Approval rates for corneal donation and the origin of donor tissue for transplantation at a university-based tertiary referral center with corneal subspecialization hosting a LIONS Eye Bank

Background With the increasing demand for corneas, eye banks must optimize the tissue donation, collection, and selection process. This retrospective monocentric study analyzed the approval rates for corneal donation and the origin of and reasons for discarding donor corneas from 2010 to 2019. Methods Data included the number of deceased, approval or rejection by the family for corneal donation and contraindications. Corneal grafts were included from all deceased persons who were full-body and multi-organ donors at the Saarland University Medical Center (UKS) and from external institutions. Additional analyzed parameters included endothelial cell count (ECC), blood sample serology for infections, and conjunctival swab testing . Results A total of 1748 corneoscleral buttons were harvested from 10,265 deceased persons (17% with no contraindication) at the UKS between 2010 and 2019, with a consent rate of 23.3%. The number of keratoplasties increased from 136 in 2010 (15% of the deceased, total = 925) to 251 in 2019 (21%, total = 1214). Both the general and department-specific data showed similar percentages for corneal donation over the years, with intensive care and palliative units recently providing the most corneas. The increase in the number of corneas processed by the cornea bank over the years (368 in 2010 compared with 857 in 2019) was linked both to a better internal supply in 2010 (262, 71.2% of the total) compared with 2019 (519, 60.6%) and to an external supply by reinforcement of cooperation with external hospitals, including Luxembourg in 2010 (106, 28.8% of the total) compared with 2019 (338, 39.4%). A total of 195 of 377 corneas (52%) were discarded in 2009 compared with 260 out of 715 (36%) in 2019. The main reasons for discarding were low ECC (36% of discarded corneas in 2009; 11% in 2019), positive conjunctival swab (11% in 2009; 13% in 2019), and blood sample serology (6% in 2009 and in 2019). Conclusion Despite an increasing number of donors, the demand for corneas is still rising. Improved cooperation with internal departments and with external clinics has led to an increasing number of explanted corneas. The main reason for discarding corneas was low ECC, followed by a positive conjunctival swab for fungal or bacterial contamination and serology. Increased donation rates and continued improvements in collection and selection processes are necessary to cover the high demand for corneas.

Arguments for ‘ocular donation’ as standardised terminology to reduce the ‘ick factor’ of ‘eye donation’

This brief report presents the global problem of the shortfall of donor corneal tissue for transplantation, a potential root cause (‘ick factor’ language), and a potential solution (modification of ‘ick factor’ language). Specifically, use of the term ‘eye donation’ is a potential hurdle to ocular tissue donation as it can stimulate the ‘ick factor.’ Verbiage such as ‘ocular (eye tissue)’ could be a method of providing terminology that is less emotive than ‘eye donor’ or ‘eye donation.’ The field of transplantation has experienced terminology shifts over time; for example, ‘cadaver’ has been replaced with ‘deceased donor,’ ‘harvest’ has been replaced with ‘recover,’ and ‘life support’ has been replaced with ‘ventilated.’ Notably, only a small number of regions worldwide are using ‘ocular’ terminology, yet it could be an important step to enhancing the informed consent process and improving donation rates, potentially increasing transplant and optimising patient quality of life for those with treatable blindness.

Opinions of healthcare students on organ and tissue donation for transplantation

ABSTRACT Objectives: to analyze the opinions of healthcare students on organ and tissue donation for transplantation. Methods: qualitative document analysis study, using the records of a database and analyzing data from two perspectives: 1) Lexical analysis, with the IRAMUTEQ software, and 2) Thematic content analysis. Results: from the analysis, 3 main categories were generated: 1) Organ and tissue donation as an act of love for others and an opportunity of a new beginning; 2) Clarification and awareness on organ and tissue donation; and 3) Importance of communicating the family and promoting organ and tissue donation. Final Considerations: despite being in favor of donation, students also recognize the presence of social taboos; the discussion in the family nucleus, promoting the theme and raising awareness in society are considered important. Additionally, the education of students is one of the possibilities of intervention for the issue.

Applying Grounded Theory to Understand Asian Women’s Motivations to Donate Healthy Breast Tissue

Background: The Komen Tissue Bank (KTB) is a clinical trial and the only global biorepository that collects and stores healthy breast tissue to be used as controls in breast cancer (BC) research. Due to a variety of barriers, there is a lack of participation by racial and ethnic minority women in tissue donation. In order to increase this participation, it is necessary to understand why or why not these populations choose to participate in clinical trials such as the KTB. This study used grounded theory methodology to explore the motivations behind Asian women’s decisions to donate their breast tissue. Methods: Guided by grounded theory, we conducted interviews with previous breast tissue donors who self-identified as Asian (n=20). We then transcribed and coded the interviews to discover common attitudes and motivations for participating in breast tissue donation. Findings: Preliminary findings were obtained from 11 interviews. We identified three common themes that influenced these women’s donations: altruistic behavior, comfort with science, and Asian identity. Identified sub-themes include factors such as personal ties to BC and background in research and clinical trials. It is of note that over half of the women expressed Asian identity and comfort with science as important factors, and all mentioned altruistic tendencies, either towards family or towards research and others. Conclusion and Future Work: We identified common factors for donating healthy breast tissue from using grounded theory to interview previous donors of Asian descent. We will transcribe and code 9 more interviews, as well as use those interviews to confirm theoretical saturation. The findings from this study will be used in the future to inform a framework for developing recruitment strategies to increase overall participation of historically excluded individuals in the KTB. Future work will include exploring the motivations of Latinas regarding donating their healthy breast tissue.

Neurodegenerative brain changes are associated with area deprivation in the United Kingdom: findings from the Brains for Dementia Research study

Socioeconomic disadvantage is associated with greater risk of dementia. This has been theorised to reflect inequalities in cognitive reserve, healthcare access, lifestyle, and other health factors which may contribute to the clinical manifestation of dementia. We aimed to assess whether area deprivation in the United Kingdom was associated with greater risk or severity of the specific neurodegenerative diseases which lead to dementia in a multi-centre cohort with autopsy assessment. Participants underwent clinical assessment prior to brain tissue donation post-mortem. Each then underwent detailed, standardised neuropathological assessment. National area deprivation statistics were derived for each participant’s neighbourhood, for use as a predictor in binary and ordinal logistic models assessing the respective presence and severity of staging of key neuropathological changes, adjusting for theorised confounders. Individuals from among the 20% most deprived neighbourhoods in the United Kingdom had significantly higher neurofibrillary tangle and neuritic plaque staging, and increased risk of cerebral amyloid angiopathy. These findings were not explained by a greater risk of diabetes or hypertension, APOE genotype, alcohol misuse or tobacco smoking, sex, or age differences. A sensitivity analysis conditioning on baseline cognitive impairment did not meaningfully change the observed association. Socioeconomic disadvantage may contribute to dementia incidence through a greater severity of specific neuropathological changes (neurofibrillary tangles, neuritic plaques, and cerebral amyloid angiopathy), independent of other indirect influences. Mechanisms through which deprivation is associated with these require further exploration.

QOLP-35. PEDIATRIC POST-MORTEM TISSUE DONATION DURING A PANDEMIC: A MODEL OF COLLABORATION

BACKGROUND Obtaining post-mortem tissue from pediatric oncology patients is not only critical to research, but studies show that participating in the process can also help grieving families heal. Since 2019, the national Gift from a Child program — a multi-institutional effort to increase the rate of rapid autopsies for pediatric CNS tumor patients — has made significant progress. Collecting high-quality post-mortem tissue has advanced research through cell line generation and genomic analyses. Unfortunately, some autopsy programs temporarily shut down during the COVID-19 pandemic. METHODS We retrospectively reviewed autopsies of four patients treated at Memorial Sloan Kettering (MSK) who underwent limited brain post-mortem examination at Weill Cornell Medicine College (WCMC) from June 2020 to June 2021. We collected patient demographics; DNR status; time of death and procedure; restrictions due to the COVID-19 pandemic; and results of the tissue analysis. Each case presented unique challenges and the timing of securing parental consent varied. RESULTS Three of four specimens were processed within 12 hours of the time of death. Two Spanish-speaking families required interpreters services to obtain consent. In all cases tumor aliquots were flash frozen for further study. All specimens contained viable tumor and cell line generation was successful in one case. All families/caregivers expressed gratitude for the opportunity to participate and for the handling of the procedures. DISCUSSION Despite the sensitive nature of these cases, clinicians should offer the option of a rapid autopsy to caregivers of pediatric patients based on the scientific need and the positive effect it has on grieving families. This paper outlines the logistical efforts required for these donations to take place and provides a framework for providers to offer rapid autopsy as an option for families through this program.

The COVID-19 pandemic and organ donation and transplantation: ethical issues

Background The COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic. Method To inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a literature review to summarize the ethical issues. Results This literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates. Conclusion This literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve.

A Gift of Generosity—An Explanation of Organ and Tissue Donation and Transplantation for Muslim Audiences

Diseased Organ and tissue donation and transplantation entails removing organ and tissues from someone (the donor) and transplanting them into another person (the recipient). Transplanting organs and tissues from one person hold the capacity to save or significantly improve the quality of life of multiple recipients. This is a rare opportunity for one to become an organ donor. In 2018, Australia had a population of 24.99 million. A total of 160,909 lives were lost that year; almost half of this death occurred in hospitals. However, a person may only be able to become a donor if their death occurs in a particular way and fulfils a defined set of special criteria—for example, while on the life support machine in an intensive care unit. Because of this, only 1211 people out of the large number of lives lost in 2018 were eligible to be potential organ donors. This is one of reasons we encourage everybody to consider the virtues of organ and tissue donation in any end-of-life discussion. Diseased organ donation occurs only when the clinician is certain that the person has died. The death is diagnosed by neurological criteria or by circulatory criteria which are discussed in detail in the article. This is an unconditional altruistic and non-commercial act. A large number of people are waiting on transplant list in Australia who are suffering from end stage organ failure; some of them will die waiting unless one receives an organ transplantation. Australians are known to be highly generous people. That is why 98% of Australian say ‘Yes’ to become an organ donor when they die. But in reality, only about 64% of families consent for organ donation on an average. There are widespread misconceptions and myths about this subject, mostly due to lack of information and knowledge. I have attempted to explain the steps of diseased organ donation in this article which, hopefully will be able to break some of those misconceptions. I have avoided to discuss living donation which is entirely a different subject. I have only touched on Islamic perspective of organ donation here as multiple Islamic scholars are going to shed lights here. We encourage everybody to ‘Discover’ the facts about organ and tissue donation, to make an informed ‘Decision’ and ‘Discuss’ this with the family. If the family knows the wishes of the loved one, it makes their decision-making process much easier during such a devastating and stressful time.