Organ Transplant

New forms of human trafficking are: I. Trafficking and exploitation of slaves. Trafficking human beings is one method of obtaining slaves. Victims are typically recruited through deceit or trickery (such as a false job offer, false migration offer, or false marriage offer), sale by family members, recruitment by former slaves, or outright abduction. II. Traffic flows of workers in Asia, Africa, Eastern Europe and former Soviet Union, Turkey. In the case of trafficking of workers there is the sexual harassment, lack of employment contract, lack of freedom of association and the very low wages. IV. Trafficking of children, eggs, embryos, adoptions, surrogate mothers, children. Child trafficking involves children around the world, both industrialized and developing countries. Children victims of trafficking are forced into prostitution are forced to marry or are illegally adopted. What is deeply troubling, in our era is the use of human bod ies, biological substances, the need created by biomedical techniques, including techniques and procreative. The body is the subject of a genuine desire, first of all by those who are the beneficiaries of the market (intermediate agencies, institutes, clinics, unscrupulous doctors) and those whose applications are exacerbated by technology offerings. V. Women in sex exploitation, construction, heavy work, as children put to work or to beg. Trafficking of women and children is a reality that is both omnipresent and invisible. This invisibility has two origins, deeply rooted: the traditional view of gender inequality makes women's bodies use an object to sexual and reproductive, and the more liberal view that redefines some forms of sexual exploitation, such as prostitution as an occupation, the legitimate sale of "services" sex as a business and rebuilt the body of the woman as a consumer product.

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insuffi- ciency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed coun- tries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not pos- sible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to opti- mise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place,...

Introduction: Renal failure (RF) is a post cardiac transplantation predictor of morbimortality. The combined cardiorenal transplant (CCRTx) in cardiac transplantation (CTx) candidates with chronic renal disease is a therapeutic option. Our aim was to evaluate the CCRTx follow up outcomes in a single Centre. Methods: Between 2/1993 and 12/2014 we performed 442 CTx. Since 2006, 20 patients (p) underwent CCRTx using allografts from the same donor. The inclusion criteria were: RF with CrCl ≤ 40 mil/min or dialysis requirement in CTx candidates. All p received Thymoglobulin and immunosuppression with tacrolimus, mycophenolate mofetil and steroids.Median follow up: 46 months (7-96). Results: Mean age: 58±7 years, 85% were male. Mean Creatinine (Cr): 3,1±2,5 mg/dl and ClCr 27,5+10 mil/min. Three p required dialysis during the pre-transplantation phase and 4 p were under chronic dialysis. Etiologies: cardiomyopathies: coronary 10 p, noncoronary 9 p and re CTx, 1 p; nephropathies: nephroangi...

Objetivo: Analisar os aspectos contextuais do comportamento apresentado pelos pacientes transplantados renais, em sua dimensão imediata e específica, geral e de metacontexto. Método: Estudo exploratório e descritivo, com abordagem qualitativa, tendo o método e técnica da história oral de vida para a apreensão dos relatos, analisados segundo a análise de contexto proposto no referencial teórico de Hinds, Chaves e Cypress. Resultados: A rede foi composta de nove pacientes, entrevistados no período de junho e outubro de 2011. Entre os comportamentos mais relatados, ressalta-se o de negação da doença e tratamento, seguido pelo processo de aceitação e retomada da vida, com duração de tempo variado para ambos. Conclusão: A retomada da vida dos transplantados renais encontrou apoio nos laços familiares e na crença divinal. O melhor entendimento do comportamento apresentado pelos pacientes traz reflexões acerca de melhorias na assistência de enfermagem a esta clientela.

Una enfermedad crónica-degenerativa inevitablemente amenaza las funciones del individuo y de su familia. Ésta tiene que reorganizarse, replantear expectativas y adecuar metas y objetivos ante la situación, tomar decisiones importantes y en ocasiones difíciles; es decir, vive un proceso donde surge como estrategia de afrontamiento la esperanza de una opción a la enfermedad y miedo a lo que ocurra generando expectativas mayores a la realidad hasta que se ajustan o no a las condiciones reales tanto institucionales, económicas y sociales. Palabras Clave: Familia, enfermedad, enfermedad crónica-degenerativa, ajuste. A chronic-degenerative disease inevitably threatens the functions of the individual and his family. The family has to take very important decisions and sometimes they are difficult. The members of the family will have to reorganize, rethink their expectations, goals and objectives to be adapted to the situation. This means they have to live a process which it emerges as a coping strategy based on hope. Family is fear of what happen and that' why they have to generate higher expectations to reality, until they conform or not to the actual institutional, economic and social conditions.

Una enfermedad crónica-degenerativa inevitablemente amenaza las funciones del individuo y de su familia. Ésta tiene que reorganizarse, replantear expectativas y adecuar metas y objetivos ante la situación, tomar decisiones importantes y en ocasiones difíciles; es decir, vive un proceso donde surge como estrategia de afrontamiento la esperanza de una opción a la enfermedad y miedo a lo que ocurra generando expectativas mayores a la realidad hasta que se ajustan o no a las condiciones reales tanto institucionales, económicas y sociales. Palabras Clave: Familia, enfermedad, enfermedad crónica-degenerativa, ajuste. A chronic-degenerative disease inevitably threatens the functions of the individual and his family. The family has to take very important decisions and sometimes they are difficult. The members of the family will have to reorganize, rethink their expectations, goals and objectives to be adapted to the situation. This means they have to live a process which it emerges as a coping strategy based on hope. Family is fear of what happen and that' why they have to generate higher expectations to reality, until they conform or not to the actual institutional, economic and social conditions.

El objetivo de este estudio fue identificar los factores asociados a la disposición hacia la donación de los órganos propios y los de un familiar cercano, de personas adultas de la provincia de Concepción, Chile.Para esto, se aplicó el Cuestionario sobre Conocimientos, Actitudes y Creencias hacia la donación de órganos (instrumento elaborado para esta investigación) a 244 personas, hombres y mujeres mayores de 18 años y pertenecientes a los grupos socioeconómicos bajo y medio. Se realizó un análisis de correspondencia simple encontrando relaciones entre la disposición a donar y la confianza en el proceso de donación y trasplante, el grado de discusión del tema en la familia, los conocimientos sobre la donación y con la religión profesada por los participantes. Se propone la creación de programas de educación orientado a la entrega de información y la invitación a discutir el tema en la familia. Palabras clave: donación de órganos, trasplante de órganos, conocimientos, actitudes, cre...

El objetivo de este estudio fue identificar los factores asociados a la disposición hacia la donación de los órganos propios y los de un familiar cercano, de personas adultas de la provincia de Concepción, Chile.Para esto, se aplicó el Cuestionario sobre Conocimientos, Actitudes y Creencias hacia la donación de órganos (instrumento elaborado para esta investigación) a 244 personas, hombres y mujeres mayores de 18 años y pertenecientes a los grupos socioeconómicos bajo y medio. Se realizó un análisis de correspondencia simple encontrando relaciones entre la disposición a donar y la confianza en el proceso de donación y trasplante, el grado de discusión del tema en la familia, los conocimientos sobre la donación y con la religión profesada por los participantes. Se propone la creación de programas de educación orientado a la entrega de información y la invitación a discutir el tema en la familia. Palabras clave: donación de órganos, trasplante de órganos, conocimientos, actitudes, cre...

Policies for allocating deceased donor kidneys have recently shifted from allocation based on Human Leucocyte Antigen (HLA) tissue matching in the UK and USA. Newer allocation algorithms incorporate waiting time as a primary factor, and in the UK, young adults are also favoured. However, there is little contemporary UK research on the views of stakeholders in the transplant process to inform future allocation policy. This research project aimed to address this issue. Discrete Choice Experiment (DCE) questionnaires were used to establish priorities for kidney transplantation among different stakeholder groups in the UK. Questionnaires were targeted at patients, carers, donors / relatives of deceased donors, and healthcare professionals. Attributes considered included: waiting time; donor-recipient HLA match; whether a recipient had dependents; diseases affecting life expectancy; and diseases affecting quality of life. Responses were obtained from 908 patients (including 98 ethnic minorities); 41 carers; 48 donors / relatives of deceased donors; and 113 healthcare professionals. The patient group demonstrated statistically different preferences for every attribute (i.e. significantly different from zero) so implying that changes in given attributes affected preferences, except when prioritizing those with no rather than moderate diseases affecting quality of life. The attributes valued highly related to waiting time, tissue match, prioritizing those with dependents, and prioritizing those with moderate rather than severe diseases affecting life expectancy. Some preferences differed between healthcare professionals and patients, and ethnic minority and non-ethnic minority patients. Only non-ethnic minority patients and healthcare professionals clearly prioritized those with better tissue matches. Our econometric results are broadly supportive of the 2006 shift in UK transplant policy which emphasized prioritizing the young and long waiters. However, our findings suggest the need for a further review in the light of observed differences in preferences amongst ethnic minorities, and also because those with dependents may be a further priority. This was not a clinical trial and so it did not require clinical trial registration. Ethical approval was obtained from Warwickshire Local Research Ethics Committee (reference number 05 / Q2803 / 86).

Objectives Organ procurement coordinators (OPCs) play a pivotal role in navigating end-of-life and second-birth narratives by securing familial consent for solid organ donation. Given the low rates of cadaveric organ donation in Türkiye and worldwide, OPCs are essential in advocating for and facilitating these donations. This study explores the reasons for refusal that OPCs have encountered during the familial consent process. Design We gathered the data through semistructured interviews with 30 OPCs. Thematic analysis was used to identify and analyse key themes, with a specific focus on cultural, religious, spiritual and folkloric barriers contributing to the low rates of cadaveric organ donation in Türkiye. Setting Hospitals and organ transplant centres operating under the jurisdiction of the Ankara Regional Coordination Centre in Türkiye. Participants Participants were recruited using a purposeful random sampling strategy to enhance credibility and reduce bias. Eligible informants included OPCs with at least 2 years of experience in the role. Among the 30 participants, 18 were based in central organ transplant centres associated with Training and Research Hospitals in Ankara, and 12 were from peripheral city hospitals. Results Coordinators identified five main barriers that hinder their ability to secure familial consent for cadaveric organ donation: (1) religion, (2) concerns about the wishes of the deceased, (3) desire to choose recipients, (4) familial dynamics and (5) folklore. Each category was further contextualised through subcategories derived from the frequency and nuances of recurring themes. Conclusion OPCs face significant challenges in promoting cadaveric organ donations due to cultural barriers. Their experiences underscore the need for culturally competent approaches in organ donation campaigns and the importance of supporting coordinators in their roles. Enhanced cultural understanding and targeted interventions could improve cadaveric organ donation rates.

In postmenopausal osteoporosis, the administration of alfacalcidol to women resulted in an increase in trabecular bone mineral density (BMD), prevention of cortical bone loss, and a significant reduction in the incidence of further vertebral fractures. There is now robust evidence that alfacalcidol may be particularly active in conditions characterized by an increased rate of bone loss. Alfacalcidol 1 microg/day fully prevented vertebral bone loss over 3 years in women after the first year of menopause. In a large cohort of individuals starting treatment with high dose corticosteroid (CS, 46.6 mg equivalent prednisolone per day), the spinal bone loss observed in untreated patients was fully prevented by administration of 1 microg/day alfacalcidol. In patients with established CS-induced osteoporosis, with or without prevalent vertebral fractures, 1 microg/day of alfacalcidol, given for 3 years, increased lumbar spine density, reduced back pain, and showed a significant reduction in ...

Introduction: Renal failure (RF) is a post cardiac transplantation predictor of morbimortality. The combined cardiorenal transplant (CCRTx) in cardiac transplantation (CTx) candidates with chronic renal disease is a therapeutic option. Our aim was to evaluate the CCRTx follow up outcomes in a single Centre. Methods: Between 2/1993 and 12/2014 we performed 442 CTx. Since 2006, 20 patients (p) underwent CCRTx using allografts from the same donor. The inclusion criteria were: RF with CrCl ≤ 40 mil/min or dialysis requirement in CTx candidates. All p received Thymoglobulin and immunosuppression with tacrolimus, mycophenolate mofetil and steroids.Median follow up: 46 months (7-96). Results: Mean age: 58±7 years, 85% were male. Mean Creatinine (Cr): 3,1±2,5 mg/dl and ClCr 27,5+10 mil/min. Three p required dialysis during the pre-transplantation phase and 4 p were under chronic dialysis. Etiologies: cardiomyopathies: coronary 10 p, noncoronary 9 p and re CTx, 1 p; nephropathies: nephroangi...

With the increasing demand for organs and the shortage of organ donations, more lives are being lost every day. Governments and national health authorities are, consequently, exploring more effective ways to increase organ donation rates, both from the living and the dead. Regarding cadaveric organ donations, the increase in organ donation rates in countries that have shifted from the opt-in (or explicit consent) system to the opt-out (or presumed consent) system has been very encouraging. As a result, some other countries still operating under the opt-in system are contemplating making the same move. In the Philippines, there are bills filed in the country’s legislative bodies proposing the shift from its current opt-in system to an opt-out system. This essay aims to assess the viability of this proposal in terms of its practical and moral soundness. It first examines the strengths and weaknesses of alternative organ donation systems in general based on the experiences of other countries. In light of the insights gathered from this examination, it then assesses the justifications advanced by proponents of the said proposal. On the whole, the paper shows that this proposal can only be practically and morally justified if the necessary supporting mechanisms are first put in place.

Organ donation cannot be mandatory in the view of the current system of organ donation in The United States due to several circumstances, and factors would cause failing the system if it was adopted.  Comparing with some European countries, which adopted the presumed consent in its organs donation system, The United States has its own special system. And the first obstacle is the freedom of practicing religion.  In this paper, when the mandatory term indicated, it means the presumed consent. And my point is that there is no doubt that the current organs donation system in The United States is not working as it should be…  , and what I am saying is that the change from organ donation system, built on a volunteering option to a  mandatory rules would not be possible, or will say raising the system to the mandatory level will not be possible, which mean the presumed consent system will not be possible.

BACKGROUND: Pneumocystis jiroveci pneumonia in HIV-negative immunocompromised patients is associated with high mortality rates. Although trimethoprim-sulfamethoxazole (TMP-SMX) provides a very effective prophylaxis, pneumocystosis still occurs and may even be emerging, due to sub-optimal characterization of patients most at risk, hence precluding targeted prophylaxis. METHODS: We retrospectively analyzed all cases of documented pneumocystosis in HIVnegative patients admitted in our institution, a referral center in the area, from January 1990 to June 2010, and extracted data on their underlying condition(s). To estimate incidence rates within each condition, we estimated the number of patients followed-up in our area for each condition, by measuring the number of patients admitted with the corresponding international classification diagnostic code, through the national hospital discharge database (PMSI). RESULTS: From 1990 to 2010, 293 cases of pneumocystosis were documented, of whom 154 (52.6%) tested negative for HIV. The main underlying conditions were hematological malignancies (32.5%), solid tumors (18.2%), inflammatory diseases (14.9%), solid organ transplant (12.3%), and vasculitis (9.7%). Estimated incidence rates could be ranked in three categories: i) high risk (incidence rates > 45 cases per 100,000 patient-year): polyarteritis nodosa, granulomatosis with polyangiitis, polymyositis/dermatopolymyositis, acute leukemia, chronic lymphocytic leukemia, and non-Hodgkin lymphoma; ii) intermediate risk (25-45 cases per 100,000 patient-year): Waldenström macroglobulinemia, multiple myeloma, and central nervous system cancer; and iii) low risk (< 25 cases per 100,000 patient-year): other solid tumors, inflammatory diseases, and Hodgkin lymphoma. CONCLUSIONS: These estimates may be used as a guide to better target pneumocystosis prophylaxis in the groups most at risk.

The anthropological literature on transplant, though theoretically and ethnographically rich, does not address religion in any substantial way. And while bio-ethical considerations of transplant regularly address religion, treatments are generally circumscribed to a list of various faith traditions and their stance toward organ transplant. Such a presentation reduces “religion” to the world’s recognized faith traditions, “religious actors” to the official spokespersons of these traditions, and “religious belief” to moral injunctions. The objective of the thesis was to illuminate the prominent place of religion in the lived experience of transplant recipients and donors, in the public policy and professional activities of transplant officials, and in the transplant discourses of North America

Abstract: Introduction: The demand for organs currently far exceeds supply. Understanding individuals’ motivations for deciding whether to donate an organ from a deceased relative would guide outreach efforts.Methods: Focus group participants and literature were used to identify attributes to create a discrete choice experiment (DCE). Participants (N=86 ages 18 to 31 [mean=20.5]) were presented with 16 choices sets and asked to choose whether they would agree to donate a deceased relative’s organs. The choices contained attributes of the recipient (age, kidney’s lifespan, reason for failure, impact if not transplanted), the deceased donor (donor’s wishes and relationship to decision maker), and monetary incentives (amount, payer, payee). Conditional logit analysis was used to estimate the model, and latent class analysis identified two distinct groups of respondents.Results: The results suggest a strong preference for donating organs, with the age of the recipient, reason for recipi...

Background: Organ donation and transplantation have become the ideal treatment for different types of end-stage organ failure. A significant problem, though, is the scarcity of available organs for transplantation. Public knowledge, attitude, and practice towards organ donation and transplantation are crucial determinants that should be addressed for the success of the donation process. Aim: This study aims to assess Al-Baha University students' knowledge, attitudes, and practices regarding organ transplantation and donation. Methods: This cross-sectional study enrolled 1065 students from Al-Baha University. An electronic questionnaire was distributed via their university emails. The questionnaire includes two sections: one for collecting sociodemographic information and the other for evaluating students' knowledge, attitudes, and practices about organ donation and transplantation. Results: Participants have a poor level of positive practice and attitude (<50%), yet their knowledge level is average (50e75%). As compared with females, males reported better knowledge scores, while higher positive practice scores (0.3261 ± 0.73305) were reported among females (0.4952 ± 0.86979). College and knowledge level are significantly correlated (P ¼ 0.005), students at medical colleges scored higher on knowledge assessments. There is no statistically significant difference in attitude based on sex, age, and college. A highly significant correlation between knowledge and attitude (P ¼ 0.000), together with attitude and positive practice was detected (P ¼ 0.000). Students have an average level of knowledge and a poor level of positive practice and attitude. As attitude and positive practice are significantly correlated with knowledge, effective education initiatives are crucial to enhancing students' awareness, as students are considered the changing agents in their communities.

Resumen: El documento analiza el efecto de la edad en la tasa de supervivencia después de un trasplante cardíaco. Primero, se introduce el tema de los trasplantes de órganos y su importancia para prolongar la vida. Luego, se presenta un marco teórico sobre los trasplantes cardíacos, el uso de ciclosporina para prevenir el rechazo y el impacto del envejecimiento. Se plantea la hipótesis de que los pacientes mayores de 60 años tendrán menor tasa de supervivencia después del trasplante. Se utiliza una base de datos del Departamento de Salud y Servicios Humanos de Estados Unidos para analizar la tasa de supervivencia en diferentes rangos de edad. Los resultados muestran una disminución en la tasa de supervivencia a mayor edad, pero el análisis estadístico indica que la edad es independiente del porcentaje de supervivencia. Se discute que, si bien la edad no es un factor directo, los adultos mayores tienen mayor riesgo de comorbilidades que afectan su supervivencia. Se concluye que, aunque la edad no es dependiente de la tasa de supervivencia, los pacientes de edad media (11-60 años) tienen mejores posibilidades de resistir el trasplante debido a sus capacidades físicas. Se reconocen limitaciones como la falta de bases de datos adicionales para contrastar los resultados. Abstract: The document analyzes the effect of age on survival rates after a heart transplant. It first introduces the topic of organ transplants and their importance in prolonging life. Then, it presents a theoretical framework on heart transplants, the use of cyclosporine to prevent rejection, and the impact of aging. It hypothesizes that patients over 60 years old will have lower survival rates after the transplant. A database from the U.S. Department of Health and Human Services is used to analyze survival rates across different age ranges. The results show a decrease in survival rates with increasing age, but the statistical analysis indicates that age is independent of the survival percentage. The discussion notes that, although age is not a direct factor, older adults have a higher risk of comorbidities that affect their survival. The conclusion is that, although age is not dependent on survival rates, middle-aged patients (11-60 years) have better chances of withstanding the transplant due to their physical abilities. Limitations are acknowledged, such as the lack of additional databases to contrast the results.

Cuba realiza trasplante renal desde hace 34 a??os, es uno de los primeros pa??ses de nuestro continente en esta experiencia. Este tipo de trasplante es el pionero en el mundo, y nosotros hemos logrado incrementar la tasa de realizaci??n por encima de 17/1 000 000 ...

Una enfermedad crónica-degenerativa inevitablemente amenaza las funciones del individuo y de su familia. Ésta tiene que reorganizarse, replantear expectativas y adecuar metas y objetivos ante la situación, tomar decisiones importantes y en ocasiones difíciles; es decir, vive un proceso donde surge como estrategia de afrontamiento la esperanza de una opción a la enfermedad y miedo a lo que ocurra generando expectativas mayores a la realidad hasta que se ajustan o no a las condiciones reales tanto institucionales, económicas y sociales. Palabras Clave: Familia, enfermedad, enfermedad crónica-degenerativa, ajuste. A chronic-degenerative disease inevitably threatens the functions of the individual and his family. The family has to take very important decisions and sometimes they are difficult. The members of the family will have to reorganize, rethink their expectations, goals and objectives to be adapted to the situation. This means they have to live a process which it emerges as a coping strategy based on hope. Family is fear of what happen and that' why they have to generate higher expectations to reality, until they conform or not to the actual institutional, economic and social conditions.

The lack of adequate financial coverage, education, and the organization has been the main limiting factor for the development of transplantation in Latin America. As occurred worldwide, the number of patients on liver waiting lists in Latin America grows disproportionately compared to the number of liver transplantations (LTs) performed. Although many law modifications have been made in the last year, most countries lack social awareness about the importance of donation and the irreversibility of brain death. The mechanisms and norms for organ procurement and infrastructure development, capable of supporting this high demand, are still in slow progress in most countries. Access to LT in the region is very heterogeneous. While some countries have no active LT programs so far, others are an international model of a public transplantation system (Brazil) or a national information system (Argentina). While some countries have only a few LT centers, others have too many LT centers performing an inadequate low number of LTs. Disparity to access transplantation remains the major challenge in the region. Cultural and educational efforts have to be accompanied by transparent public policies that will likely increase organ donation and activity in transplantation. The purpose of this article is to review the trends and current activity in LT within Latin America, based on prior publications and the information available in each country of the region.

As the field of Vascular Composite Allotransplantation (VCA) grows, demand for VCA donations will increase. The public should be made aware of this treatment option to support patients&#39; informed decision‐making and authorization for deceased donation. We assessed the availability and quality of existing VCA public education materials from organ procurement organizations (OPOs), transplant centers, the Organ Procurement and Transplant Network, Veterans Affairs, and the Department of Defense. A content analysis was performed to identify topics covered and important gaps. In total, 1314 public education materials were analyzed, including OPO Facebook posts (61.6%), OPO Twitter posts (29.9%), websites (6.4%), and written documents (eg, fact sheets, research reports) (2.1%). Upper extremity (34.7%) and face (34.5%) transplants were more commonly covered than reproductive (6.4%) or other VCA types (2.8%). Most materials (76.6%) referenced a specific VCA story. However, few materials d...

Background. The Kidney Donor Profile Index (KDPI) was created in 2014 to measure the likelihood of graft failure for a given donor compared with the median kidney donor from the previous year. This scale is based on the American population only. Mexico is one of the countries with greater incidence of chronic kidney disease, a long waiting list, and not enough kidney donors with KDPI smaller than 80%. This has led transplant centers to take kidney grafts with a higher KDPI. Objective. To investigate the agreement between the KDPI and histologic scores (preimplantation renal biopsy) and assess the relationship between the Kidney Donor Risk Index (KDRI), KDPI, and the histologic score on graft survival. Methods. A retrospective, analytical, transversal study was performed. Data were collected from patients with kidney grafts from deceased donors from January 1, 2011, to June 30, 2019, at our hospital. The variables analyzed were age, weight, height, sex, race and/or ethnicity, history of hypertension or diabetes, cause of death, serum creatinine, KDPI, KDRI, and biopsy result from each graft prior to transplant. Results. The total population was 59 deceased kidney donors. For our patients, a high KDPI did not increase mortality rate; it provided greater benefit than staying on dialysis. Conclusions. We conclude that the use of KDRI should only be considered to assess the degree of fibrosis, not to rule out a transplantable kidney, in addition to the consistent demonstration that high KDPI kidneys (even 91%-100%) confer greater survival benefits to patients regarding the waiting list.

Background: Epithelioid haemangioendothelioma (EHE) is an ultra-rare malignant vascular tumour with a prevalence of 1 per 1,000,000. It is typically molecularly characterised by a WWTR1::CAMTA1 gene fusion in approximately 90% of cases, or a YAP1::TFE3 gene fusion in approximately 10% of cases. EHE cases are typically refractory to therapies, and no anticancer agents are reimbursed for EHE in Australia. Methods: We report a cohort of nine EHE cases with comprehensive histologic and molecular profiling from the Walter and Eliza Hall Institute of Medical Research Stafford Fox Rare Cancer Program (WEHI-SFRCP) collated via nation-wide referral to the Australian Rare Cancer (ARC) Portal. The diagnoses of EHE were confirmed by histopathological and immunohistochemical (IHC) examination. Molecular profiling was performed using the TruSight Oncology 500 assay, the TruSight RNA fusion panel, whole genome sequencing (WGS), or whole exome sequencing (WES). Results: Molecular analysis of RNA, D...

Introduction: Renal failure (RF) is a post cardiac transplantation predictor of morbimortality. The combined cardiorenal transplant (CCRTx) in cardiac transplantation (CTx) candidates with chronic renal disease is a therapeutic option. Our aim was to evaluate the CCRTx follow up outcomes in a single Centre. Methods: Between 2/1993 and 12/2014 we performed 442 CTx. Since 2006, 20 patients (p) underwent CCRTx using allografts from the same donor. The inclusion criteria were: RF with CrCl ≤ 40 mil/min or dialysis requirement in CTx candidates. All p received Thymoglobulin and immunosuppression with tacrolimus, mycophenolate mofetil and steroids.Median follow up: 46 months (7-96). Results: Mean age: 58±7 years, 85% were male. Mean Creatinine (Cr): 3,1±2,5 mg/dl and ClCr 27,5+10 mil/min. Three p required dialysis during the pre-transplantation phase and 4 p were under chronic dialysis. Etiologies: cardiomyopathies: coronary 10 p, noncoronary 9 p and re CTx, 1 p; nephropathies: nephroangi...

Psychiatric evaluation of organ donor candidates in a university hospital and their anxiety, depression and quality of life levels Objective: The aim of this study was to conduct a psychiatric evaluation of organ donor candidates and to investigate their levels of anxiety, depression and quality of life. Material and Methods: This study was performed between May 2015 and February 2016. It included 102 volunteers. The socio-demographic Data Collection Form, DSM-IV Clinical Interview Form-Clinical Version Structured for Axis Diagnoses (SCID-I/CV), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Symptom Checklist (SCL-90-R), and SF-36 Quality of Life Survey (SF-36) were administered to the patients. Results: The average age of the applicants was found to be 41.64±12.02, 42.2% (n=43) being male and 57.8% (n=59) being female. When it comes to the degree of affinity between potential donors and recipients, 57.8% (n=59) were first-degree relatives, 19.6% (n=20) were spouses, and 22.5% (n=23) were other relatives and/or close relations. By dividing donor candidates into groups by the degree of their affinity to recipients, there were statistically significant differences revealed between BDI, BAI and SCL-90-R total scores and interpersonal sensitivity subscale scores. Conclusion: As compared to the global average, the number of living donors is higher than cadaver donors; and donor candidates mostly comprise spouses and first-degree relatives. Therefore, family members and first-degree relatives who are affected directly or indirectly by the transplant process are exposed to social and psychological effects more as the donor candidates/donors. It is of crucial importance to evaluate the psychosocial states of donors, in addition to recipients, in order to manage the long-lasting transplant process, a treatment-and care-demanding one in a more appropriate way.

Pseudomyogenic hemangioendothelioma (PMH) is a rare, mostly indolent vascular tumor. Extensive cases are treated with amputation as chemotherapy seems to be ineffective. Recently, promising results were published using mammalian target of rapamycin (mTOR) inhibitors in tumors of vascular origin. Here, we present a case of a child with advanced PMH relapsing after surgery and chemotherapy. Sirolimus achieved significant clinical improvement and stabilization of the lesions without any remarkable toxicity. This case contributes to the growing evidence regarding the efficacy of mTOR inhibitors, such as sirolimus, in multifocal PMH.

Aims: Kaposi's sarcoma (KS) is a lymphoangioproliferative multicentric disorder. Among its four distinct clinical variants, iatrogenic KS (iKS) typically affects patients who have received immunosuppressant regimens for organ transplants, proliferative disorders, or immune-mediated diseases. The aim of the current study was to examine the characteristics of a cohort of patients with iKS, evaluating the differences in terms of epidemiological and clinical features, management and outcomes between organ transplant recipients (OTR) and patients immunosuppressed for other medical conditions. Materials and methods: This retrospective study included, out of 1389 KS patients, 143 patients suffering from iKS being followed in an Italian tertiary care centre from November 1995 to December 2016. Demographic data, clinical features, previous immunosuppressive therapies, management, and outcomes were recorded for each patient. Results: We detected iKS in 10.3% of the analysed KS population. The mean age was 71.9 years in non-OTR versus 51.4 years in OTR (P ¼ 0.04). Staging at diagnosis showed a more severe disease in non-OTR than in OTR, with stage IA observed in 33.3% of OTR versus 11.8% of non-OTR (P < 0.001) and stage IVB in 29.1% of non-OTR versus 12.1% of OTR (P ¼ 0.001). Corticosteroids represented the most frequent immunosuppressive drugs at diagnosis in both groups, in conjunction with cyclosporine A in OTR. Immunosuppressant reduction or withdrawal was carried out in 93.9% of OTR versus 63.6% of non-OTR (P < 0.001). Conclusions: As corticosteroids and cyclosporine A are the most common iKS-inducing drugs, their reduction or withdrawal, wherever possible, is needed. Differences in disease severity at presentation between OTR and non-OTR may interfere with the choice of management strategy and the consequent outcome.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all individual participants included in the study.

The paper describes 20 years of the thriving evolution of the organ donation system in Slovenia. Even before the turn of the century, Slovenia was a pioneering country in SouthEast Europe in terms of the organizational, legislative, medical, and ethical development of donor and transplantation medicine. Real progress came in the year 2000 when the national donation and transplant competent organization the Slovenija-transplant (ST) institute was established, modern national legislation was introduced, and the country met the demanding entrance requirements to join Eurotransplant (ET), an international foundation for organ and tissue exchanges. Joining the ET led to improvements in numbers of organs procured from deceased donors, allowed better transplant treatment options for Slovenian patients (especially urgent, hyper sensibilized, etc.), reduced patient waiting lists, while the larger 'pool' of patients meant that a suitable match could be found for procured organs. Over the 20 years of deceased donation development, priorities have included assuring the quality, safety, and traceability of human organs, tissues, and cells within an efficient, transparent and ethical transplant system. Great attention has always been placed on frequent, open, transparent, and high-quality communication with the public. Entailing a retrospective study, the article presents analysis of key figures and quality indicators of the Slovenian deceased donation program for the period 2000-2019. Slovenia has stood out for its rate of consent for deceased donation (the 20-year average exceeds 75%), been a world leader in the number of heart transplants per million population (at around 11 heart transplants pmp), and has a consistent deceased donor rate (around 20-22 deceased donors pmp). In the challenging pandemic year of 2020, Slovenia once more demonstrated its quality and professionalism. It was one of the countries that best adapted to the crisis. With regular videoconferences on a daily/weekly basis that included professionals and the frequent alteration of safety protocols, the national deceased and transplantation programs were able to remain active and without drops in numbers. The quality of organs and safety for patients was not under threat. Statistics for 2020 show that even more deceased donors and transplantations were performed than in 2019. The article provides an example of good practice of adaptation of the world renowned "Spanish donation model" to suit a specific national context. The findings are useful and transferable to clinical settings in other smaller countries that still need to establish national organ and tissue donation programs. Unfortunately, in many countries around the world (even in Europe), transplant treatment is neither available nor accessible to many patients in need.

BackgroundThis observational, retrospective effort across Europe, US, Australia, and Asia aimed to assess the activity of systemic therapies in EHE, an ultra‐rare sarcoma, marked by WWTR1‐CAMTA1 or YAP1‐TFE3 fusions.MethodsTwenty sarcoma reference centres contributed data. Patients with advanced EHE diagnosed from 2000 onwards and treated with systemic therapies, were selected. Local pathologic review and molecular confirmation were required. Radiological response was retrospectively assessed by local investigators according to RECIST. Progression free survival (PFS) and overall survival (OS) were estimated by Kaplan‐Meier method.ResultsOverall, 73 patients were included; 21 had more than one treatment. Thirty‐three patients received anthracyclines regimens, achieving 1 (3%) partial response (PR), 25 (76%) stable disease (SD), 7 (21%) progressive disease (PD). The median (m‐) PFS and m‐OS were 5.5 and 14.3 months respectively. Eleven patients received paclitaxel, achieving 1 (9%) PR...

Introducción: en Uruguay funciona desde el año 2003 un programa de trasplante pulmonar (TP) mediante un convenio binacional con la República Argentina, con Fundación Favaloro, centro regional de referencia. Objetivos: describir los resultados del programa y herramientas en curso para mejorar la procuración pulmonar en Uruguay. Material y método: estudio descriptivo, retrospectivo, entre 2003 y 2017. Recopilación de datos del registro electrónico y análisis mediante SPSS. Resultados: ingresaron a lista 70 pacientes, 27 fueron trasplantados, 95% se reinsertaron a actividades sociales o laborales. Las etiologías fueron enfisema (33%), fibrosis quística (26%) y fibrosis pulmonar idiopática (11%). Las complicaciones más frecuentes fueron infecciones respiratorias y alteraciones de la vía aérea. La mortalidad postrasplante es 34% y la supervivencia mediana condicional supera los ocho años. La elevada mortalidad en lista (32%) impulsó el establecimiento de nuevas estrategias de procuración pulmonar. Destacamos: seguimiento longitudinal de pacientes, modificación de umbral de convocatoria, realización de maniobras de reclutamiento alveolar, realización sistemática de fibrobroncoscopía; minimización de tiempos de traslado y entrenamiento de equipo quirúrgico uruguayo para ablación. La procuración pulmonar pasó de 0 por millón de población (pmp) en 2014 y 2015 a 1,8 pmp en 2017. Conclusiones: el Programa Uruguayo de Trasplante Pulmonar ha tenido importantes avances. Los últimos dos años han sido claves para el crecimiento de la procuración pulmonar. Los resultados, la sobrevida y la morbimortalidad son comparables a los descritos internacionalmente. Las perspectivas a futuro serán consolidar el programa en un centro de referencia y realización de ablación e implante en nuestro territorio.