Experimental and Clinical Transplantation最新文献

{"title":"Predictive Performance of Artificial intelligence Models on Heart and Lung Posttransplant Health Outcomes: A Systematic Review.","authors":"George C Sargiotis, Theodoros N Sergentanis, Elpida Pavi, Kostas Athanasakis","doi":"10.6002/ect.2024.0207","DOIUrl":"10.6002/ect.2024.0207","url":null,"abstract":"<p><strong>Objectives: </strong>The efficacy and capacity of artificial intelligence models to predict posttransplant health complications have been disputed over the past few years. In this systematic review, we assessed the performance of different artificial intelligence models in predicting health outcomes after heart and lung transplantations.</p><p><strong>Materials and methods: </strong>We researched online databases. We gathered and analyzed data on performance metrics of artificial intelligence applications in heart and lung transplantations. In addition, we conducted a risk of bias assessment.</p><p><strong>Results: </strong>Of the 122 initial studies that we gathered, 15 were included in the analyses. The artificial intelligence models showed high performance, with metrics for discrimination such as the area under the receiver operating curve ranging from 0.620 to 0.921 and good calibration for long-term outcomes. Random forest and extreme gradient boosting models outperformed other models, particularly traditional linear models. North American, White people were the predominant subsample, and pediatric populations were excluded from the analysis. Most studies demonstrated a high overall risk of bias, whereas applicability to research questions showed a low risk.</p><p><strong>Conclusions: </strong>Supervised machine learning models performed well in predicting posttransplant health outcomes. However, biases and ethical concerns on the application of artificial intelligence models in transplantation must be considered to draw safe conclusions.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 11","pages":"823-833"},"PeriodicalIF":0.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Early Postoperative Active Bleeding After Liver Transplantation in Pediatric Patients by 384-Slice Computed Tomography Angiography.","authors":"Dinara Mamedova, Burak Yağdiran, Çağla Güneş, Ravana Ahmadli, Emre Karakaya, Mehmet Coşkun, Mehmet Haberal","doi":"10.6002/ect.pedsymp2024.O26","DOIUrl":"https://doi.org/10.6002/ect.pedsymp2024.O26","url":null,"abstract":"<p><p>Liver transplant is a complex procedure often complicated by postoperative bleeding events. Early detection of active bleeding is crucial for effective intervention. In this study, we evaluated the efficacy of 384-slice computed tomography angiography in identifying early postoperative active bleeding events after liver transplant. We retrospectively analyzed 53 liver transplant recipients from February 1, 2022, to December 26, 2023. All patients underwent 384-slice computed tomography angiography, capturing arterial, venous, and delayed phases. Results showed that 34.2% of patients experienced bleeding events, with 28.57% of these patients having active bleeding complications. Recurrent bleeding occurred in 3.77% of cases. Computed tomography angiography demonstrated 100% sensitivity, specificity, and positive predictive value in detecting bleeding. Bleeding primarily originated from the perihepatic region and was predominantly arterial. Our findings underscore the value of 384-slice computed tomography angiography in early detection and localization of postoperative bleeding, which enhances patient management and outcomes. Integrating this advanced imaging tool into routine postoperative care can significantly improve intervention accuracy and patient recovery.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 Suppl 5","pages":"90-93"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Near-Infrared Spectroscopy as a Tool to Monitor Perfusion of Transplanted Kidney in Adults in the Posttransplant Period.","authors":"Shubhendu Singh, Praveen Kumar Das, Shilpi Misra, Samiksha Parashar, Namrata Rao, Alok Srivastava","doi":"10.6002/ect.2024.0110","DOIUrl":"https://doi.org/10.6002/ect.2024.0110","url":null,"abstract":"<p><strong>Objectives: </strong>After renal transplant, identification of early graft dysfunction is crucial for graft survival. We aimed to assess the perfusion of the transplanted kidney using near-infrared spectroscopy and to see any correlations between regional saturation and serum creatinine and urine output.</p><p><strong>Materials and methods: </strong>We included male and female patients, aged 18 to 65 years, with end-stage renal disease and undergoing living related donor renal transplant in our study. Near-infrared spectroscopy was used for continuous monitoring of regional saturation. Urine output and serum creatinine were recorded at baseline and then every 24 hours until postoperative day 5.</p><p><strong>Results: </strong>Among 21 patients included in the study, mean age was 30.23 ± 4% at postoperative day 5. We found a significant negative correlation between regional saturation and serum creatinine at all time intervals (P < .05). A significant negative correlation between regional saturation and urine output was observed at baseline and at 24, 72, 96, and 120 hours (P < .05). Four patients developed postoperative complications. A significant change in regional saturation was detected at 40 hours, 1 hour, 2 hours, and 48 hours earlier by near-infrared saturation in 4 patients compared with other traditional indexes of renal function monitoring.</p><p><strong>Conclusions: </strong>Monitoring with near-infrared spectroscopy is feasible and safe in postoperative renal transplant patients. Near-infrared spectroscopy may be projected as a surrogate tool for real-time monitoring of renal perfusion in renal transplant recipients.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 10","pages":"754-759"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bulevirtide Treatment of Hepatitis Delta Virus Infection in a Kidney Transplant Recipient: A Case Report.","authors":"Biagio Pinchera, Rosa Carrano, Fabrizio Salemi, Amerigo Piccione, Elisa Schettino, Federica Cuccurullo, Antonio Riccardo Buonomo, Ivan Gentile","doi":"10.6002/ect.2024.0204","DOIUrl":"https://doi.org/10.6002/ect.2024.0204","url":null,"abstract":"<p><strong>Objectives: </strong>Hepatitis delta virus infection poses a significant challenge in solid-organ transplant recipients due to its aggressive nature and limited therapeutic options. Bulevirtide is a novel antiviral agent approved by the European Medicines Agency in 2020 for the treatment of hepatitis delta virus infection, but limited data are available on its use in solid-organ transplant recipients.</p><p><strong>Materials and methods: </strong>We present a case report of a 42-year-old male kidney transplant patient with coinfection of hepatitis B virus and hepatitis delta virus who was treated with bulevirtide over a 6-month period.</p><p><strong>Results: </strong>The patient exhibited virological and bioc-hemical responses and achieved undetectable serum hepatitis delta virus RNA and normalized transaminase levels within 2 months of therapy. Bulevirtide was well tolerated, with only mild tenderness at the injection site and mild asthenia. Pharmacological evaluation indicated potential drug interactions with tacrolimus, which led to increased serum levels of tacrolimus, whereas everolimus levels remained stable.</p><p><strong>Conclusions: </strong>This case emphasizes the importance of an individualized treatment approach and highlights the potential efficacy of bulevirtide in solid-organ transplant recipients with hepatitis delta virus infection. Further research is warranted to better understand manage-ment factors in this patient population.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 10","pages":"810-813"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Posterior Segment Graft in Adult Living-Donor Liver Transplantation: A Report of 17 Years of Experience at a Single Institution.","authors":"Masashi Kadohisa, Yukihiro Inomata, Tomoaki Irie, Keita Shimata, Seiichi Kawabata, Kohei Miura, Kaori Isono, Masaki Honda, Shintaro Hayashida, Yuki Ohya","doi":"10.6002/ect.2024.0239","DOIUrl":"https://doi.org/10.6002/ect.2024.0239","url":null,"abstract":"<p><strong>Objectives: </strong>The right posterior segment graft can be selected in cases where neither the right nor left lobe graft satisfies the selection criteria for adult living donor liver transplant. However, vascular and biliary anatomy may cause technical difficulties in procurement of posterior segments in donors of living donor liver transplant and may require specific attention in vascular and biliary reconstruction in the recipient. In this study, we examined the feasibility of right posterior segment grafts in adult living donor liver transplants through donor safety and recipient outcomes and clarified the anatomic points of the surgical technique.</p><p><strong>Materials and methods: </strong>We retrospectively reviewed 296 cases of adult living donor liver transplants treated at Kumamoto University between August 2000 and March 2017.</p><p><strong>Results: </strong>Among 296 cases, graft types were right lobe (n = 162), left lobe (n = 119), and right posterior segments (n = 9). Among donors, no significant differences were shown in operative time, blood loss, or incidence of postoperative complications between early and late phases among the 3 groups. Four cases ofright posterior segment had >2 biliary duct stumps, and 2 cases had 2 portal vein stumps. Among recipients, median actual graft-to-recipient weight ratio was 0.82% (range, 0.52%-1.22%), with no factors, including graft type, significantly associated with graft survival. Hepatic artery thrombosis and rupture of hepatic artery pseudoaneurysm occurred in 1 case as an early complication, and biliary anastomotic stricture occurred in 4 cases as a late complication.</p><p><strong>Conclusions: </strong>The right posterior segment graft may be an effective alternative in living donor liver transplant when no eligible candidates for conventional grafts are available among families and relatives. Careful preoperative anatomic evaluations and simulations are important.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 10","pages":"786-793"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of Kidney Transplant in Pediatric Recipients: Experience of a Single Center.","authors":"Farhod Khadjibaev, Pulat Sultanov, Khikmat Anvarov, Dilshod Ergashev, Bekhruz Bazarov, Nodir Sultonov, Ruslan Sadikov, Jur'at Djuraev, Nurbek Iskhakov, Azizbek Ismatov","doi":"10.6002/ect.pedsymp2024.O8","DOIUrl":"https://doi.org/10.6002/ect.pedsymp2024.O8","url":null,"abstract":"<p><strong>Objectives: </strong>Congenital abnormalities of the kidneys and the urinary tract are common reasons for endstage renal disease in children. We studied the features of postoperative management and possible complications after pediatric kidney transplant.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 29 children aged from 9 to 18 years who underwent kidney transplants from April 2018 to December 2013 (17 boys and 12 girls). All recipients were on hemodialysis for 3 to 18 months (mean of 10.17 ± 4.52 mo). Etiology of end-stage kidney disease included chronic glomerulonephritis (n = 12 [41.4%]), urolithiasis (n = 3 [10.3%]), and congenital abnormalities of the kidneys and the urinary tract (n =14 [48.3%]), including urinary reflux (n = 5 [17.2%]). Donors were parents in 16 cases, siblings in 5, uncles in 5, and aunts in 3 cases. HLA mismatching ranged from 2 to 5 (mean of 2.93 ± 1.39). Three patients had intraoperative nephrectomy, and 2 patients had hydronephrosis and urethroplasty with megaureter to prevent urinary tract infection.</p><p><strong>Results: </strong>Six patients (20.6%) had early postoperative complications: 2 with delayed graft function, 1 with venous anastomosis thrombosis, 2 with hematoma around the graft, and 1 with lymphocele. Venous anastomosis thrombosis was eliminated by open thrombectomy, with graft function restored on postoperative day 17. The lymphocele was eliminated by puncture and drainage. Hematomas did not require surgical correction and blood transfusion. Ten patients (34.4%) had late postoperative complications: 1 with stricture of vesicoureteral anastomosis, 3 with vesicoureteral reflux, and 5 with urinary tract infection (3 with bacterial culture). Stricture of vesicoureteral anastomosis was successfully resolved by open surgery. Vesicoureteral reflux was eliminated with hydrogel. One patient developed chronic kidney rejection within 6 months because of noncompliance with posttransplant regimen and required transplantectomy.</p><p><strong>Conclusions: </strong>A major factor in reducing frequency of infections after surgery is the recipient's nephrectomy.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 Suppl 5","pages":"49-53"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Organ Transplantation and Learning Disabilities: A Systematic Review.","authors":"Kübra Nur Kabakcı Sarıdağ, Betül Şahin Kılınç, Emine Koç, İlçim Ercan Koyuncu, Tuğçe Uçgun","doi":"10.6002/ect.pedsymp2024.P3","DOIUrl":"https://doi.org/10.6002/ect.pedsymp2024.P3","url":null,"abstract":"<p><strong>Objectives: </strong>Organ transplant is a vital treatment for pediatric patients. Kidney, liver, heart, and other organ transplants can significantly improve the quality of life for children with various chronic diseases and can improve long-term survival rates. However, the effects of transplant on cognitive and educational aspects should be considered, including the effects of pre- and posttransplant treatment protocols, medications, psychosocial stress, and surgical interventions. Learning disabilities can negatively affect the child's educational life, social relationships, and overall quality of life. We aimed to examine the prevalence of learning difficulties after organ transplant, the influencing factors, and the interventions aimed at solving these problems by conducting a systematic review of existing research on learning difficulties associated with pediatric organ transplant.</p><p><strong>Materials and methods: </strong>For this systematic review, We searched PubMed, Cochrane, Web of Science, Science Direct, and Scopus databases to examine studies conducted during the past decade. We used the key words organ transplantation, pediatrics, and learning disabilities for our search. We included English language, full-text articles in the study; meta-analyses, systematic reviews, and case reports for which the full text was not available in English were excluded from the study.</p><p><strong>Results: </strong>Among an initial search result of 174 articles, 4 met the inclusion criteria. Across all studies, a consistent observation emerged that indicated a decline in neurocognitive functions among children who had undergone organ transplant. Specific areas affected included verbal intelligence, memory, reading/spelling skills, mathematical ability, motor skills, attention, and memory, collectively contributing to learning difficulties.</p><p><strong>Conclusions: </strong>In light of the findings, minimizing learning difficulties in children after organ transplant necessitates strategies such as reducing transplant waiting times, seamlessly integrating children into the posttransplant school environment, and implementing specialized programs within educational institutions.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 Suppl 5","pages":"111-116"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advanced Prediction of Glomerular Filtration Rate After Kidney Transplantation Using Gradient Boosting Techniques.","authors":"Meraj Alam Siddiqui, Esra Baskın, Kaan Gülleroğlu, Adem Şafak, Emre Karakaya, Mehmet Haberal","doi":"10.6002/ect.pedsymp2024.O18","DOIUrl":"https://doi.org/10.6002/ect.pedsymp2024.O18","url":null,"abstract":"<p><strong>Objectives: </strong>Clinicians often face uncertainty when interpreting whether a decline in estimated glomerular filtration rate is within the patient's expected range of fluctuation or if the decline signals a substantial deviation. Thus, accurate predictions of glomerular filtration rate can be an early warning system, prompting timely interventions, such as biopsies to preclude early graft rejection and adjustments in immunosuppression. Traditional models, encompassing linear and conventional methods, typically struggle with variabilities and complexities in posttransplant data.</p><p><strong>Materials and methods: </strong>We evaluated the efficacy of a gradient boosting model in predicting posttransplant glomerular filtration rate, to potentially enhance accuracy over traditional prediction approaches. Our patient dataset included 68 pediatric patients aged 1 to 18 years who underwent kidney transplant between 2017 and 2023 at Baskent University Hospital (Ankara, Turkey). The dataset comprised 2285 glomerular filtration rate measurements, along with patient demographics and transplant-related data. For our model, we included \"days to transplant\" (glomerular filtration rate values pretransplant), \"days from transplant\" (glomerular filtration rate values up to 7 days posttransplant), patient age, sex, and donor types. We divided the dataset into a training set (70%) and a test set (30%). To evaluate model performance, we used mean absolute error and root mean squared error, with a focus on the accuracy of glomerular filtration rate predictions at various posttransplant stages.</p><p><strong>Results: </strong>In the training set, the gradient boosting model demonstrated a significant improvement in prediction accuracy, achieving an mean absolute error of ~5.64 mL/min/1.73 m².</p><p><strong>Conclusions: </strong>Our model underscored the promise of advanced machine learning techniques in refining prediction of glomerular filtration rate after kidney transplant. With its augmented precision, the model can support clinicians in making informed decisions regarding early biopsies and interventions, thus highlighting the vital role of sophisticated analytical methods in medical prognosis and the monitoring of pediatric patient care.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 Suppl 5","pages":"78-82"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Evaluation in Children With Chronic Renal Failure and Effect of Kidney Transplant.","authors":"Mehtap Küçük, Emil Akbarov, Esra Baskın, Birgül Varan, Kaan Savaş Gülleroğlu, İlkay Erdoğan, N Kürşad Tokel, Emre Karakaya, Mehmet Haberal","doi":"10.6002/ect.pedsymp2024.O14","DOIUrl":"https://doi.org/10.6002/ect.pedsymp2024.O14","url":null,"abstract":"<p><strong>Objectives: </strong>Cardiovascular diseases are an important cause of mortality and morbidity in children with chronic renal failure. Cardiac evaluation and followup are crucial for these patients before and after renal transplant. Echocardiography is a noninvasive imaging modality that allows for the assessment of cardiac structure and function.</p><p><strong>Materials and methods: </strong>We retrospectively investigated pretransplant and posttransplant echocardiography findings for 55 pediatric patients who had underwent kidney transplant. We recorded patient characteristics before and after transplant, including age, sex, follow-up period, etiology of renal failure, left ventricular systolic and diastolic diameters and the associated z scores, left ventricular mass indexes and z scores, ejection fraction and fractional shortening, aortic valve and atrioventricular valve insufficiencies, presence of pulmonary hypertension, and pericardial effusion (if any) in echocardiography. All participants underwent echocardiography at baseline and after 6 months following the transplant procedure.</p><p><strong>Results: </strong>Posttransplant echocardiography evaluations showed that the z scores of left ventricular systolic and diastolic diameters decreased significantly, mitral regurgitation decreased, and left ventricular systolic functions and left ventricular mass index increased.</p><p><strong>Conclusions: </strong>Our study revealed that kidney transplant has a beneficial effect on the cardiovascular status of patients with end-stage renal disease, as shown by improvements in both structural and functional echocardiographic features. Cardiac functions must be monitored regularly before and after transplant. Transplantation is the optimal treatment option for preservation and improvement of cardiovascular functions.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 Suppl 5","pages":"54-59"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethics of Organ Donation and Transplantation: Toward Self-Sufficiency.","authors":"Ehtuish F A Ehtuish","doi":"10.6002/ect.pedsymp2024.O1","DOIUrl":"https://doi.org/10.6002/ect.pedsymp2024.O1","url":null,"abstract":"<p><p>Organ donation, intersecting medical necessity and ethical responsibility, calls for policies respecting individual autonomy while aiming for societal selfsufficiency. This article evaluates various government policies, emphasizing the ethical use of nudges in decision-making and the potential impact on autonomy. We argue that, while some policies might be coercive, others may inadvertently disrespect autonomy through subtle influences on decisionmaking. To reach self sufficiency in organ donation and transplantation and to keep adherent to medical ethics, especially informed consent, and gift of life campaigns, governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are 4 feasible options to choose from: optin, opt-out, mandated active choice, and voluntary active choice. This article investigated the ethics of these policies' use of nudges and pokes to affect organ donor registration ways, rules, and rates. We argue that the use of nudges in this context is morally problematic. It is disrespectful of people's autonomy to take advantage of their cognitive biases since doing so involves bypassing, not engaging, their rational capacities. We conclude that, although mandated active choice policies are not problem free, they are coercive; after all, voluntary active choice, opt-in, and opt-out policies are potentially less respectful of people's autonomy since their use of nudges could significantly affect people's decision making.</p>","PeriodicalId":50467,"journal":{"name":"Experimental and Clinical Transplantation","volume":"22 Suppl 5","pages":"30-34"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}