The shortage of organs is a worldwide challenge for transplantation. To alleviate such organ shortage and keep pace with the world’s development and experience on organ transplantation, the pilot program of organ donation after citizen death (DCD) has been carried out in China, with support and attention from the Chinese government. From 2010, with the joint efforts of the government and medical workers for these years, a series of laws, regulations and related process management have been formulated, and great achievements have been made in DCD work. Currently, the main source of organs in China has come from DCD. However, some difficulties still restrict organ donation rates. Firstly, resistance to organ donation in China is often due to the conventional view among citizens. Secondly, some medical workers do not fully understand the definition and diagnosis criteria of brain death and therefore do not uphold and promote DCD work. Thirdly, the existing laws and institutions for organ transplantation fail to implement and remain defective. Nevertheless, China has made a firm and strong stride in DCD work. In order to carry out DCD work better, Chinese government, people and medical workers have to do much more.
Part of the book: Organ Donation and Transplantation
The rapid development of immunosuppressants (IS) has already improved the prognosis of recipients post solid organ transplantation (SOT) in the past decades. However, the individual difference in IS metabolism may lead to either rejection or drug toxicity, thus suggesting the importance of personalized therapy. Gene polymorphisms (GP) regarding metabolic enzymes and medication transporters of the IS consist the footstone for personalized therapy, which are the hotspots in recent years. However, although a great of efforts have been put into researching the association between GP and pharmacokinetics (PK) or pharmacodynamics (PD), controversial results still remained. The only consensus that has been reached is the use of GP-based IS therapy could help the recipients to reach target concentration faster with less dose adjustment. Whether the GP-based IS therapy could improve the clinical long-term outcome needs further confirmation. In our chapter, we would summarize the information associated with GP of IS, and discuss the potential impact of GP on clinical practice to provide new insights into guiding tailored therapy of IS in SOT.
Part of the book: Genetic Diversity and Disease Susceptibility
Liver transplantation has been developed in Mainland China for about 40 years, from clinical trials to maturity. Its number has become the second in the world, its quality is also in line with the international level, and the source of donors has gradually transitioned to donation after citizen’s death (DCD). This chapter is aimed to elaborate the liver transplant work in China from the history and current status of liver transplantation, the main operating methods, major indications, donor maintenance and donor quality assessment, postoperative major complications, and application of immunosuppressive agents to the postoperative follow-up. Liver transplantation is a meaningful and challenging work currently in China; all the Chinese transplant surgeons and scholars are devoting themselves to this work in order to give more effective help to the patients.
Part of the book: Surgical Challenges in the Management of Liver Disease