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Guide to the quality and safety of organs for transplantation

What has changed in the 7th Edition?

In this 7th edition, all chapters have been thoroughly revised according to the state of the art, and new and important chapters have been added.

  • Chapter 2 (‘Identification and referral of possible deceased organ donors’) has been updated, including a complete section devoted to the application of intensive care to incorporate the option of organ donation into the end-of-life care plans of patients.
  • Chapter 3 (‘Determination of death by neurologic criteria’) not only provides a detailed description of the physical exams and ancillary tests necessary for the diagnosis of brain death, but gives guidance on professional practice following the determination of death by neurologic criteria.
  • Chapter 4 (‘Consent/authorisation for post mortem organ donation’) describes the current European legal frameworks regarding consent for organ donation, and has expanded on best practice in supporting relatives of deceased organ donors and communicating bad news, both in the process of donation after brain death and in that of donation after circulatory death.
  • Chapter 5 (‘Management of the potential donor after brain death’) has been updated, based on current knowledge in the field. Additionally, new sections have been included on nutritional support, multi-organ brain death management, optimisation of the timing in performing organ recovery and donor management during organ procurement.
  • Other enhancements to the Guide have been the complete revision of Chapter 6 (‘General donor characterisation, assessment and selection criteria’) to include summaries of all issues related to the donor without focus on any specific organ, covering the risk of disease transmission and which measures should be taken to avoid such unintended transmissions.
  • Chapter 7 (‘Specific organ characterisation, assessment and selection criteria’) provides the information required for the evaluation of each organ individually considered.
  • Chapter 8 (‘Risk of transmission of infectious diseases’) has been revised to include up-to-date developments in the field of emerging pathogens, updating the screening algorithms for an extensive list of pathogens. The chapter has also taken into account the impact of new direct-acting antiviral agents in the treatment of hepatitis C virus infection to elaborate updated recommendations on the use of organs from donors infected by this virus.
  • Chapter 9 (‘Risk of transmission of neoplastic diseases’) has been entirely reviewed to provide current evidence for assessment of the risk of transplanting organs from donors with a past or present history of malignancies. Grading of risk is provided for an extensive list of malignancies that may be identified in the donor history or be discovered at the time of organ procurement.
  • Chapter 10 (‘Risk related to the use of organs from donors with other conditions and diseases’) has also been revised to provide recommendations about the use of organs from donors with conditions other than poisoning and inherited diseases, e.g., allergies and auto-immune, neuro-degenerative and demyelinating diseases.
  • Chapter 11 (‘Organ procurement, preservation and transportation’) has been reviewed, providing up-to-date information about the history of organ procurement and on different perfusion solutions, with information about new trials in preservation (e.g. machine perfusion, cold-storage, normo/hypothermic storage).
  • Chapter 12 (‘Donation after circulatory death’) now includes a detailed description of the use of in situ preservation techniques that may help to increase the quality of organs recovered from donors after circulatory death. It also includes, for the very first time, recommendations on the transplantation of hearts from this type of donor. Chapter 13 (‘Living donation’) now also addresses aspects of lung living donation, ABO- and HLA-incompatible living transplantation and kidney paired exchange programmes.
  • The new Chapter 14 (‘Donation of vascularised composite allografts’) addresses this novel field of transplantation, which in many countries is still being performed under research protocols.
  • Chapter 15 (‘Biovigilance and surveillance’) has been expanded to provide guidance on how to identify, report, assess and manage severe adverse reactions and events.
  • Chapter 16 (‘Achieving and measuring quality in organ donation and transplantation’) has been updated to provide detailed principles of quality management for organ donation and procurement, as well as for transplantation activities.
  • Finally, the new Chapter 17 (‘Measuring outcomes in transplantation’) reviews the factors to be considered when measuring outcomes in transplantation.
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