Organ donation and transplantation in China have developed rapidly, ranking second in the world in terms of both donation and transplantation volume. However, both the quantity and quality of organ transplants remain to be further improved to satisfy the demands of the vast number of recipients awaiting transplantation. Artificial intelligence (AI) facilitates the integration, analysis, and application of multi-source clinical big data. It is capable of assisting in expanding the pool of available donor organs and enhancing graft quality, thereby providing a novel technological foundation for alleviating the imbalance between the supply and demand of transplant organs. To standardize the auxiliary application of AI throughout the entire process of organ donation and transplantation in China, a team of multidisciplinary experts were convened to formulate the Chinese Expert Consensus on AI-Assisted Clinical Decision-Making in Organ Transplantation. By establishing unified requirements for data and models, this consensus forms a technical framework covering clinical scenarios across the entire workflow of organ donation and transplantation, including donor assessment and maintenance, organ matching, organ preservation and transport, transplant surgery, and post-transplant recipient management. Furthermore, it clarifies ethical and regulatory constraints as well as the boundaries of responsibility subjects. The aim is to further enhance the standardization and safety of AI-assisted organ donation and transplantation, ultimately promoting the high-quality development of this field in China.

Pancreas transplantation and simultaneous pancreas-kidney transplantation are the most effective treatments for diabetes, end-stage diabetic nephropathy, or diabetes combined with end-stage renal disease, which have achieved good therapeutic effects in the treatment of type 1 diabetes and some cases of type 2 diabetes. However, acute rejection of transplant pancreas remains one of the important factors affecting the survival of recipients and the transplant pancreas after pancreatic transplantation, and it is a key issue that needs to be urgently addressed. In order to further standardize the clinical diagnosis and treatment of acute rejection of transplant pancreas, experts in organ transplantation, transplantation pathology and immunology from the Branch of Organ Transplantation of Chinese Medical Association organized a joint effort to formulate the "Clinical diagnosis and treatment guidelines for acute rejection of transplant pancreas". The content covers 14 key clinical issues such as acute T-cell mediated rejection of transplant pancreas, acute antibody-mediated rejection, transplant pancreas biopsy, pathological standards, diagnosis and treatment methods. It summarizes 17 evidence-based recommendations. The guideline was developed based on the evidence grading and recommendation strength standards of the Oxford University Evidence-Based Medicine Center's 2009 edition, aiming to guide clinical practice through evidence-based methods, with the goal of improving the diagnosis and treatment level of acute rejection of transplant pancreas in China.

As the only effective treatment for end-stage diseases, organ transplantation has been facing core challenges such as shortage of donor organs, technical bottlenecks, and inadequate system construction. Based on the practical experience of the organ donation and transplantation team of the First Affiliated Hospital of Xi’an Jiaotong University, this article systematically reviews the pathways for the specialization of organ donation and the disciplinary development of Organ Procurement Organization (OPO). It thoroughly analyzes the innovative achievements in kidney transplantation, including key breakthroughs in the establishment of technical standards for donor and organ evaluation, preservation and repair, the research and development of mechanical perfusion repair systems, the creation of an independent human leukocyte antigen (HLA) detection platform, and the improvement of the rejection prevention and control system. Meanwhile, combined with the latest research progress at home and abroad, this paper discusses current issues in the field of organ donation and transplantation such as the utilization of marginal donors, multidisciplinary collaboration, and ethical norms. It proposes a future direction to promote the systematic disciplinary development with "Chinese Technology, Chinese Standards, and Chinese Solutions", providing a reference for the high-quality development of organ transplantation in China.

Clinical death refers to the permanent cessation of life functions. This article reviews the definition of clinical death and the various scenarios in which it occurs, classifies the process of clinical death, and discusses the criteria for determining uncontrollable cardiac death, controllable cardiac death and the criteria and workflow for determining brain death. It elaborates on the relationship between brain death and death, and proposes the areas to note when standardizing the medical documentation of death cases. Based on this, it introduces the content of the management system and workflow construction for death determination in medical institutions, including management structure, personnel qualifications, document norms, quality control system and training mechanism. Paying attention to the construction of the management system and workflow for death determination in medical institutions is of great significance for ensuring medical quality and safety, promoting the healthy development of organ donation, and maintaining the seriousness of legal and ethical practices.

As a critical measure for treating patients with end-stage organ failure, organ donation and transplantation has become an important benchmark reflecting a country’s comprehensive capacity in healthcare, modernization of governance and progress in social civilization. In 2024, the total number of organ transplant procedures worldwide exceeded 180 000, representing an annual growth rate of 2.4%. China ranked second globally with 24 000 transplant procedures, accounting for 13.8% of the global total. Meanwhile, driven by the growing burden of transplantation-related non-communicable diseases, the global demand for organ transplantation has reached an all-time high. At present, the global development of organ donation and transplantation features a landscape of coexisting strategic opportunities and risks and challenges. On the one hand, technological breakthroughs and institutional innovations have accelerated the rapid development of the field. On the other hand, issues such as uneven regional development, supply-demand imbalance, and lagging governance remain to be addressed. This study integrates multi-dimensional authoritative monitoring data, systematically summarizes twelve key characteristics of the global organ donation and transplantation sector, distills ten major developmental features and regional leading effects of China at the current stage, and elaborates on the practical connotation and contemporary value of the “Chinese Model”. The findings not only provide important references for countries to promote the sustainable development of the industry, narrow regional development gaps, and improve the equitable access to medical resources, but also offer comprehensive research support and scientific decision-making basis for China to consolidate its developmental advantages, refine Chinese solutions, and deeply participate in the construction of the global organ donation and transplantation governance system.

Currently, driven by rigid health demands, technological iteration and innovation, and the reshaping of the global development landscape, the global field of organ donation and transplantation presents a development trend featuring "continuous expansion of transplantation scale, diversified donor sources, multiple breakthroughs in core technologies, and sustained optimization of supporting policies". Meanwhile, it still faces profound challenges including prominent contradiction between supply and demand, unbalanced regional development, increasing governance difficulties, and lack of dynamic adaptation of ethical norms. Under the continuous initiative and promotion of the United Nations, the World Health Organization and relevant international academic groups, organ donation and transplantation have become an important issue for promoting the harmonious development of human society and improving global public health governance. At the present stage, the reshaping of the global development pattern and the impact of uncertainties in the international situation cannot be ignored, which not only brings challenges to transnational cooperation in the field of organ donation and transplantation, but also forces all countries to accelerate the construction of an independent, controllable, safe and efficient working system. Based on the development characteristics revealed by data insights, this paper further sorts out the innovative practical progress, policy evolution context and latest orientations of countries around the world in solving the development dilemmas of organ donation and transplantation in recent years, analyzes the core challenges and prospectively judges future policy trends. It not only provides experience reference for countries to carry out industrial governance, but also consolidates the decision-making foundation for China to build an independent knowledge system and a discourse system with Chinese characteristics, and deeply participate in the construction of the global governance system.

The technology of xenogeneic organ transplantation, as one of the core strategies to address the current contradiction between the supply and demand of transplant organs, has achieved significant breakthroughs from basic research to clinical application driven by factors such as the innovation of gene modification technology, the injection of research capital and the expansion of clinical trials, especially with the first actual clinical application of a pig heart-to-human transplant. China is also at the forefront of this field. This article intends to summarize the international research trends of xenogeneic organ transplantation (including financial support, the evolution of research stages and global clinical trial cases), and analyze the evolution and optimization of xenogeneic transplantation immunosuppression schemes, as well as the breakthroughs and unresolved scientific issues in current key clinical application technologies. The aim is to comprehensively present the progress of this field from basic research to clinical transformation, and provide references for promoting the rapid development of China's xenogeneic transplantation technology and subsequent clinical transformation and research directions.

Objective To establish an "human serum - porcine aortic endothelial cells (PAEC) - human platelets" in vitro model and explore the mechanism of xenotransplantation-related coagulation dysfunction mediated by immune complexes - platelet FcγRⅡa (CD32a) receptor. Methods Healthy human serum was co-incubated with PAEC to prepare the supernatant containing immune complexes, which was then used to stimulate healthy human platelets, or directly treated with the serum of xenogeneic liver transplant recipients. Flow cytometry was used to detect platelet activation markers CD62P and surface IgG binding levels, and the platelet adhesion function was evaluated by platelet-PAEC adhesion experiments. CD32a blocking antibody IV.3 and SYK blocker SKYIN 4 were used to clarify the signaling pathways. Results The supernatant from the co-incubation of healthy human serum and PAEC could significantly induce platelet activation and endothelial adhesion. The use of the serum from xenogeneic liver transplant recipients could also significantly induce platelet activation. Antibody IV.3 and SYK blocker SKYIN 4 could significantly inhibit these effects. Conclusions In xenotransplantation, the immune complexes formed by human serum antibodies and porcine endothelial antigens may induce abnormal platelet activation through the platelet CD32a receptor, which is an important mechanism of non-complement-dependent post-transplant coagulation dysfunction, providing a new target for the intervention of coagulation complications in xenotransplantation.

Objective To investigate the role and potential mechanism of secreted phosphoprotein 1 (SPP1)⁺ macrophages in the formation of chronic renal allograft fibrosis. Methods The expression features of SPP1⁺ macrophages in renal allografts of chronic allograft dysfunction (CAD) patients were analyzed based on single-cell transcriptome data of renal tissues from patients with CAD. Transcription factor VIPER analysis and DoRothEA transcription factor activity analysis were performed on the single-cell transcriptome data. Renal tissue samples were collected from kidney transplant recipients, including the CAD group (n=5) and the non-renal allograft fibrosis group (CTL group, n=5). A mouse model of chronic allograft rejection was established and divided into the allogeneic kidney transplantation group (CAD group, n=3) and the syngeneic kidney transplantation group (SYN group, n=3). Hematoxylin-eosin staining was used to detect renal tissue injury in mice, and Masson staining was used to detect renal tissue fibrosis. Immunofluorescence staining was performed to detect SPP1 expression in renal tissues of transplant recipients and mouse renal allografts. Bone marrow-derived macrophages (BMDMs) were extracted from mice and subjected to hypoxia stimulation. The expression of hypoxia-inducible factor (HIF)-1α and SPP1 was detected by Western blot, and SPP1 expression was detected by flow cytometry. BMDMs were transfected with HIF-1α overexpression plasmid and HIF-1α small interfering RNA (siRNA) followed by hypoxia intervention, and the expression of HIF-1α and SPP1 was detected by Western blot. Mouse aortic endothelial cells (MAECs) were co-cultured with the supernatant of BMDMs, and the expression of endothelial-mesenchymal transition (EndMT)-related markers was detected by Western blot and immunofluorescence. Results Single-cell transcriptome analysis showed that the proportion of SPP1⁺ macrophages in renal allograft tissues was significantly higher in the CAD group than in the CTL group (P<0.05). The renal injury score and the percentage of interstitial fibrotic area in the CAD group were significantly higher than those in the SYN group (both P<0.05). Immunofluorescence staining showed that the proportion of SPP1⁺ macrophages was increased in the CAD group compared with the CTL group, and also increased in the CAD group compared with the SYN group (both P<0.05). VIPER analysis and DoRothEA transcription factor activity analysis revealed activation of the hypoxia pathway and upregulated expression of transcription factors such as HIF-1α in SPP1⁺ macrophages. SPP1 expression was elevated in BMDMs under hypoxic conditions. Knockdown of HIF-1α inhibited hypoxia-induced SPP1 protein expression, whereas overexpression of HIF-1α upregulated SPP1 protein levels. After co-culture of hypoxia-induced BMDMs with MAECs, the expression levels of EndMT-related markers were increased. Conclusions SPP1⁺ macrophages differentiated under hypoxia are significantly infiltrated in the formation of chronic renal allograft fibrosis, and may promote renal allograft fibrosis by inducing EndMT in renal vascular endothelial cells.

Objective To evaluate the safety and efficacy of a self-developed micro-normothermic machine perfusion (NMP) system (micro-perfusion device) for preserving isolated porcine limbs. Methods Five healthy Landrace pigs were selected, and their left and right forelimbs were randomly divided into the NMP group and static cold storage (SCS) group. The NMP group was perfused with the self-developed micro-perfusion device and polymerized hemoglobin perfusate for 32 hours at normothermia, while the SCS group was preserved at 4 ℃. Hemodynamic parameters such as perfusion pressure and flow were monitored. The pH value, partial pressure of oxygen (PO₂), lactic acid (Lac), creatine kinase (CK) and lactate dehydrogenase (LDH) in the perfusate were measured. Hematoxylin-eosin staining was used to assess the muscle tissue structure, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling was employed to evaluate muscle cell apoptosis, and immunohistochemistry staining was applied to detect the expressions of tumor necrosis factor (TNF)-α and interleukin (IL)-6. A mixed-effects model was used to analyze the effects of time and treatment methods on tissue structure, cell apoptosis and inflammatory factors. Results The device could stably maintain a perfusion pressure of (69±15) mmHg and a flow rate of (117±42) mL/min. The pH value and electrolytes of the perfusate were generally stable, with PO₂ maintained at a high level. Lac was maintained at 5.38(3.81, 6.45) mmol/L, while CK and LDH increased over time. After 32 hours of perfusion in the NMP group, both the myocyte spacing and apoptosis rate were better than those in the SCS group. Mixed-effects model analysis showed that there were statistically significant differences in the effects of NMP treatment and SCS treatment on myocyte spacing and apoptosis rate per unit time (both P < 0.05). There were no statistically significant differences in TNF-α and IL-6 between the two groups, and mixed-effects model analysis showed no statistically significant differences in the effects of NMP treatment and SCS treatment on TNF-α and IL-6 per unit time (both P > 0.05). Conclusions The micro-perfusion device used in this study may achieve 32-hour normothermic preservation in a porcine limb amputation model, maintain basic metabolism and ionic homeostasis, reduce muscle structural damage and cell apoptosis without inducing additional inflammatory responses. This technology is expected to significantly extend the time window for replantation of amputated limbs in disaster rescue and long-distance transportation, providing an important technical basis for clinical translation and subsequent replantation research.