3. Organ donation work procedure after Chinese citizens' death

On August 1, 2012, the Red Cross Society of China and the Ministry of Health published the "Opinion on Further Promoting human organ donation work (Zhonghong Zi, No. 39)," officially announcing the organ donation process after the death of Chinese citizens. The main contents include enrollment registration, donation evaluation, donation confirmation, organ acquisition, organ distribution, body processing, memory, humanitarian assistance, and so on (Figure 3).

DCD organ procurement process (Figures 4–7).

China Human Organ Transplantation Technology Clinical Application Committee passed and announced the Chinese human organ donation classification standers, that is, the

China Category I (C-I): This includes internationally standardized donation after brain death (DBD), that is, brain death cases. After rigorous medical examination, the indicators of potential donors are in line with the latest international and current domestic brain death standards (China Journal of Cerebrovascular Diseases, 2009 Volume 6, Issue 4), by the Ministry of Health commissioned by the agency-certified brain death experts who clearly identified it as brain death. Family members also come under this category, who fully understand the situation and choose to stop the treatment and donate organs, at the same time, having obtained the

China Category II (C-II): Internationally standardized cardiac death organ donation (DCD)

China Category III (C-III): This includes donation after brain death awaiting cardiac death (DBCD). Similar to Maastricht's standard class IV, it is a controlled type and meets the diagnostic criteria for brain death. Since the brain death law has not yet been established, and family members cannot accept donations of organs under cardiac beating, donations should be made according to the DCD procedure, that is, life support should be removed, and donations should be made after cardiac arrest. The C-III is in line with China National

In March 2012, the National Health and Family Planning Commission (formerly the Ministry of Health) and the Red Cross Society jointly held a wrap-up meeting on the organ donation pilot work throughout the country in Hangzhou, Zhejiang Province, and summarized their experience in organ donation work [15]. After 2 years of pilot work, under the joint promotion of the Red Cross and the National Health and Family Planning Commission, the Pilot Regions had to do a lot of work and achieved initial success in setting up sound organizations, applying for specialized agencies, revising of laws, exploring relief mechanisms, standardizing work processes and coordinating training, guiding the public in a scientific way and carrying out scientific assessments. As of March 15, 2012, the pilot completed a total of 207 donations, contributing 546 organs and saving more than 500 lives [16]. In August 2012, the National Health and Family Planning Commission and the Red Cross jointly issued the "Opinions on Further Promoting human organ donation work" (Zhonghong Zi, No. 39) in order to continue this steady progress. It specified the guiding ideology, basic principles, work objectives and specific measures for human organ donation. It also announced the organizational structure and responsibilities of the organ donation system and the organ donation process after the death of Chinese citizens, including eight important aspects, which are registration, donation evaluation, donation confirmation, organ acquisition, organ distribution, body processing, memory and humanitarian aid [17]. On March 25, 2013, the National Health and Family Planning Commission and the Red Cross jointly held a video conference on organ donation work throughout the country,

approval and support from the hospital and relevant leading departments.

includes the I–III case of the Maastricht standard classification.

110 Organ Donation and Transplantation - Current Status and Future Challenges

2.2. The pilot project of DCD has been carried out smoothly

following three categories:

conditions [14].

Figure 3. The process chart of Chinese DCD work [11].

Figure 4. Flow chart of organ donation and procurement (C-I) [20].

The distribution of organs is based on the following seven basic principles of "Basic Principles for the Allocation and Sharing of Human Organs in China (2010 edition)" [21]:

2. The transplant hospital has the right, based on sound medical judgment, to refuse to

Current Situation of Organ Donation in China http://dx.doi.org/10.5772/intechopen.74711 113

3. Human organ distribution and sharing must take place according to the transplantation of hospitals, provinces (municipalities and autonomous regions), three levels of organ distri-

accept unsuitable organs for transplant wait-ins.

Figure 5. Flow chart of organ donation and procurement (C-II) [20].

bution and sharing level by level

1. The distribution and sharing of human organs should meet the medical needs.

Figure 5. Flow chart of organ donation and procurement (C-II) [20].

The distribution of organs is based on the following seven basic principles of "Basic Principles

for the Allocation and Sharing of Human Organs in China (2010 edition)" [21]:

Figure 4. Flow chart of organ donation and procurement (C-I) [20].

112 Organ Donation and Transplantation - Current Status and Future Challenges

1. The distribution and sharing of human organs should meet the medical needs.


Figure 6. Flow chart of organ donation and procurement (C-III) without ECMO assistance [20].

4. Human organ distribution and sharing process should avoid the waste of organs to maximize the patient's chance of receiving a transplant and improve the efficiency of organ distribution.

5. To optimize the matching quality of organs and recipients and improve the postoperative survival rate and quality of life of transplant recipients, on the premise of ensuring the

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lowest possible death rate in the transplant waiting list.

Figure 7. Flow chart of organ donation and procurement (C-III) with ECMO assistance [20].

Figure 7. Flow chart of organ donation and procurement (C-III) with ECMO assistance [20].

4. Human organ distribution and sharing process should avoid the waste of organs to maximize the patient's chance of receiving a transplant and improve the efficiency of

Figure 6. Flow chart of organ donation and procurement (C-III) without ECMO assistance [20].

114 Organ Donation and Transplantation - Current Status and Future Challenges

organ distribution.

5. To optimize the matching quality of organs and recipients and improve the postoperative survival rate and quality of life of transplant recipients, on the premise of ensuring the lowest possible death rate in the transplant waiting list.

6. To ensure the fairness of organ distribution and reduce the physical, pathological and geographical differences caused by uneven distribution of organs.

4.1. DCD working group

Cross.

1. The donor's responsible doctor: the doctor participates in the entire donation process except for the removal of the organ. Major responsibilities: find potential donors, have a preliminary assessment of potential donors with donation conditions; responsible to inform the families of patients, after the family members express the intention to terminate treatment; contact the Provincial organ Donation Committee (PODC); submit the basic information of potential donors; assist in organ donation coordination and discuss organ donation matters with family members; consult with family members to decide to remove cardiopulmonary support treatment; responsible for the implementation of the removal; confirm and announce the death of the donor; carry out necessary medical intervention of donors before donation; fill DCD records; review the case and report to the hospital organ

Current Situation of Organ Donation in China http://dx.doi.org/10.5772/intechopen.74711 117

2. Organ donation coordinator: the main responsibility is to discuss the organ donation with the family members and obtain the legal documents such as the donation of informed consent and so on. The organ donation coordinator is trained and qualified by the Red

3. Organ donation evaluation expert: the team is composed of high-quantified chief physicians or above-ICU physicians, neurologists and surgeons and is mainly responsible for

4. OPO group: the team is mainly responsible for organ removal and not participating in the

5. The Hospital Organ Donation Committee/The Hospital Organ Transplant Ethics Committee: the team checks whether the relevant legal documents for supervision and donation are perfect, whether the donation process accords with the informed consent principle and

6. Other related members, including the anesthesiologist, operation staff, and so on, mainly

1. Constituent conditions: The Organ Organization (OPO) is established by provincial health administration department and comprises one or several human organs' organ transplant surgeons, neurologists, critical care physicians and nurses under the unified leadership of the Health and Family Planning Commission. The OPO must establish a team of human organ donation coordinators with specialized skills and qualifications. OPO also needs to formulate medical standards of identifying and screening potential donors, to establish standard human donation organs' procurement, technical specifications and provide specialized personnel and equipment to ensure the quality of organ

donation committee and hospital organ transplant ethics committee.

confirming whether the patient meets organ donation conditions.

supervises the DCD reporting medical records and record management.

assist the OPO team to complete the organ procurement [24].

removal of cardiopulmonary support.

4.2. Organ procurement organization

procurement.

7. Regularly review and amend human organ distribution and sharing policies.

With the progress of the human organ donation pilot work in our country, in order to further standardize organ procurement, distribution and transplantation, the National Health and Family Planning Commission issued the "Regulation on the Administration and Accession of Human Donated Organs (Trial Implementation)" in 2013. The regulation further develops the organizational structure and normative process of organ procurement and distribution system. It also has consolidated the legal basis for the establishment of the organ procurement and distribution system in our country. Not only does it promote the birth of organ procurement organization (OPO) but it also empowers the China Organ Transplant Response Systems (CORS) (www.cot.org.cn) to exercise the power of organ distribution. The regulation compulsively demands that donated organ must be distributed through the organ distribution system, and organizations or individuals cannot allocate donated organs outside the organ distribution system to ensure the origin and fairness of organ donation. At the same time, it requires OPOs to obtain the organ according to the china organ donation after cardiac death classification standard [22].

In order to guarantee the implementation of laws, regulations and policies, the medical database associated with it has also been gradually improved in recent years. Following the establishment of the four major scientific systems of kidney, liver, heart and lung transplantation, the China Organ Transplant Response Systems (CORS), China Organ Transplant Surgeon Registration System and Human Organ Donation Coordinator Registration System have also been constructed and put into use one after another. Since the "Regulations" were implemented through April 30, 2015, the organ distribution system has performed a total of 6170 organ matches, including 1738 liver and 4432 kidneys. Among them, 83.2% (5136 cases) were assigned to wait in hospital and 16.8% (1034 cases) were shared with other transplant hospitals in and outside the province. According to the statistics, the organ distribution system calculates the matching list for no more than 8 s and takes an average of 1.2 h for organ sharing [23]. The organ distribution system operates efficiently without human intervention. Through the assistance and data exchange between the various systems, invisible monitoring network of Chinese organ procurement and transplant is formed, which means that China's organ transplant, based on the legal management, further deepens scientific information management.
