Objective We investigated the effectiveness of legislation in developed countries by analyzingtheir legislation, and produced ideas and strategies for organ transplantation and brain death legislation in China.Methods Official websites were searched as follows: UNOS, TCE, CLTR, ANZDATA, and SRTR through December6, 2008. We included statistical reports and data analysis of organ donations and transplants, and excluded literatureabout non-solid organs. The absolute transplantation numbers were standardized to per one million people. Results 1.The following data was retrieved: The number of eight kinds of organ transplants and organ donations in Britain, the United States, New Zealand, Spain, France, Italy, Germany, and Australia from 2003 to 2005; the number of deceased donors in the United States and Spain from 1988 to 2007; the total number of organ transplants in Australia from 2002 to 2006; the amount of organ transplants in the United States from 1993 to 2006; liver and kidney transplant totals in the United States from 1988 through March, 2008; liver transplants number of China from 1993 through March, 2008; and the number of kidney transplants in some provinces and cities in China. 2. Transplant totals were greatest in the United States; in Spain, after ONT was founded in 1990, the rate of donation from the deceased was the most in theworld. 3. Spain had the best rate of donation with 34.5 pmp, 10.9 pmp higher than in the United States with separate legislation from 2003 to 2005. There was a rate difference of 0.98 pmp between Germany and the United Kingdomwhich implemented separated legislation nine years earlier. 4. Southern Australia had a maximum rate of average kidneytransplant in the country from 2002 to 2006. 5. Live donor kidney transplants accounted for 31.2~44% compared to4.3% and 4.1% for liver transplants in 2006 and 2007 respectively in the United States. 6. The following have been appliedglobally to regulate organ transplantation and brain death: 1) International or multilateral treaties; 2) Regulation ofNGOs; 3) Self-discipline in the field of organ transplantation; 4) Expert consensus; 5) Establishment of patient’s alliance.Conclusion Countries that have implemented organ transplantation and brain death laws have developed successfulmeasures to improve and support insurance and follow-up information for donors and recipients, however, legislation isstill urgently needed in China. As long as brain death and organ transplant laws are reasonably developed and legislatorsresolve to deal with the difficult issues, then the legislation and its subsequent enforcement will reflect the interests of the people and improve health quality for all.
Objective To summarize and further investigate the initial experience of organ procurement process for organ donation after cardiac death （DCD）. Methods The clinical data，the selected standard，and the organ procurement process of 28 cases of DCD from July 2009 to January 2012 in the liver transplantation center of Guangzhou General Hospital were reviewed and analyzed. Results Twenty-eight cases of DCD all had donated organs successfully. Among these cases，there were 3 cases （10.7%） of the Maastricht Ⅲ， and one case （3.6%） of the Maastricht Ⅳ，and 24 cases （85.7%） of the organ donation after brain death plus cardiac death （DBCD）．Three cases of the Maastricht Ⅲ were practiced the organ procurement process of DCD．One case of the Maastricht Ⅳ was practiced the organ procurement process of DBCD without the extracorporeal membrane oxygenation （ECMO）．Twenty-four cases of DBCD were practiced the organ procurement process of DBCD with the ECMO．The donator warm ischemic time was zero min in DBCD，18 min in Maastricht Ⅳ，and mean 25 min （22-28 min） in MaastrichtⅢ．All the donated organs included 28 livers，40 kidneys，and 2 hearts．And all these organs had been practiced the liver transplantation，the kidney transplantation，and the heart transplantation. Conclusions The organ procurement process for organ DCD includes the DCD process and the DBCD process in China，and the later includes the organ procurement process with the ECMO and without the ECMO．The ECMO could well control the warm ischemia for protecting the donors just without ethics dispute. So，the using of the ECMO for the organ DCD of citizen in China has a very important contribution．
Objective To explore the donor maintenance points of donor donation after brain death （DBD）. Methods From December 2011 to January 2012，two cases of organ DBD in our hospital were performed. After diagnosis of brain death，mechanical ventilation，fluid resuscitation，vasoactive drugs，inotropic drugs，and so on were used，and invasive arterial pressure， central venous pressure，heart rate，blood gas exchange，urine output，electrolyte and acid-base balance，body temperature， hematocrit，albumin level were monitored，the donors vital organ perfusion were successfully kept at acceptable level. Results The vital signs of two cases of DBD donors were stable. The livers，kidneys，and corneas were donated，and the functions were stable and normal. Case one was diagnosed for brain death 6h after ICU admitted，the period from diagnosis to organ procurement was 33h. Case two was diagnosed for brain death 8h after ICU admitted，the period from diagnosis to organ procurement was 31h. All transplanted organs，livers，kidneys，and corneas，were working well after operation. Conclusions Donor maintenance process of DBD is the cornerstone to ensuring successfully organ donation and transplantation，which is important to improve the utilization rate of donated organs，and release the severely shortage of organ.
Objective To explore the protective effect and mechanism of Astragalus polysaccharides (APS) on liver injury in the state of brain death in New Zealand rabbits. Methods Twenty-four New Zealand rabbits were randomly divided into 3 groups (n=8): the blank control group, the brain death group, and the APS group. We obtained blood and liver tissue specimens from rabbits of three groups at 4 h and 8 h after treatment respectively (n=4). The rabbits of blank control group simulated the procedures of anesthesia and surgery of the brain death, without the Foley balloon catheter being pressurized, and maintained anesthesia. The brain death group: brain-dead models were established. The APS group: injection of APS (12 mg/kg) via the femoral vein bolus immediately after anesthesia, brain-dead models were established as same as rabbits of brain death group. The blood and liver tissue samples were taken at 4 h and 8 h after treatment to detect aminotrans-ferase (AST), alanine amino-transferase (ALT) and tumor necrosis factor α (TNF-α), and to observe the change of liver tissue by HE staining and immunohistochemical staining〔expression level of nuclear transcription factor p65 protein (NF-κB p65) could be detected by immunohistochemical staining〕. Results ① ALT and AST. Compare with the blank control group at the same time (4 h and 8 h), levels of ALT and AST in brain death group and APS group were significantly increased (P<0.05), and the levels of ALT and AST in brain death group were higher than those of APS group at each time point (P<0.05). In the same group, compared with 4 h, there was no significant difference in the levels of ALT and AST in blank control group at 8 h (P>0.05); the levels of ALT and AST in brain death group at 8 h were both higher than those of 4 h (P<0.05); the levels of ALT at 8 h in APS group was higher than that of 4 h, but there was no significant difference in the level of AST between 4 h and 8 h (P>0.05). ② TNF-α. Compare with the blank control groups at same time (4 h and 8 h), levels of TNF-α in brain death group and APS group were significantly increased(P<0.05), and level of TNF-α in brain death group was higher than that of APS group at 4 h and 8 h (P<0.05). ③ The HE results. The liver tissue structure of blank control group, brain death group, and APS group at 4 h had no obvious change. The liver tissue structure of brain death group at 8 h showed the evident tissue damage: liver cells showed the balloon samples, disordered arrangement, cytoplasmic loose light dye net-like, and inflammatory cells infiltrated in portal area. The liver tissue structure of APS group at 8 h showed that, liver cells showed mild edema, normal arrangement, and a small amount of inflammatory cells infiltrated in portal area. The liver tissue structure damage of APS group at 8 h was milder than that of brain death group. ④ Immunohistochemical staining results. There was no significant difference in expression levels of NF-κB p65 protein among blank control group, brain death group, and APS group at 4 h (P>0.05). But at 8 h, the expression levels of NF-κB p65 protein in brain death group and APS group were higher than that of blank control group (P<0.05), and the expression level of NF-κB p65 protein in brain death group was higher than that of APS group (P<0.05). The expression levels of NF-κB p65 protein in brain death group and APS group at 8 h was higher than that of 4 h in the same group (P<0.05), but there was no significant difference between 4 h and 8 h in blank control group (P>0.05). Conclusions Brain death will cause liver damage and the injury degree may be related to the continuous time. The damage at 8 h was more serious than that of 4 h. APS has a protective effect on liver of brain-dead rabbits' and its mechanism may be closely related to inhibit TNF-α and NF-κB by diverse ways to reduce the inflammation of the liver injury.
Heart transplantation remains the most effective treatment for patients with end-stage heart failure. Over the past decade, significant advancements have been made in the field of heart transplant surgery. However, the enormous demand from heart failure patients and the severe shortage of available donor hearts continue to be major obstacles to the widespread application of heart transplantation. With the development of donor heart recovery, preservation, and evaluation techniques, the use of extended criteria donors and donation after circulatory death has increased. These technological advancements have expanded the safe ischemic time and geographic range for donor heart procurement, significantly enlarging the donor pool and driving a rapid increase in heart transplant cases. Concurrently, many new techniques have emerged in heart transplant surgery and perioperative management, particularly the rapid advancements in mechanical circulatory support and artificial intelligence, which hold the potential to revolutionize the field. This article reviews and discusses the current status and major surgical advancements in adult heart transplantation in the United States, aiming to provide insights and stimulate ongoing exploration and innovation in this field.