Public perception of organ donation and transplantation policies in Southern Spain

BackgroundThis research explores how public awareness and attitudes towards donation and transplantation policies may contribute to Spain’s success in cadaveric organ donation.Materials and MethodsA representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018.ResultsMost participants trust Spain’s donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), while few non-donors have expressed their refusal (14%). Only a minority is aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased’s preferences and be consulted when the deceased’s wishes are unknown, as is the case in Spain.ConclusionsPublic trust in the transplant system may contribute to Spain’s high performance in organ donation. High levels of societal support towards organ donation and transplantation do not correspond in Spain with similar levels of public awareness of donation and transplantation policies.

Does Transportation Mean Transplantation? Impact of New Airline Routes on Sharing of Cadaveric Kidneys

Every year, nearly 5,000 patients die while waiting for kidney transplants, and yet an estimated 3,500 procured kidneys are discarded. Such a polarized coexistence of dire scarcity and massive wastefulness has been mainly driven by insufficient pooling of cadaveric kidneys across geographic regions. Although numerous policy initiatives are aimed at broadening organ pooling, they rarely account for a key friction—efficient airline transportation, ideally direct flights, is necessary for long-distance sharing, because of the time-sensitive nature of kidney transplantation. Conceivably, transplant centers may be reluctant to accept kidney offers from far-off locations without direct flights. In this paper, we estimate the effect of the introduction of new airline routes on broader kidney sharing. By merging the U.S. airline transportation and kidney transplantation data sets, we create a unique sample tracking (1) the evolution of airline routes connecting all the U.S. airports and (2) kidney transplants between donors and recipients connected by these airports. We estimate the introduction of a new airline route increases the number of shared kidneys by 7.3%. We also find a net increase in the total number of kidney transplants and a decrease in the organ discard rate with the introduction of new routes. Notably, the posttransplant survival rate remains largely unchanged, although average travel distance increases after the introduction of new airline routes. Our results are robust to alternative empirical specifications and have important implications for improving access to the U.S. organ transplantation system. This paper was accepted by Vishal Gaur, operations management.

A National Consensus Forum on improving cornea donation and transplantation access in Canada

A consensus meeting was held in Toronto on February 9–10, 2020 to discuss ways to improve cornea donation and transplantation access in Canada. The meeting brought together eye and tissue bank representatives, health authority and hospital leadership, transplant ophthalmologists, organ donation organizations, transplant recipients, donor families and several national organizations. Through facilitated discussions in multidisciplinary, gender-balanced, and geographically balanced small groups, participants identified opportunities for improvement in the Canadian cornea donation and transplantation system. Discussion occurred around broad themes of donor tissue demand, supply, access, utilization, interprovincial sharing and cost recovery, interprovincial knowledge sharing and research. This event marked the first time in 10 years in which the Canadian cornea transplantation community came together.

Analysis of law regulation of the human anatomical material transplantation in Ukraine

The article deals with analysis of the legal support of transplantation of human anatomical materials in Ukraine. The peculiarities of the problems of launching a transplantation system for a full-fledged settlement of the legal framework are revealed. Improving the transplant system in Ukraine is important for our country. Today, transplantation is considered worldwide as an extremely effective and in many cases non-alternative method of treating irreversible diseases and injuries of such vital organs as kidneys, liver, pancreas, lungs, heart, etc. Ukraine also lags far behind European countries in the pace of development of cell transplantation, in particular hematopoietic stem cell transplantation. Therefore, the analysis of the legal provision of transplantation of human anatomical materials in Ukraine reveals the shortcomings of the legal framework that need to be improved. The necessity of making additions to the legislation of the researched topic is substantiated.

SUPPORT OF MAKING THE DECISION ABOUT DONATION POSSIBILITY ON THE BASIS OF CIVIL LAW GROUNDS

In this paper, the actuality and importance of the process of supporting the decision-making about the possibility of donation based on the civil law grounds are proved. This realized process will help to decide about the possibility or impossibility of donation, in any case, taking into account all existing civil law grounds. A review of the literature was conducted. It proved that the known information systems in the field of donation and transplantology don’t propose the method of supporting the decision-making about the possibility of donation based on the civil law grounds. The review of the civil law grounds of donation in Ukraine was conducted. Production rules and method of supporting the decision-making about the possibility of donation based on civil law grounds has been first time developed. This method helps to the transplantation clinic staff to correctly form the Register of donors (living donors and posthumous donors), taking into account all current civil law grounds. The developed method standardizes the procedure of including donors in the Register, minimizing the impact of subjectivism and the human factor herewith. Thus, the developed method of supporting the decision-making about the possibility of donation minimizes the damage that the whole medical transplantation system may suffer and leverages the occurrence for its improvement. Experiment has shown that the developed method is workable and effective in determining the possibility of donation based on all currently existing civil law grounds in the complex. The perspective direction of the future authors' work is the design and development of the subsystem for supporting the decision-making about the possibility of donationn– on the basis of the production rules and method of support of making the decision about donation possibility on the basis of civil law grounds, which are developed in this paper.

Reforming the organizational and legal component of the United States of America donation and transplantation system to increase its effectiveness

Background. The demand for transplants leads to an increase in the demand for donor organs and as the result to their shortage all over the world. The United States is one of the world leaders in the number of donors and organ transplants. The article presents the results of an analysis focused on finding ways to improve the efficiency of the American donation and transplantation system. Purpose. The aim of the study is to analyze the organizational and legal components of the United States organ donation and transplantation system and identify possible ways to reform it. Materials and methods. The study carries out informational analysis and assessment of the effectiveness of the US donation and transplantation system based on the available official statistics for the period from 1991 to 2019, the results of the simulation of the application of the presumption of consent to posthumous donation, regulatory legal acts, insurance programs and scientific research of foreign and Russian scientists in the transplantation field. Results. A statistical data comparison showed that, despite the significant success of the United States in the development of donation and transplantation, there is a growing shortage of donor organs in the country, as in the whole world. The results of the analysis identified promising directions for reforming the donation and transplantation system in order to increase its effectiveness. There is great potential for increasing the supply of donor organs by the possible transition of the United States from the model of requested consent to the presumption of consent for posthumous donation. Centers for the procurement of donor organs have the least efficiency in the US organizational model of donation and transplantation. The financial vulnerability of living donors and organ donor recipients requires attention, because insurance programs do not cover their expenses, incl. on immunosuppressive drugs, due to the gap between the standards of care for organ donor recipients and the policies of insurance companies. The ongoing support measures or living donation are clearly insufficient. Conclusion. The directions of the US donation and transplantation system reforming identified in the course of the study require further elaboration and discussion in American society, the adoption of new regulatory legal acts, the development of new rules for the work of the system participants, adjustments to the assessment procedure, funding and support at the state and international level. Only a set of organizational, legal, financial and stimulating measures will help to increase the number of donor organs and the number of transplants.

Is Post-Mortem Organ Donation a Duty Towards Society and Can It Be Justified by Public Interest? Recent Bills to Amend the German Transplantation Law

The issue of organ donation from deceased donors remains unsatisfactorily resolved in Germany. The number of donors has remained very low in recent years. Consequently, the German Bundestag was holding a debate on two MP bills aimed at amending the organ transplantation law. Two main bills were presented by different groups of MPs. The more controversial of them, supported by the Minister of Health, tried to introduce the opt-out model into Germany’s organ transplantation system. The second one aimed to improve the existing opt-in model. During the final voting, the Bundestag decided against the opt-out model and in favour of the improved opt-in one. In some experts’ eyes, an opt-out model imposes an obligation on the citizens to donate an organ after brain death. Can such a duty to the society be justified by public interest or other principles? The goal of this article is to offer an answer to this question by analysing the provisions of the German constitution.