significant challenges faced. This review aims to comprehensively explore these barriers and propose actionable strategies to address them.

METHOD

A narrative review was conducted by searching electronic databases, including PubMed, Google Scholar, Scopus, and JSTOR. The review prioritized studies addressing the challenges of organ transplantation in Africa, focusing on socioeconomic factors, healthcare infrastructure, cultural beliefs, legal frameworks, and the impact of infectious and non-communicable diseases. Studies offering solutions tailored to the African context were also included.

RESULTS

The review identified several key obstacles, including high costs of transplantation, a limited number of transplant centers, and a critical shortage of skilled healthcare professionals. Cultural beliefs and widespread misconceptions impede organ donation acceptance. Additionally, infectious and non-communicable diseases complicate the transplantation process and outcomes. Weak legal frameworks exacerbate the risks of organ trafficking and unethical practices, while low public awareness further undermines efforts to enhance organ donation rates.

CONCLUSION

Addressing these multifaceted challenges necessitates a comprehensive approach. Strengthening healthcare infrastructure, enhancing capacity-building programs, developing robust legal and ethical frameworks, and implementing targeted public education campaigns are critical for improving organ transplantation in Africa.

Global Variation in Living Donor Liver Transplantation Practices Impacts Donor and Recipient Short-Term Outcomes: Initial Insights from the International LDLT Registry

Living donor liver transplantation (LDLT) is crucial for addressing organ scarcity and improving survival and quality of life. Variations in practices and outcomes are influenced by geographic, economic, and cultural factors. This study examined the association between short-term LDLT outcomes and the Human Development Index (HDI), a composite metric ranking countries by life expectancy, education, and income. Data from September 2023 to June 2024 were prospectively collected through the International LDLT Registry, involving 70 institutions from 26 countries. This prospective global cohort included 1,575 pairs (3,150 cases). Donors from very high HDI regions had a higher prevalence of comorbidities (17.4%) than those from low HDI regions (1.2%, p<0.001). High HDI regions showed lower donor complication rates (9.8%) compared to lower HDI regions (21.4%, p<0.001). Multivariable analysis indicated significantly reduced short-term postoperative donor morbidity in very high HDI regions (OR 0.32, 95% CI 0.23-0.44, p<0.001). Failure-to-rescue rates were substantially higher in low HDI regions (83.3% vs. 2.3%, p<0.001). The study highlights the significant disparities in LDLT practices and short-term outcomes across HDI levels, emphasizing the need for global cooperation to standardize practices and enhance care quality to ensure equitable access to liver transplantation worldwide.

Hospital-Related Determinants of Refusal of Organ Donation in France: A Multilevel Study

In a worldwide context of organ shortage, refusal of organ donation remains the main reason for the non-procurement of organs from deceased donors. Many studies have characterized the clinical or psychological factors of refusal but not organizational and structural factors in healthcare centers. We used multilevel logistic regression models with hospitals as a random effect to analyze organ procurement among 6734 potential brain-dead donors recorded in the national register in France in 2018 and 2019. According to the opt-out law, 29% of the potential donors refused to donate. Among hospital-related factors, low probability of refusal was related to hospitals audited for the organ donation process by the national program (adjusted odds ratio [aOR] 0.74, 95% confidence interval [CI]: 0.58-0.94), hospitals with high inpatient satisfaction scores for care (aOR 0.95, 95% CI 0.92-0.99) and facilities with a high ratio of nurse donor coordinators to donors (aOR: 0.78; 95% CI: 0.64-0.95). Among clinical factors, the odds of refusal were associated with age younger than 65 years (18-49 years; aOR 1.58, 95% CI 1.37-1.83) and donors with blood group B (aOR 1.32, 95% CI: 1.10-1.59). Hospital-related factors are just as important as individual factors in the procurement of organs from potential brain-dead donors.

Global transplantation: Lessons from organ transplantation organizations worldwide

Although national transplant organizations share common visions and goals, the creation of a unified global organization remains impractical. Differences in ethnicity, culture, religion, and education shape local practices and infrastructure, making the establishment of a single global entity unfeasible. Even with these social disparities aside, logistical factors such as time and distance between organ procurement and transplantation sites pose significant challenges. While technological advancements have extended organ preservation times, they have yet to support the demands of transcontinental transplantations effectively. This review presents a comparative analysis of the structures, operational frameworks, policies, and legislation governing various transplant organizations around the world. Key differences pertain to the administration of these organizations, trends in organ donation, and organ allocation policies, which reflect the financial, cultural, and religious diversity across different regions. While a global transplant organization may be out of reach, agreeing on best practices for the benefit of patients is essential.

Small Donors, Big Impact: Optimizing Organ Utilization in Simultaneous Pancreas and Kidney Transplantation From Extra Small Pediatric Donors

INTRODUCTION

Simultaneous pancreas-kidney transplantation (SPK) is the preferred treatment for individuals with type-1 diabetes and end-stage renal disease. However, a limited supply of "Ideal Pancreas Donors" contributed to a growing disparity between available organs and recipients. Even though SPK outcomes from pediatric donors match those from adult donors, unclear guidelines on minimum age and weight criteria for extra small pediatric pancreas donors lead to hesitancy among several transplant centers to utilize these grafts due to concerns about inadequate islet mass, technical challenges, and increased risk of allograft thrombosis.

METHODS

This report details the successful outcomes of SPK transplantations performed at the study center between December 2021 and January 2024, using four extra small pediatric brain-dead donors (ESPDs). Each donor was aged ≤5 years and weighed <20 kg.

RESULTS

All SPK recipients achieved immediate posttransplant euglycemia without requiring insulin. None of the recipients experienced graft pancreatitis, graft thrombosis, allograft rejection, or required re-exploration. During a 5-27-month follow-up period, all ESPD recipients maintained optimal graft function, as evidenced by normal glucose tolerance tests and HbA1c (4.9%-5.2%), with 100% graft and patient survival.

CONCLUSION

This report examines the usage of ESPDs in SPK transplantation, highlighting their potential to expand the donor pool and reduce wait times in areas with scarce deceased organ donations, thereby increasing the number of available organs for transplantation with acceptable outcomes. Revising donor selection guidelines to reflect the diverse risk-benefit profiles of waitlisted individuals is crucial to addressing geographical disparities and reducing organ discard rates.

An Update on Brain Death/Death by Neurologic Criteria since the World Brain Death Project

The World Brain Death Project (WBDP) is a 2020 international consensus statement that provides historical background and recommendations on brain death/death by neurologic criteria (BD/DNC) determination. It addresses 13 topics including: (1) worldwide variance in BD/DNC, (2) the science of BD/DNC, (3) the concept of BD/DNC, (4) minimum clinical criteria for BD/DNC determination, (5) beyond minimum clinical BD/DNC determination, (6) pediatric and neonatal BD/DNC determination, (7) BD/DNC determination in patients on ECMO, (8) BD/DNC determination after treatment with targeted temperature management, (9) BD/DNC documentation, (10) qualification for and education on BD/DNC determination, (11) somatic support after BD/DNC for organ donation and other special circumstances, (12) religion and BD/DNC: managing requests to forego a BD/DNC evaluation or continue somatic support after BD/DNC, and (13) BD/DNC and the law. This review summarizes the WBDP content on each of these topics and highlights relevant work published from 2020 to 2023, including both the 192 citing publications and other publications on BD/DNC. Finally, it reviews questions for future research related to BD/DNC and emphasizes the need for national efforts to ensure the minimum standards for BD/DNC determination described in the WBDP are included in national BD/DNC guidelines and due consideration is given to the recommendations about social and legal aspects of BD/DNC determination.