Inter-discipline is formed by the interpenetration and integration of multiple disciplines, which has become a notable trend involving interdisciplinary activities and a combination of research and development. Learned from experience worldwide, the management mode for organ donation and procurement activities varies among countries, but the core of the disciplinary construction of organ donation remains the same. The theoretical basis and practice of organ donation is not purely a matter of coordination, but its ground of knowledge is built upon multidisciplinary integration and its implementation relies on a joint-effort approach and requires collaboration of multiple teams. From the sociological viewpoint, organ donation represents the gift of life for transplant patients, which founds the key element in enhancing the harmony of society. While, from a practical perspective, its professionalism has been widely recognized by the international medical community. As a complex medical and social act, organ donation is a medical-centered subject with sociological, humanistic, ethical, psychologic, and juristic attributes. This chapter will provide an overview of how multidisciplinary collaboration empowers the science of organ donation, followed by the summary of recent efforts taken in China in pursuit of this goal as an example.

Jiang, Wenshi; Xue, Wujun; Ye, Qifa; Chen, Zhonghua; Fang, Qiang; Wu, Xiaotong; Wang, Yue; Xu, Xiao; Wang, Haifeng; Sun, Xuyong; Li, Li; Gu, Min Author Information

Ma, Yajie1; Xue, Wujun2; Ye, Qifa3; Chen, Zhonghua4; Fang, Qiang5; Wu, Xiaotong1; Wang, Yue6; Jiang, Wenshi1 Author Information

1Shanxi Provincial Organ Procurement and Allocation Center, Taiyuan, Shanxi Province, People’s Republic of China.

近年来,我国的器官捐献与移植已经处于稳定发展的阶段.尽管如此,移植器官来源短缺、器官供需矛盾突出仍是实现世界卫生组织所倡导"实现器官移植自给自足"的瓶颈.世界卫生组织定义的"器官捐献关键路径"中阐述的供者丢失的关键原因包括潜在供者的识别和转介以及器官的维护与修复问题.器官捐献工作的顺利开展及高效率、高质量发展离不开重症医学的支持,并与重症监护室(ICU)医务人员对该项工作的认知、认可及参与程度息息相关.本文就ICU医务人员对器官捐献的认知、态度及意愿的研究现状进行综述,讨论相关影响因素,并尝试就如何改善相关困境给出针对性建议.

Within the last decade, deceased organ donation and transplantation in China have made great progress, but there is still much room for improvement. Inefficient communication with the family of potential organ and tissue donors is one of the major reasons for donor loss. In this study, the current progress of the deceased organ donation program in China was summarized, with a particular focus on the analysis of problems and solutions for achieving best practices in communication with the family of potential organ and tissue donors. This paper is in compliance with the Helsinki Congress and the Declaration of Istanbul.

Inter-discipline is formed by the interpenetration and integration of multiple disciplines, which has become a notable trend involving interdisciplinary activities and a combination of research and development. Learned from experience worldwide, the management mode for organ donation and procurement activities varies among countries, but the core of the disciplinary construction of organ donation remains the same. The theoretical basis and practice of organ donation is not purely a matter of coordination, but its ground of knowledge is built upon multidisciplinary integration and its implementation relies on a joint-effort approach and requires collaboration of multiple teams. From the sociological viewpoint, organ donation represents the gift of life for transplant patients, which founds the key element in enhancing the harmony of society. While, from a practical perspective, its professionalism has been widely recognized by the international medical community. As a complex medical and social act, organ donation is a medical-centered subject with sociological, humanistic, ethical, psychologic, and juristic attributes. This chapter will provide an overview of how multidisciplinary collaboration empowers the science of organ donation, followed by the summary of recent efforts taken in China in pursuit of this goal as an example.

人体器官移植技术是20世纪生命医学科学的重大进展,挽救了众多器官功能衰竭患者的生命,具有划时代的意义.随着原国家卫生部2010年启动公民逝世后器官捐献(Chinese Organ Donation after Citizen's Death,CODCD)试点工作,2013年在全国范围内推广开展,原国家卫生计生委于2013年 8月出台了《人体捐献器官获取与分配管理规定(试行)》(以下简称《规定(试行)》),要求公民逝世后捐献器官的获取和分配由人体器官获取组织(organ procurement organization,OPO)按照相关规定实施,OPO正式进入了我国器官捐献与移植的历史舞台 [1].

Introduction: While the reform of organ transplantation in China has achieved success, the organ procurement model for different regions in the country varies. Starting from a hospital-based organ procurement organization (OPO), Shanxi OPO was established as the first independent non-profit provincial OPO in China, which covers a donation area of 37.29 million population and serves 6 transplant hospitals in the region. Shanxi OPO was established in 2018 under the supervision of Shanxi provincial health commission. This study compares results before and after the establishment in regard to the quantity, quality and efficiency of organ donation and transplantation (OD & OT) within Shanxi Province, aiming at exploring a feasible and up-to-date procurement management mode in China. Method: From the point of organizational structure, personnel composition, equipment management and core quality indicators, we analyze the data from 2015 to 2021 and compare the results before and after the establishment of the provincial OPO. Results: In the past two years, a professional team with 7 departments has been built. Besides, advanced facilities like those for donor maintenance and information collection are equipped. Then in 2020, an ethics and scientific committee have been founded to guide scientific research and supervise ethical norm compliance. Through analyzing the quality control indicators, the number of OD has increased from 35 cases (PMP: 0.99) in 2015 to 126 cases (PMP: 3.61) in 2021, with an increase rate of 260%. The growth trend remains within Shanxi Province even under the influence of COVID-19 pandemic in 2020, while the case number of the country decreased. Since 2018, the number of organs procured from per donor and the organ utilization rate of Shanxi OPO have risen year by year, reaching 3.02 and 98.7% respectively in 2021. Moreover, the DBD rate has increased from 1.1% in 2019 to 20.63% in 2021, though there is still a gap compared to the national and international level. These positive changes indicate that the quality of our service in organ viability assessment, donor maintenance, organ recovery and coordination have been gradually improved. Conclusion: Efficiency and quality of the organ procurement and allocation have been greatly improved in the past few years because of the establishment of Shanxi OPO. This kind of provincial OPO also provides a solution, which will lead a clear direction for the standardization of organ procurement in China.

Introduction: The total number of organ donation (OD) exceed 5,000 in 2020 in China, accounting for 14.5% of the global deceased OD. Under the supervision of the national health authority, currently there are 118 organ procurement organizations (OPOs) developed in China to manage daily practice of organ donation and procurement for transplantation. This study provides an overview for the development of OPOs in China and challenges facing in the developing phase. Suggestions were summarized, with aims at seeking up-to-date management model & strategies to increase operational efficiency and service quality. Methods: Characteristic of current Chinese OPOs management mode and key elements of constructing an OPO with high efficiency were summarized by an expert consensus meeting and a survey completed by 72 experts from 21 provinces. Among them, 42% are the leader from hospital/OPO/transplantation department, and 38% are OPO professionals/coordinators, and 11% are medical staff from transplant department. The rest are professionals in the field of ICU and others. Results: There are 4 OPO management models adopted in China, namely, provincial independent OPO (developed as an independent & unique non-profit organization in a province), provincial OPO (a unique but hospital-affiliated OPO in a province), the transplant hospital-based OPO (there are more than one OPOs in a province), and the OPO alliance (the OPO is developed by more than one transplant hospitals together. There are more than one OPO alliance in a province). Results from the survey show that different OPO management models have its pros and cons. In terms of medical resources & facilities, hospital-based OPO is better than the others. On the other hand, provincial independent OPO has stronger advantages on autonomous control in institutional and financial management. Provincial independent OPO model ranks first in the comprehensive competing score, followed by the hospital-based OPO model. By collecting the views of experts on the key elements of constructing an efficient OPO, 20 key elements were identified. The most important three elements are, namely, availability of support of national/ local policies for OPO, the creation of effective donation hospitals cooperation network and a well-organized financial management model. Conclusion: OPOs have been established in China to manage organ donation and procurement activities. The OPO management models & their performance metric vary among provinces. To achieve better results, the number of OPOs needed to be reduced in regions with more than one OPO.

Introduction: Although COVID-19 pandemic has caused a significant impact worldwide, organ donation & transplantation (OD & OT) practice continuous in most of the countries. Since China launched the pilot program of voluntary deceased OD in 2010, the national organ donation & procurement system has been developing towards standardization. In this study, features of the global & national trends in OD & OT during the COVID-19 pandemic were summarized. Method: A retrospective study using data from the global observatory on donation and transplantation (GODT) was conducted. We analyzed the collected data to obtain the results and conclusions. Results: The summed-up characteristics covered different aspects and could be outlined as the followings: 1) The number of global OT has been increasing until the outbreak of COVID-19 pandemic in 2020. There were 129,681 OT performed worldwide in 2020, a decrease of 17.6% comparing to that of 2019. The percentage of China’s annual OT to the global OT number rose from 7.9% among in 2015 (10,057 cases) to 13.8% in 2020 (17,949 cases). 2) In China, joint-efforts have been made to achieve self-sufficiency of OT on the national level. The total number of OD exceed 5,000 in 2020, accounting for 14.5% of the global deceased OD. The China OD & OT program works orderly with implementation of prevention control policy under the pandemic. 3) DBD remains as the major source for OT worldwide while the number of DCD has been increasing in the recent year. With the lasting promotion of clinical practice in brain death diagnosis, the percentage of DBD in China has increased over the past five years. 4) The percentage of global living donor (LD) transplants has decreased year-on-year. With the implementation of deceased OD program in different Asian countries, living donation does not comprise the majority of organ source for OT in Asia. 5) The percentages of liver, kidney and lung transplantation in China were on the rise compared to the global total and the liver transplantation accounted for the highest proportion. 6) China’s OT activity ranks second in the world, but the PMP of deceased OD & OT is low, indicating rooms for improvement. 7) Innovative transplant approaches were explored worldwide to meet the increasing transplant demands. Efforts have been made in China to promote innovation for transplantation, examples can be seen, such as the fact that China completed ischemia-free liver/kidney/heart transplantation, and successfully performed the world’s first double-lung transplant with COVID-19 patient in 2020. Conclusion: Summary of current features in OD & OT in China and worldwide were analyzed in this study. The degree of OT program development varies across the world but all making efforts to meet the ever-changing demands for transplants. Chinese reform on OD & OT marks it one of the countries contributing to the increase of OD & OT activities worldwide but still has room for improvement in operational efficiency.

通过参与观察研究和文献梳理,总结当前我国公民逝世后器官捐献伦理审查存在的问题,如审查机构不明确、审查时间滞后、审查形式有缺陷、审查内容及标准不具体、审查监管不足等.依据人体器官捐献的伦理原则及我国相关法律法规和文件规定,针对谁来审查、何时审查、怎样审查、审查什么、如何监管5个问题提出规范伦理审查的建议,以期加强器官捐献伦理审查制度建设和伦理委员会审查能力建设,促进我国器官捐献与移植工作由高速度增长向高质量发展转型.

Background Kidneys obtained from deceased donors increase the incidence of delayed graft function (DGF) after renal transplantation. Here we investigated the influence of the risk factors of donors with DGF, and developed a donor risk scoring system for DGF prediction. Methods This retrospective study was conducted in 1807 deceased kidney donors and 3599 recipients who received donor kidneys via transplants in 29 centers in China. We quantified DGF associations with donor clinical characteristics. A donor risk scoring system was developed and validated using an independent sample set. Results The incidence of DGF from donors was 19.0%. Six of the donor characteristics analyzed, i.e., age, cause of death, history of hypertension, terminal serum creatinine, persistence of hypotension, and cardiopulmonary resuscitation (CPR) time were risk factors for DGF. A 49-point scoring system of donor risk was established for DGF prediction and exhibited a superior degree of discrimination. External validation of DGF prediction revealed area under the receiver-operating characteristic (AUC) curves of 0.7552. Conclusions Our study determined the deceased donor risk factors related to DGF after renal transplantation pertinent to the Chinese cohort. The scoring system developed here had superior diagnostic significance and consistency and can be used by clinicians to make evidence-based decisions on the quality of kidneys from deceased donors and guide renal transplantation therapy.

本文通过剖析成立、运行近两年来的"山西模式"下人体器官捐献工作进程，分析比较山西省人体器官获取与分配服务中心成立前后山西省人体器官捐献发展趋势变化，运行效率，医疗服务质量，以期进一步探索我国人体器官获取组织建设的发展，更好地促进人体器官捐献与移植的发展。

当前,新型冠状病毒肺炎（新冠肺炎）疫情全球各地形势不一,疫情防控仍然不能松懈。在面对各自的社会环境和医疗资源配置的考验下,以及在行业赖以生存的体系运作惯性及固有生产力的支撑下,各国器官捐献和移植工作仍在努力前行。山西省人体器官获取与分配服务中心是在国家专家委员指导下,由原山西省卫生和计划生育委员会于2018年8月28日批准成立的全省唯一、独立运行的非营利性医疗机构。本文通过剖析疫情期间美国和西班牙的器官捐献与移植数据,结合山西省人体器官获取与分配服务中心器官捐献工作的开展情况,进一步探索符合我国国情、省情的公民器官捐献与移植工作体系的建设。

Objective To investigate the cognition towards organ donation,kidney transplantation and willingness to donate in driving license holders in China.Methods From January 2013 to March 2013,25 000 questionnaires were distributed to 25 transplant centers in China,which were the member units of the Kidney Transplantation Group of Chinese Urological Association.The survey on local driving license holders was performed by each center randomly.The questions in the questionnaire included demographic characteristics of respondents as well as their understanding of kidney transplantation and organ donation and personal willingness.All the questionnaires were collected to Peking University Third Hospital for final statistics and the results were analyzed by epidemiology specialists.Results Total 25 000 questionnaires were distributed and 12 807 collected (51.2％).The effective response rate of questionnaires was 95.3％ (12 205/12 807).74.4％ respondents supported voluntary organ donation.64.0％ advocated organ donation after death and 48.4％ wanted to be volunteers of organ donation.Conclusions Although most of the interviewee accept organ donation,less than half wish to be a volunteer of organ donation.The reasons for this are various and more propaganda will be needed to promote the voluntary organ donation in China. Key words: Organ; Donation; Kidney transplantation ; Questionnaires