•Poltransplant's standpoint regarding the use of organs, tissues, and cells other than hematopoietic cells for the purpose of grafting in connection with SARS-CoV-2 infections is ...discussed.•Epidemiologic reports concerning SARS-CoV-2 infections, which are responsible for the development of COVID-19, including prevention, treatment options, and mortality, are discussed.•Legal regulations regarding the issues of the COVID-19 pandemic are presented.•Experience regarding the risks and benefits of transplant therapies, including the fact that organ grafting is a life-saving procedure, is discussed.•Knowledge on the risk of infection transmission from a graft donor to the recipient and the possibility of infection in a recipient is discussed.
In this article, we present the standpoint and recommendations of Poltransplant on the use of organs, tissues, and cells other than hematopoietic cells for transplant in connection with SARS-CoV-2 infections (January 15, 2021).
In 2010 Poltransplant organized a national network of donor hospital transplant coordinators involved in the recruitment of potential deceased organ donors. One of the employed coordinators’ tasks is ...monitoring donation potential at hospitals and reporting their results with the use of a tele-information tool www.koordynator.net.
The aim of our study was to evaluate the organ donation potential at hospitals in 2018 based on the analysis of reports and on the comparison of these results with organ donation indicators elaborated within the European Commission project entitled Improving the Knowledge and Practices in Organ Donation (DOPKI).
Reports concerning deaths were applied to a retrospective analysis regarding a possibility to diagnose deaths according to neurologic criteria and to detect possible donations. In total, 1214 reports from 116 hospitals were delivered to the tele-information system during 2018. The analysis was made based on 840 full monthly reports from 70 hospitals. Numbers and indicators connected to the organ donation potential, both in the hospital and the intensive care unit (ICU) scales, have been calculated: numbers of beds and admissions, total number of deaths, deaths due to reasons frequently leading to death according to neurologic criteria, number of brain death diagnoses, and number of organ donations.
In the scales of hospital and ICU the studied indices showed the following: 1. distinctly lower ratios related to brain death determination in the total number of beds, admissions, deaths, and deaths with selected International Classification of Diseases and Related Health Problems (ICD) codes in comparison with DOPKI results and 2. distinctly higher ratio of donations in the total number of brain deaths confirmed (69%) in comparison with DOPKI (42%).
Based on obtained data from respective hospitals, the analysis showed the following in comparison with data coming from international European study (DOPKI): 1. low frequency of brain death determination procedures in the total number of deaths in Polish hospitals and ICUs, probably also in cases where such mechanism of death has occurred (the discrepancy may reach 1974 cases per year) and 2. high percentage of donations in the total number of brain-dead persons (conversion index), which may be caused by successful authorization of donation and acceptance of risky donors and organs by transplant teams but (what is more probable) may be explained by the ICUs’ habit that procedures of brain death protocol is implemented only in cases when donation is expected.
•The program is aimed at monitoring organ donation potential and reporting all deaths in intensive care units at hospitals in which donation coordinators were employed to Poltransplant and to the managing board of medicinal entities.•The aim of our study was to evaluate the organ donation potential at Polish hospitals in 2018 based on the analysis of reports and the comparison of gathered results with the indices of organ donation prepared within the European Commission project known under Improving the Knowledge and Practices in Organ Donation.•Based on obtained data from respective hospitals, the analysis of deaths at intensive care units demonstrated a difference between the number of deaths due to reasons frequently leading to death according to neurologic criteria and the number of reliable cerebral death certifications.
Summary
Donation after circulatory death (DCD) has become an accepted practice in many countries and remains a focus of intense interest in the transplant community. The present study is aimed at ...providing a description of the current situation of DCD in European countries. Specific questionnaires were developed to compile information on DCD practices, activities and post‐transplant outcomes. Thirty‐five countries completed the survey. DCD is practiced in 18 countries: eight have both controlled DCD (cDCD) and uncontrolled DCD (uDCD) programs, 4 only cDCD and 6 only uDCD. All these countries have legally binding and/or nonbinding texts to regulate the practice of DCD. The no‐touch period ranges from 5 to 30 min. There are variations in ante and post mortem interventions used for the practice of cDCD. During 2008–2016, the highest DCD activity was described in the United Kingdom, Spain, Russia, the Netherlands, Belgium and France. Data on post‐transplant outcomes of patients who receive DCD donor kidneys show better results with grafts obtained from cDCD versus uDCD donors. In conclusion, DCD is becoming increasingly accepted and performed in Europe, importantly contributing to the number of organs available and providing acceptable post‐transplantation outcomes.
Organ, tissue and cell procurement from deceased donors for transplantation requires consent and authorization, documented donor's positive acceptance, or lack of objection to donation expressed ...while alive. It also requires the fulfillment of other legal conditions required by the law, such as person's legal abilities to act in this field or to obtain approval for donation. Consent to and authorization of donation from deceased donors requires regulations on national level. Poland developed an opting-out policy since 1996, when The Central Register of Objections (CRO) was introduced. The purpose of this article is a formal analysis of all submitted objections and objection withdrawals managed by the CRO since the introduction of the registry until the end of 2020.
All data collected by the CRO during 25 years of service was subject of analysis. The objections and withdrawals of objections are summarized in the tables, along with the age, sex and place of residence of registered person.
By December 2020, a total 37,728 records were registered, including 37,392 registered objections and 336 registered withdrawals of objections; this means that 0.09% of the country's population expressed objection to deceased donation.
The CRO is an indispensable option in a country with opt-out system as a part of deceased donation authorization protocol. Number of registered objections is extremely low, in practice, this leads to a situation where the will of the deceased most often is obtained from the family.
Kidney allocation policy in Poland is strictly patient oriented. Kidneys are transplanted by the same center that made procurement. Sometimes kidneys are transferred for transplantation to another ...center due to medical or logistic reasons or according to allocation rules.
The aim of the study was to compare early graft and recipient survival rates in cases of kidneys exported for transplantation to another center and in cases of kidneys transplanted typically.
Data came from national transplant registry. Kidney transplants from the years 2008 to 2017 were divided into several groups. One-year graft and patient survival rates were calculated for each group, and statistical differences were cross-calculated between groups.
Groups were compared by using the χ2 test. Statistical analysis showed significantly lower graft and recipient survival rates: in the group of kidney transplantations performed in another transplant centers vs group of kidneys not transferred, where kidney transplantations were performed in a regional transplant center (P = .005 and = .02); and in the group of kidneys transferred due to logistic reason and allocation rules vs group of kidneys not transferred, where kidney transplantations were performed in regional transplant center (P = .01 and = .04).
Early results of kidneys procured and transplanted by the same regional transplant center are significantly better than kidneys that have been transferred for transplantation to another center, but this result concerns only the subgroup of kidneys shifted due to logistic or allocation reasons. Early results of kidneys discarded by a regional team due to medical reasons and transplanted by another team are not different from results of transplantations performed by the same center that made the procurement.
•Kidney allocation policy in Poland is based on one national waiting list and is strictly patient oriented.•Kidneys are transplanted by the same center that made procurement. Sometimes, kidneys are transferred for transplantation to another center due to medical or logistic reasons or according to allocation rules•Every year in Poland more than 5% of procured kidneys are not transplanted.
The coronavirus disease 2019 (COVID-19) pandemic, due to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which began in March 2020, affected organ donor acceptance and ...rates of heart, lung, kidney, and liver transplants worldwide. According to data reported to POLTRANSPLANT, the number of solid organ transplants decreased by over 35% and the number of patients enlisted de novo for organ transplantation was reduced to 70% of its pre-COVID-19 volume in Poland. Most transplant centers in Western Europe and the USA have also drastically reduced their activity when compared to the pre-pandemic era. Areas of high SARS-CoV-2 infection incidence, like Italy, Spain, and France, were most affected. Significant decreases in organ donation and number of transplant procedures and increase in waitlist deaths have been noted due to overload of the healthcare system as well as uncertainty of donor SARS-CoV-2 status. Intensive care unit bed shortages and less intensive care resources available for donor management are major factors limiting access to organ procurement. The impact of the COVID-19 outbreak on transplant activities was not so adverse in Asia, as a result of a strategy based on experience gained during a previous SARS pandemic. This review aims to compare the effects of the COVID-19 pandemic on solid organ transplantation during 2020 in Poland with countries in Western Europe, North America, and Asia.
•Long-term complication rates are the same in younger and older kidney recipients.•Five-year serum creatinine occurrence is more frequent in older kidney recipients.•Death-censored kidney-graft ...survival is similar in younger and older recipients.•Early surgical complications lower rates of kidney-graft survival among older individuals.•Early infections after kidney transplant lower rates of survival among younger patients.
Long-term results of kidney transplant (KTx) in older patients may differ from younger recipients owing to increased cardiovascular comorbidities. The study aimed to analyze surgical and nonsurgical complications that develop in the long-term follow-up period after KTx, and factors that influence results of KTx in recipients aged 60 years and older (≥60) compared with younger recipients (<60).
One hundred seventy-five patients aged ≥60 years and 175 patients aged <60 years who received a kidney graft from the same deceased donor were enrolled in the study. In the long-term follow-up period (3 months to 5 years after KTx) the incidence of surgical and nonsurgical complications, as well as patient and kidney graft survival, were compared. Additionally, the influence of early complications on patients and kidney graft survival was assessed.
There were no differences between recipients aged ≥60 years compared with recipients aged <60 years in occurrence of surgical complications (graft artery stenosis: 0.6% vs 2.3%; ureter stenosis: 3.4% vs 1.1%; lymphocele: 6.9% vs 3.4%) and nonsurgical complications (urinary tract infection: 19.4% vs 23.4%; pneumonia: 8.6% vs 8.6%; cytomegalovirus infection: 6.3% vs 8%; new-onset diabetes after transplant: 16.6% vs 17.1%; cancer incidence: 5.7% vs 4.6%; acute rejection episode: 13.1% vs 17.1%). Five-year recipient survival was lower in a group of patients aged ≥60 years (death, 15.4% vs 8%; death with functioning graft, 12% vs 5.1%).
The incidence of surgical and nonsurgical complications, as well as kidney-graft survival, in recipients aged ≥60 years in a 5-year follow-up period is comparable to younger recipients aged <60 years.
In the pandemic year 2020, 634 allogeneic hematopoietic stem-cell (HSC) transplants were performed in Poland, including fully matched and haploidentical family donors (n = 248) as well as unrelated ...donors transplantation (n = 386). In 48 recipients (7.6%) for allogeneic transplantation, hematopoietic bone marrow cells were transplanted, and in 586 recipients (92.4%), peripheral blood hematopoietic cells. The effect of the pandemic was noticeable but not disastrous—the number of HSC transplants from unrelated donors was lower by 9% compared to 2019 and the use of haploidentical donors slightly increased compared to 2019.
Out of all 386 unrelated HSC transplants, the material for 143 transplants (37%) came from international donors, whereas for 243 transplants (63%) material collected from domestic donors was used. Along with the increase in the number of potential bone marrow donors in the national resources, the share of transplants from Polish donors in the total number of transplants increased noticeably from 2006 to 2020.
The total number of allogeneic transplants performed in 18 Polish transplant centers between 2006 and 2020 is 7426. Total transplant rates (cumulative number of all allogeneic HSC transplants performed from 2006 to 2020 per 1 million inhabitants) differs between regions and for regions with nonzero number of transplants varies from 520 in Mazowieckie Voivodship to 14 in Lodzkie Voivodship.
Poland’s Central Unrelated Potential Bone Marrow Donor and Cord Blood Registry (CBMDR Poltransplant) was established in 2011. Affiliated with the World Marrow Donor Association (WMDA) as PL5, the ...CBMDR is an internationally recognized hematopoietic stem cell donor registry with a large, high-quality donor database. Overall, Polish resources in this domain are the second largest in Europe and the fourth largest in the world, accounting for 4.8% of the WMDA Register of over 33.5 million records. In the last 10 years, the number of potential hematopoietic stem cell donors registered in Poland has increased more than 10-fold, from about 146,000 to 1,579,809 at the end of 2018. Such a growing number of donors in the CBMDR is contributing to an increase in overall numbers of donor searches in Polish databases, as well as in donations from Polish donors.
•Polish resources are the second largest in Europe and the fourth largest in the world, accounting for 4.8% of the WMDA Register of over 33.5 million records.•As of the end of 2018, over 92% of Polish resources were HLA-A, B, C, DR, and DQ high- or at least intermediate-resolution typed, mostly by way of genomic typing techniques.•The most marked development of the Polish resources has taken place in the last decade, hence the reason the CBMDR stands out in terms of the young ages of potential donors.•The file featuring Polish donors is searched by centers all over the world.•The growing number of donors in the CBMDR is contributing to an increase in overall numbers of donor searches in Polish databases, as well as in donations from Polish donors.•The increasing donor pool means better chances of donors being found by Polish transplant centers within the Polish database, without any need for foreign donors to be resorted to.
Job demands-resources (JD-R) model of professional burnout states that job demands predict the feeling of
exhaustion
, and lack of job resources—
disengagement
from work. This research project ...investigated professional burnout and it correlates, including sex, death anxiety, and relationship status in 108 Polish donor transplant coordinators involved in organ, tissue, and cell transplantations. This study employed the Polish version of the Oldenburg Burnout Inventory which follows the JD-R model, the Psychosocial Working Conditions Questionnaire—a Polish instrument based on the model of job stress proposed by Karasek—and the Polish version of the Fear of Death and Dying Questionnaire. The results were suggestive of average levels of job stress and burnout in the studied population, with men being more disengaged than women. Participants who were in relationship had significantly higher levels of exhaustion than those who were single. Exhaustion was positively correlated with years of working as a transplant coordinator but not with participants’ age. Multiple negative correlations were detected between exhaustion/disengagement and different aspects of job control, social support, and well-being. Moreover, positive correlations between different components of fear of death and dying and exhaustion were detected. Our findings, linking fear of death and dying with some aspects of professional burnout in transplant coordinators, suggest that a pre-employment screening for the level of death anxiety in candidates for transplant coordinators could be useful as this job provides chronic exposure to mortality cues.
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