In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist.The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of “no-touch time,” circulatory death was declared.Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.

In February 2018, the Withdrawal of the Life-sustaining Treatment (WLST) Decision Act was legalized in Korea. Donation after circulatory death (DCD) after WLST was classified as DCD category III. We report the first case of successful organ donation after WLST in Korea. A 52-year-old male who experienced cerebral hemorrhage was a potential brain-dead donor with donation consent. During the first brain death examination, Babinski reflex was present, which disappeared two days later. Then, electroencephalography was performed five times at intervals of 2 to 3 days, according to the recommendation of a neurologist.The patient was transferred to the OR at 19:30 July 3, 2020. At 20:00, an intensive care unit specialist performed extubation and discontinued vasopressors. Oxygen saturation fell to < 70% in 1 minute, which signaled the beginning of functional warm ischemia. At 20:15, asystole was confirmed; after 5 minutes of “no-touch time,” circulatory death was declared.Organ procurement surgery was initiated, with surgeons performing the recipient surgery ready in the adjacent OR. Through the first successful DCD case, we expected that DCD will be actively implemented in Korea, saving the lives of patient waiting for transplantation and resolving the imbalance between organ receipt and donation.

The Republic of Korea has been using malaria antibody assays to screen blood donors and reduce the risk of transfusion-transmitted malaria (TTM). This study examined the effectiveness of the current malaria antibody test for screening blood donors and calculated the positive predictive value (PPV) with the real-time polymerase chain reaction (RT-PCR) as the reference. The reactive rate and PPV of the malaria antibody screening assay during particular period from 2020 to 2021 were 0.82% (248/30,309) and 0.40% (1/248), respectively. The low PPV of current malaria antibody screening in blood donors suggests that the effectiveness of this test is limited in terms of balancing blood safety and supply in low-prevalence situations.

There were 10 cases of transfusion-transmitted P. vivax malaria from 1990 to 2021. The Korean Centers for Disease Control and Prevention (KCDC) designated the areas showing a high frequency of malaria as a malaria-endemic area and has restricted whole blood donation from these areas. While the number of malaria infections has declined in recent years, the blood inventory has declined sharply due to the COVID-19 pandemic. Accordingly, the Ministry of Health and Welfare temporarily approved the donation of whole blood from malaria-endemic areas to secure the supply of blood products. In the present study, an anti-malaria screening and nucleic acid amplification test (NAT) was performed on samples collected from the malaria-endemic areas from May 20 to June 30, 2020. A total of 14,741 samples were collected and tested. NAT was performed for 1096 runs to test all the collected samples. The 117 (0.79%) samples showed initial reactive results due to the contamination of abnormal PCR results. Negative results were obtained for the samples showing initial reactive results using a duplicated re-test. From the NAT tests, no sample showed a true positive result. The results of the malaria antibody screening test were reactive in 10 out of the 14,741 samples. The malaria antibody screening needs to be reviewed through further study because of its insufficient sensitivity and specificity. According to this study, excluding the 10 reactive malaria antibodies, additional blood components could be secured from 14,731 blood donors for a stable blood supply.

There were 10 cases of transfusion-transmitted P. vivax malaria from 1990 to 2021. The Korean Centers for Disease Control and Prevention (KCDC) designated the areas showing a high frequency of malaria as a malaria-endemic area and has restricted whole blood donation from these areas. While the number of malaria infections has declined in recent years, the blood inventory has declined sharply due to the COVID-19 pandemic. Accordingly, the Ministry of Health and Welfare temporarily approved the donation of whole blood from malaria-endemic areas to secure the supply of blood products. In the present study, an anti-malaria screening and nucleic acid amplification test (NAT) was performed on samples collected from the malaria-endemic areas from May 20 to June 30, 2020. A total of 14,741 samples were collected and tested. NAT was performed for 1096 runs to test all the collected samples. The 117 (0.79%) samples showed initial reactive results due to the contamination of abnormal PCR results. Negative results were obtained for the samples showing initial reactive results using a duplicated re-test. From the NAT tests, no sample showed a true positive result. The results of the malaria antibody screening test were reactive in 10 out of the 14,741 samples. The malaria antibody screening needs to be reviewed through further study because of its insufficient sensitivity and specificity. According to this study, excluding the 10 reactive malaria antibodies, additional blood components could be secured from 14,731 blood donors for a stable blood supply.

BACKGROUND: This retrospective study analyzed the causes of failure in the management process from the identification of brain-dead potential organ donors to actual donation in Korea over the past 5 years. METHODS: Data of 8,120 potential brain deaths reported to the Korea Organ Donation Agency were used, including information received at the time of reporting, donation suitability evaluation performed by the coordinator after the report, and data obtained from interviews of hospital medical staff and the donor's family. RESULTS: From January 2012 to December 2016, the total number of brain-dead potential organ donors in Korea was 8,120, of which 2,348 (28.9%) underwent organ procurement surgery with designated recipients. While the number of transplant donors has increased over time, the ratio of transplant donors to medically suitable brain-dead donors has decreased. The common causes of donation failure included donation refusal (27.6%), non-brain death (15.5%), and incompatible donation (11.6%); 104 potential donors (7.8%) were unable to donate their organs because they were not pronounced brain dead. CONCLUSION: The rate of successful organ donation may be increased by analyzing the major causes of failure in the brain-dead organ donation management process and engaging in various efforts to prevent such failures.
Brain Death ; Humans ; Korea* ; Medical Staff, Hospital ; Retrospective Studies ; Statistics as Topic* ; Tissue and Organ Procurement ; Tissue Donors* ; Transplantation