Work-related problems faced by coordinators of organ, cell, and tissue transplantations in Poland and possible ways of ameliorating them

In recent years in Poland, the numbers of reported potential cadaveric donors of organs, tissues, and cells, and the numbers of transplantations being carried out seem to be low in the context of the size of the country population and the presumed consent legal principle which rules transplantations. This research project was carried out on 109 Polish transplant coordinators by means of a questionnaire created specifically for this study. The goal of the project was to detect problems specific to transplant coordinators working in Poland which, when properly addressed, might improve the efficacy of transplantation network within the Polish health care system. The results suggest that Polish transplant coordinators face a variety of issues in their work. It appears that the most important interventions which could improve working conditions for in this population and—as a result—also improve the efficacy of transplantation network in Poland could include: (1) a variety of training programs for transplant coordinators; (2) a social campaign promoting transplantations and spreading awareness of the transplantation-related legislation; and (3) introduction of changes in the regulations pertaining to medical professions in Poland.

En Bloc Transplantation of Horseshoe Kidney from Deceased Donor: An Unusual Transplantation Utilizing Kidneys with Congenital Fusion Abnormality

Transplanting horseshoe kidneys is challenging and has higher complication rates due to the unusual anatomy of the vascular and urinary collecting systems. Most centers avoid using these kidneys for transplantation. However, if chosen carefully, these organs can be used successfully to reduce organ shortage. In this paper, we will describe the technique of procurement of horseshoe kidneys from cadaveric donors, back table preparation, and its successful implantation in a recipient. With good planning and skillful surgical techniques, horseshoe kidneys can be successfully transplanted in suitable recipients. If properly selected, these kidneys can be used to reduce the organ scarcity and diminish waitlist morbidity and mortality.

Donor selection for lung transplant in Turkey: Is it necessary to wait for an ideal donor?

Background: The aim of this study was to evaluate the donor criteria used in lung transplantation in our clinic. Methods: A total of 55 cadaveric donors who were accepted for lung transplantation in our clinic between December 2016 and January 2019 were retrospectively analyzed according to ideal donor criteria. The donors were divided into two groups as ideal and non-ideal ones according to their age, partial pressure of oxygen in arterial blood, history of smoking, and ventilation day. Donor data, recipient characteristics and survival outcomes were evaluated. Results: Of 55 donors accepted for lung transplantation, 24 (43.7%) were ideal and 31 (56.3%) were non-ideal donors. The 90-day mortality and one-year survival rates were not significantly different between the two groups. The 90-day mortality was 25% in the ideal group and 22.6% in the non-ideal group (p=0.834). The one-year survival rates after lung transplantation were 64.5% versus 70.6% in the ideal and non-ideal groups, respectively (p=0.444). Conclusion: The whole clinical picture should be evaluated before accepting or rejecting donors for lung transplantation. The use of lung donors that do not meet the ideal criteria does not impair short- and mid-term results, compared to ideal lung donors. Strict implementation of donor criteria may prevent using suitable donors for lung transplantation. Use of non-ideal donors can reduce waiting list mortality.

Do I Own My Organs?

This chapter evaluates the author's narrative after her meeting with Deb Porter Gill. It offers a variety of outcomes if the author had not liked Deb and withdrawn the offer to donate. That could have been for any reason, including political values, lifestyle, religion, or skin color. The chapter argues that living donors are treated by the law and by doctors as the owners of their bodies, and their body parts are considered goods that they can donate or not to whomever they want. The chapter examines the justice-based approach to organ allocation. In contrast with the living donors, cadaveric donors are generally put into national pools and allocated according to nationally agreed-upon criteria. The chapter states that their use is governed not by the autonomy-based preferences of the donor or the donor's family but, instead, by considerations of justice that are built into the administrative rules that dictate how organs should be allocated. Ultimately, the chapter presents the practical reasons for treating cadaveric organs differently than organs from a living donor.

DEVELOPMENT OF HUMAN DERIVED ACELLULAR DERMAL MATRIX: NOVEL TECHNIQUE IN PANDEMIC TIMES

INTRODUCTION Tissue support is capital to achieve good results in reconstructive and aesthetic surgery. Radiotherapy, infection and trauma among others are frequent predictors of surgery failure as they decrease tissue healing capacity. Tissue mobilization is not always an eligible option as raising comorbidities in general population and elder patients are often seen in daily practice. Furthermore, the possibility of sequels in donor zones makes many surgeons be reluctant to use flaps, especially in aesthetic surgery. In aesthetic breast surgery, ADMs provide well known benefits such as reduced capsule contracture rate and improved inframammary fold in breast augmentation procedures METHODS A decellularization protocol is proposed by our group to obtain biocompatible ADMs from cadaveric donors. An experimental animal study is designed to assess the histocompatibility of the samples and the influence of the storage method. Biomechanical tests are also done to evaluate tissue performance after decellularization. RESULTS Histopathological studies showed no signs of acute nor chronic inflammatory response in experimental group. Normal fibroblasts growth without early apoptosis signs are seen in samples. Biomechanical properties ensure optimal load and tensile strength for most reconstructive procedures. CONCLUSIONS Current protocol proposed by our group include all steps from harvesting samples from cadaveric donors till matrix storage after decellularization process. The result is a high valued biomaterial in terms of biocompatibility and security profile available in pandemic times. Local production of this biomaterial leads to cost minimization derived from harvesting and manufacturing matrices in our center and avoid out-of-stock and storage issues.

MO089HISTOMORPHOMETRIC ANALYSIS OF GLOMERULI AND CAPILLARIES DENSITY IN THE INTERSTITIUM IN PREIMPLANTATION NEEDLE BIOPSIES OF PAIRED KIDNEYS HARVESTED FROM ADULT CADAVERIC DONORS

Background and Aims Preimplantation needle biopsy of kidney allows more precise interpretation of subsequent kidney biopsies performed after transplantation and potentially also may predict kidney graft survival. It is unknown, whether it is justified to perform the biopsy of one kidney only and then to transmit obtained results also to the second kidney or biopsies of both kidneys are mandatory. The aim of the study was to assess differences regarding glomerular volume, glomerular density and capillary density in the interstitium of both kidneys harvested from the same deceased donor. Method The study involved 40 pairs of kidneys (all together 80 kidneys) in which preimplantation kidney biopsies were performed. Kidneys were harvested from 40 deceased donors (17 females and 23 males; mean age 42.3 [37.6-47.0] years old) died because of intracranial haemorrhage (17 donors) or cerebral trauma due to accident (23 donors). Histomorphometric analysis was performed using “Olympus BX51” microscope (Olympus, Tokyo, Japan) coupled with “Olympus BX50” camera and the “cellSens Standard” software (Olympus, Tokyo, Japan). Weibel-Gomez formula was adapted to calculate glomerular volume. Results No significant differences were found between mean kidneys length [115.8 (112.4-119.1) vs.115.5 (112.5-118.5) mm], glomerular volume [2.59 (2.24-2.93) vs 2.49 (2.15-2.84) μm3 x106 ], glomerular density [3.43 (3.07-3.80) vs 3.24 (2.87-3.61) n/mm2] and interstitial capillaries density [233.58 (211.26) vs 217.80 (199.45-236.47) n/mm2] of both kidneys harvested from the same deceased donor. Conclusions 1. Both kidneys harvested from the same deceased donor did not differ significantly in kidney length, glomerular volume, glomerular density and capillary density. 2. Our results justify to preimplantation biopsy of only one kidney and the results from the histomorphometric analysis may be used in the future also for assessment of the second kidney.

Multi-tissue integrative analysis of personal epigenomes

Evaluating the impact of genetic variants on transcriptional regulation is a central goal in biological science that has been constrained by reliance on a single reference genome. To address this, we constructed phased, diploid genomes for four cadaveric donors (using longread sequencing) and systematically charted noncoding regulatory elements and transcriptional activity across more than 25 tissues from these donors. Integrative analysis revealed over a million variants with allele-specific activity, coordinated, locus-scale allelic imbalances, and structural variants impacting proximal chromatin structure. We relate the personal genome analysis to the ENCODE encyclopedia, annotating allele- and tissue-specific elements that are strongly enriched for variants impacting expression and disease phenotypes. These experimental and statistical approaches, and the corresponding EN-TEx resource, provide a framework for personalized functional genomics.