4. The composition and responsibilities of the DCD working group

The DCD team includes the donor's responsible doctor, organ donation coordinator, member of human organ procurement organization (OPO), surgical group, anesthesiologist, organ donation management committee, organ transplantation ethics committee, and so on. The above members constitute the DCD working group to participate in the DCD implementation process, each of which does its job, divides the labor and cooperate and jointly decides the key procedures.

#### 4.1. DCD working group

6. To ensure the fairness of organ distribution and reduce the physical, pathological and

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 classifica-

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,

4. The composition and responsibilities of the DCD working group

The DCD team includes the donor's responsible doctor, organ donation coordinator, member of human organ procurement organization (OPO), surgical group, anesthesiologist, organ donation management committee, organ transplantation ethics committee, and so on. The above members constitute the DCD working group to participate in the DCD implementation process, each of which does its job, divides the labor and cooperate and jointly decides the key

geographical differences caused by uneven distribution of organs.

116 Organ Donation and Transplantation - Current Status and Future Challenges

tion standard [22].

procedures.

further deepens scientific information management.

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


#### 4.2. Organ procurement organization

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 procurement.

2. Responsibilities: (1) appropriate medical assessment of potential donors in their service area; (2) in accordance with the "Regulations," sign the human organ donation informed consent or other human organ donation legitimacy document with the donors or their spouse, adult children, parents (or other legal guardians), and so on. (3) maintenance of organ donation; (4) entry of clinical data and legal documents of potential donors and donated organs into CORT; (5) use of organ distribution system to start donation of organs; (6) acquire, save and deliver donated organs and confirm the transfer of donated organs according to the distribution result of the organ distribution system and the hospital with human organ transplantation qualification where the organ transplant recipients who obtained the organ are located; (7) carry out medical treatment on the remains of donors according to ethical principles and participate in the memory and condolences work; (8) protect the personal information of donors, recipients and waiters and protect their legal rights and interests; (9) organize relevant medical staff in medical institutions within the scope of their services to participate in professional training and assist the executive on the regular OPO coordinator training and assessment, conduct scientific research and academic exchanges; and (10) publicity and education on knowledge of human organ donation to the general public [25].

hospitals in the province that can carry out organ transplants, of which three hospitals can carry out a variety of organ transplants and the remaining five can only carry out kidney transplantation; there are a total of four existing OPOs in Hunan Province and under the joint

Current Situation of Organ Donation in China http://dx.doi.org/10.5772/intechopen.74711 119

In order to carry out the work of DCD better, each transplantation hospital has set up some working groups: the OPO leadership group, the DCD ethics committee, the DCD work hospital coordination group, the full-time coordinator team, the OPO procurement group, the DCD work post-processing group, and so on. The composition and responsibilities of each group

Composition: includes the hospital main party and government leaders, functional departments and potential DCD clinical department leaders and transplant center responsible

1. to protect the development of DCD work and provide a good platform for colla-

2. to carry out publicity work inside and outside the DCD and regularly report to the

5. to protect, such as ambulances, equipment, care, medical, legal and other aspects of

Composition: Includes the management, medical, psychological, nursing, pharmacy, law, ethics, community representatives and other aspects of the composition of the residents.

1. confirming and identifying that medical institutions have the relevant qualifications

2. discuss and approve DCD organ transplantation and confirm that the donor source is

3. to confirm that the donor and the recipient of the documents meet the requirements of

2. DCD Working Coordination Group: Composed of the Medical Services Department, the Department of Health, Propaganda Department, the vehicle team, the hospital legal

3. regular inspection, to grasp the legality of the DCD process;

support to ensure the smooth flow of DCD work.

legitimate and matching type is reasonable;

legal documents, that there is no sale of human organs;

4. to give DCD work in financial support and financial supervision; and

adviser, potential DCD medical department director, nurse and coordinators.

consultation divided into four OPO service areas [27].

are as follows [28]:

person.

1. OPO leadership group

Responsibilities:

boration;

3. DCD Ethics Committee

Responsibilities:

and conditions;

higher authorities;

#### 4.3. Division principle of OPO service areas

In order to encourage and promote effective DCD work in all the provinces and avoid unnecessary competition and looting, under the coordination of the health administrative departments, various provinces and cities established a number of independent OPO organizations and divided the service scope of OPO organizations at the same time. The OPO group must comply with the following principles [26]:


The number of OPOs varies from province to province. Most provinces adhere to the principle of free combination among transplant hospitals. For example, hospitals that are more advanced in DCD work and have a higher transplantation professional level and can carry out multiple organ transplants can form independent OPOs. A strong transplant center can lead a weaker transplant center to form an OPO. An experienced transplant center can lead an inexperienced transplant center to form an OPO. To avoid organ waste, centers that only can carry out one kind of transplantation can form an OPO with centers that can carry out multiple kinds of transplantation.

Taking Hunan as an example: With a population of 67.83 million (in 2015), Hunan Province has a total area of 211,800 km2 and a total of 14 cities and 122 counties. There are eight hospitals in the province that can carry out organ transplants, of which three hospitals can carry out a variety of organ transplants and the remaining five can only carry out kidney transplantation; there are a total of four existing OPOs in Hunan Province and under the joint consultation divided into four OPO service areas [27].

In order to carry out the work of DCD better, each transplantation hospital has set up some working groups: the OPO leadership group, the DCD ethics committee, the DCD work hospital coordination group, the full-time coordinator team, the OPO procurement group, the DCD work post-processing group, and so on. The composition and responsibilities of each group are as follows [28]:

1. OPO leadership group

2. Responsibilities: (1) appropriate medical assessment of potential donors in their service area; (2) in accordance with the "Regulations," sign the human organ donation informed consent or other human organ donation legitimacy document with the donors or their spouse, adult children, parents (or other legal guardians), and so on. (3) maintenance of organ donation; (4) entry of clinical data and legal documents of potential donors and donated organs into CORT; (5) use of organ distribution system to start donation of organs; (6) acquire, save and deliver donated organs and confirm the transfer of donated organs according to the distribution result of the organ distribution system and the hospital with human organ transplantation qualification where the organ transplant recipients who obtained the organ are located; (7) carry out medical treatment on the remains of donors according to ethical principles and participate in the memory and condolences work; (8) protect the personal information of donors, recipients and waiters and protect their legal rights and interests; (9) organize relevant medical staff in medical institutions within the scope of their services to participate in professional training and assist the executive on the regular OPO coordinator training and assessment, conduct scientific research and academic exchanges; and (10) publicity and education on knowledge of

In order to encourage and promote effective DCD work in all the provinces and avoid unnecessary competition and looting, under the coordination of the health administrative departments, various provinces and cities established a number of independent OPO organizations and divided the service scope of OPO organizations at the same time. The OPO group must

3. All organs must be assigned to the China Organ Transplant Response System for uniform

4. Each OPO has a priority in the allocation of its organs but should ensure that organs will

The number of OPOs varies from province to province. Most provinces adhere to the principle of free combination among transplant hospitals. For example, hospitals that are more advanced in DCD work and have a higher transplantation professional level and can carry out multiple organ transplants can form independent OPOs. A strong transplant center can lead a weaker transplant center to form an OPO. An experienced transplant center can lead an inexperienced transplant center to form an OPO. To avoid organ waste, centers that only can carry out one kind of transplantation can form an OPO with centers that can carry out multiple

Taking Hunan as an example: With a population of 67.83 million (in 2015), Hunan Province has a total area of 211,800 km2 and a total of 14 cities and 122 counties. There are eight

human organ donation to the general public [25].

118 Organ Donation and Transplantation - Current Status and Future Challenges

1. Provincial OPOs cannot procure organs across provinces.

2. Each OPO cannot procure organs across their own service area.

4.3. Division principle of OPO service areas

comply with the following principles [26]:

distribution.

be used effectively.

kinds of transplantation.

Composition: includes the hospital main party and government leaders, functional departments and potential DCD clinical department leaders and transplant center responsible person.

Responsibilities:


Composition: Includes the management, medical, psychological, nursing, pharmacy, law, ethics, community representatives and other aspects of the composition of the residents.

Responsibilities:


4. to confirm whether necessary inspections have been given to the donors and recipients to ensure clinical efficacy.

5. Chinese organ donation coordinator

1. has good conduct and loves organ donation career

coordinator should meet one of the following conditions:

5.2. Coordinator training in China at the current stage

"There is no organ transplant without organ donation, no organ donation without coordinator" [30]. This fully demonstrates the importance of coordinators in organ donation and transplantation. At present, there are two main types of coordinators in China: Red Cross

Current Situation of Organ Donation in China http://dx.doi.org/10.5772/intechopen.74711 121

Based on relevant regulations "Management of human organ donation coordinator" promul-

4. are formal or hired personnel of local regulatory agencies or persons recommended by

According to the "Regulation on Procurement and Distribution of Human Donated Organs (Provisional)" issued by the National Health and Family Planning Commission, the OPO

1. bachelor's degree or above in medical college, holds a valid "People's Republic of China physician practicing certificate", with more than 2 years of clinical work experience and is

2. has a college degree on nursing or above and has "People's Republic of China nurse practicing certificate." The person must have more than 2 years of clinical nursing experience and is a registered nurse engaged in clinical nursing activities in a medical institution.

In addition, the coordinator should also have a serious working attitude, a certain degree of communication skills and language skills as well as good psychological quality and psychological endurance. Only in this way can we properly handle the relationship with donors and their families, do a good job in organ donation coordination and push forward the donation of

From 2010 to 2012, the Chinese Red Cross is mainly responsible for the training of coordinators. After the establishment of China Organs Donation Administration Center after 2013, it specially undertook the training of coordinators and organized 4–5 training courses each year. It invited experts in medicine, law, ethics and psychology from all over the country to give lectures and organized domestic relevant experts who compiled the "Training Materials on Human Organ Donation Coordinator in China" (the first and second volumes) [33]. The coordinators were required to attend relevant studies and pass the qualification examination.

gated on June 1, 2013, the coordinator shall meet the following conditions [31]:

2. has medical and other related disciplines' specialist qualifications

a licensed doctor engaged in medical work in medical institutions.

5.1. Basic requirements of coordinator

Coordinator and OPO Coordinator.

3. has at least 2 years of work experience

medical institutions

human organs [32].

4. DCD determination group

Composition: Includes the brain death or DCD identification of neurological and surgical experts. Requirements:


Composition: Includes professional transplantation medical staff and related staff.

Responsibilities:


Composition: Formed by the Medical Department, the vehicle team, the Propaganda Department, logistics department, coordinators and Red Cross staff, and so on.

Responsibilities:


DCD work in Hunan Province has always been in a leading position in the country. The success of DCD work in Hunan Province is mainly attributed to the strong support and cooperation of the Provincial Health and Family Planning Commission, the Red Cross Society and the transplant hospitals. Figure 1 shows DCD in eight hospitals in Hunan Province for 2010–2016 and Figure 2 shows implementation of DCD in China. The work of organ transplantation in China is also known as the "Hospital president project" and all the transplant centers that have better development are fully supported by their presidents [29].
