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Rasheed HA, Pensler M, Diaz S, Roney E, Barrett M, Sonnenberg EM. Organ Offer Review Cards: Improving Transparency on the Kidney Transplant Waitlist. Clin Transplant 2024; 38:e15388. [PMID: 38990103 DOI: 10.1111/ctr.15388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION The 2022 National Academy of Sciences, Engineering, and Medicine report on equity in organ transplantation highlighted limited transparency and accountability for organ offer declines and recommended prioritizing patient engagement in decisions regarding organ offers. Yet, there is no guidance on how to incorporate patients in organ offers. We elected to study the experiences of patients on the waitlist and their perception of a novel Organ Offer Review Card (OORC). METHODS A prototype OORC was created using Donornet refusal codes. Sixty randomly selected kidney waitlist patients at a single center were asked to participate in a web-based survey focusing on current medical decision-making preferences and perceptions of the prototype OORC. RESULTS Among the 43 patients reached, 17 (39.5%) completed the survey. Most participants (88.2%) expressed it was important to be involved in the decision-making about organ offers, with 100.0% of respondents wanting to know why an organ was declined. Regarding the prototype OORC, 94.1% thought it helped them understand the factors and priorities considered when selecting an organ, and 88.2% said it increased their belief that their team was acting in their best interest. CONCLUSION An OORC could increase transparency and communication during the waitlist process while enhancing trust in the transplant team.
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Affiliation(s)
| | | | - Sarah Diaz
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Emily Roney
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Meredith Barrett
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth M Sonnenberg
- Department of Surgery, Division of Abdominal Transplant Surgery University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Ten Haaft BHEA, Furumaya A, Nooijen LE, Kazemier G, Ubbink DT, Erdmann JI. Current level of shared decision-making in hepatobiliary surgical oncology (SAPACHA). HPB (Oxford) 2024; 26:451-460. [PMID: 38161079 DOI: 10.1016/j.hpb.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Shared decision-making (SDM) may improve patient autonomy and health outcomes. This study assessed the level of SDM at both ends of the spectrum of hepatobiliary surgery to identify needs and opportunities for improvement. METHODS A mixed-methods study was performed. Consultations regarding surgery for perihilar cholangiocarcinoma (pCCA) or hepatocellular adenoma (HCA) were prospectively included between September 2020 and December 2022. The level of patient involvement in treatment decision-making was assessed objectively by analysis of audio-recorded consultations using the OPTION-5 instrument. The perceived level of SDM was appreciated by patients (SDM-Q-9) and surgeons (SDM-Q-doc) through questionnaires. Higher scores indicated higher levels of SDM. Outcomes were compared between patient groups and two focus groups were held. RESULTS Ten pCCA- and nine HCA-patients were included in the quantitative part of the study. Median OPTION-5, SDM-Q-9 and SDM-Q-doc scores were 35% (IQR: 25-45%), 86% (IQR: 76-96%), and 73% (IQR: 71-78%), respectively. SDM-Q-9 scores among HCA-patients (79% [IQR: 71-82%]) were significantly lower than in pCCA-patients (96% [IQR: 93-100%], p < 0.001). In focus groups, patients reported a lack of information, support, and expressed positive attitudes towards decision support tools (DSTs). CONCLUSION Patient involvement and information provision among HPB-surgical patients show room for improvement, particularly for HCA-patients. DSTs may be helpful for this purpose.
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Affiliation(s)
- Britte H E A Ten Haaft
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Alicia Furumaya
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Lynn E Nooijen
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Geert Kazemier
- Cancer Center Amsterdam, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Dirk T Ubbink
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
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3
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Saxena D, Yasobant S, Trivedi P, Bhavsar P. Complexity of Decision-Making!: Case Studies of Cadaveric Organ Donations in Ahmedabad, India. Healthc Policy 2022; 15:2147-2154. [DOI: 10.2147/rmhp.s376879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/10/2022] [Indexed: 11/22/2022] Open
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Decision-making Among Hepatitis C Virus-negative Transplant Candidates Offered Organs from Donors with HCV Infection. Transplant Direct 2022; 8:e1341. [PMID: 35923812 PMCID: PMC9298473 DOI: 10.1097/txd.0000000000001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background Historically, many organs from deceased donors with hepatitis C virus (HCV) were discarded. The advent of highly curative direct-acting antiviral (DAA) therapies motivated transplant centers to conduct trials of transplanting HCV-viremic organs (nucleic acid amplification test positive) into HCV-negative recipients, followed by DAA treatment. However, the factors that influence candidates' decisions regarding acceptance of transplant with HCV-viremic organs are not well understood. Methods To explore patient-level perceptions, influences, and experiences that inform candidate decision-making regarding transplant with organs from HCV-viremic donors, we conducted a qualitative semistructured interview study embedded within 3 clinical trials investigating the safety and efficacy of transplanting lungs and kidneys from HCV-viremic donors into HCV-negative recipients. The study was conducted from June 2019 to March 2021. Results Among 44 HCV-negative patients listed for organ transplant who were approached for enrollment in the applicable clinical trial, 3 approaches to decision-making emerged: positivist, risk analyses, and instinctual response. Perceptions of risk contributed to conceptualizations of factors influencing decisions. Moreover, most participants relied on multiple decision-making approaches, either simultaneously or sequentially. Conclusions Understanding how different decisional models influence patients' choices regarding transplant with organs from HCV-viremic donors may promote shared decision-making among transplant patients and providers.
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Rosaasen C, Rosaasen N, Mainra R, Trachtenberg A, Ho J, Parsons C, Delaney S, Mansell H. Waitlisted and Transplant Patient Perspectives on Expanding Access to Deceased-Donor Kidney Transplant: A Qualitative Study. Can J Kidney Health Dis 2022; 9:20543581221100291. [PMID: 35615070 PMCID: PMC9125065 DOI: 10.1177/20543581221100291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A concerning number of kidneys (eg, expanded donor criteria, extended criteria, or marginal kidneys) are discarded yearly while patients experience significant morbidity and mortality on the transplant waitlist. Novel solutions are needed to solve the shortage of kidneys available for transplant. Patient perceptions regarding the use of these less than ideal kidneys remain unexplored. Objective: To explore the perspectives of patients who have previously received a less than ideal kidney in the past and patients awaiting transplant who could potentially benefit from one. Design: Qualitative description study. Setting: 2 provinces in Canada participated (Saskatchewan and Manitoba). Patients: Patients with end-stage kidney disease who were awaiting kidney transplant and were either (a) aged 65 years and older, or (b) 55 years and older with other medical conditions (eg, diabetes). Methods: Criterion sampling was used to identify participants. Semi-structured, one-on-one interviews were conducted virtually, which explored perceived quality of life, perceptions of less than ideal kidneys, risk tolerance for accepting one, and educational needs to make such a choice. The interviews were transcribed verbatim and thematic analysis was used to analyze the data. Results: 15 interviews were conducted with usable data (n = 10 pretransplant; n = 5 posttransplant). Participants were a mean of 65.5 ± 8.8 years old. Four interrelated themes became prominent including (1) patient awareness and understanding of their situation or context, (2) a desire for information, (3) a desire for freedom from dialysis, and (4) trust. Subthemes of transparency, clarity, standardization, and autonomy were deemed important for participant education. The majority of pretransplant participants (n = 8/10) indicated that between 3 and 5 years off of dialysis would make the risk of accepting a less than ideal kidney feel worthwhile. Limitation: The study setting was limited to 2 Canadian provinces, which limits the generalizability. Furthermore, the participants were homogenous in demographics such as ethnicity. Conclusion: These findings indicate that patients are comfortable to accept a less than ideal kidney for transplant in situations where their autonomy is respected, they are provided clear, standardized, and transparent information, and when they trust their physician. These results will be used to inform the development of a new national registry for expanding access to deceased-donor kidney transplant. Trial Registration: Not registered.
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Affiliation(s)
- Canute Rosaasen
- Johnson Shoyama Graduate School of Public Policy, University of Saskatchewan, Saskatoon, Canada
| | - Nicola Rosaasen
- Saskatchewan Transplant Program, Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Rahul Mainra
- Division of Nephrology, Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Aaron Trachtenberg
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Julie Ho
- Department of Internal Medicine and Department of Immunology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
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Shanahan W, Jacob B, McCarthy C, McDonnell B, MacNicholas R. An exploratory analysis of patient factors influencing acceptance of extended criteria liver grafts. Ann Hepatol 2022; 27:100686. [PMID: 35192962 DOI: 10.1016/j.aohep.2022.100686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES There is a shortage of ideal donor organs with consequential increasing waitlist times, drop-off, and mortality. Teams have thus extended the donor criteria. Little is known about patients' actual choices and what factors may influence their decisions regarding different extended criteria liver grafts. PATIENTS AND METHODS The documented acceptance or refusal of seven extended criteria liver graft types of patients consented for transplant in a single institution over a 2-year period was reviewed. Patient factors including sex, age, indication, aetiology, and model for end-stage liver disease (MELD) score were analysed using logistic regression. RESULTS Most patients were willing to accept most graft types. MELD score did not impact the acceptance or refusal of any graft type. Older patients and those with hepatocellular carcinoma (HCC) or ascites had significantly higher rates of acceptance. Hepatitis B or C disease aetiology was predictive of willingness to accept a similarly infected graft, respectively. HCC was predictive of acceptance of grafts from donors with a cancer history. CONCLUSIONS In general, patients embrace the available extended criteria donors. Our analysis suggests that consent should be revisited as patients deteriorate or ameliorate on the waitlist, especially if in the form of ascites or HCC but not necessarily MELD score.
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Affiliation(s)
- William Shanahan
- National Liver Transplant Unit, St Vincent's University Hospital, Merrion Road, Dublin, Ireland.
| | | | - Colm McCarthy
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Brian McDonnell
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Ross MacNicholas
- National Liver Transplant Unit, St Vincent's University Hospital, Merrion Road, Dublin, Ireland
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Hamid M, Rogers E, Chawla G, Gill J, Macanovic S, Mucsi I. Pretransplant Patient Education in Solid-organ Transplant: A Narrative Review. Transplantation 2022; 106:722-733. [PMID: 34260472 DOI: 10.1097/tp.0000000000003893] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Education for pretransplant, solid-organ recipient candidates aims to improve knowledge and understanding about the transplant process, outcomes, and potential complications to support informed, shared decision-making to reduce fears and anxieties about transplant, inform expectations, and facilitate adjustment to posttransplant life. In this review, we summarize novel pretransplant initiatives and approaches to educate solid-organ transplant recipient candidates. First, we review approaches that may be common to all solid-organ transplants, then we summarize interventions specific to kidney, liver, lung, and heart transplant. We describe evidence that emphasizes the need for multidisciplinary approaches to transplant education. We also summarize initiatives that consider online (eHealth) and mobile (mHealth) solutions. Finally, we highlight education initiatives that support racialized or otherwise marginalized communities to improve equitable access to solid-organ transplant. A considerable amount of work has been done in solid-organ transplant since the early 2000s with promising results. However, many studies on education for pretransplant recipient candidates involve relatively small samples and nonrandomized designs and focus on short-term surrogate outcomes. Overall, many of these studies have a high risk of bias. Frequently, interventions assessed are not well characterized or they are combined with administrative and data-driven initiatives into multifaceted interventions, which makes it difficult to assess the impact of the education component on outcomes. In the future, well-designed studies rigorously assessing well-defined surrogate and clinical outcomes will be needed to evaluate the impact of many promising initiatives.
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Affiliation(s)
- Marzan Hamid
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
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8
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Guidelines for Perioperative Care for Liver Transplantation: Enhanced Recovery After Surgery (ERAS) Recommendations. Transplantation 2022; 106:552-561. [PMID: 33966024 DOI: 10.1097/tp.0000000000003808] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Enhanced Recovery After Surgery (ERAS) is a multimodal, evidence-based, program of care developed to minimize the response to surgical stress, associated with reduced perioperative morbidity and hospital stay. This study presents the specific ERAS Society recommendations for liver transplantation (LT) based on the best available evidence and on expert consensus. METHODS PubMed and ClinicalTrials.gov were searched in April 2019 for published and ongoing randomized clinical trials on LT in the last 15 y. Studies were selected by 5 independent reviewers and were eligible if focusing on each validated ERAS item in the area of adult LT. An e-Delphi method was used with an extended interdisciplinary panel of experts to validate the final recommendations. RESULTS Forty-three articles were included in the systematic review. A consensus was reached among experts after the second round. Patients should be screened for malnutrition and treated whenever possible. Prophylactic nasogastric intubation and prophylactic abdominal drainage may be omitted, and early extubation should be considered. Early oral intake, mobilization, and multimodal-balanced analgesia are recommended. CONCLUSIONS The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the e-Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.
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9
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Khalili M, Cardinal H, Ballesteros F, Fortin MC. Kidney transplant candidates' and recipients' perspectives on the decision-making process to accept or refuse a deceased donor kidney offer: Trust and graft survival matter. Clin Transplant 2022; 36:e14604. [PMID: 35099833 DOI: 10.1111/ctr.14604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/13/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The decision to accept a kidney from a deceased donor can be a difficult one. This study aims to capture the perspectives of transplant candidates (TCs) and kidney transplant recipients (KTRs) on the decision-making process when a deceased kidney is offered. METHODS We conducted six focus groups with KTRs and TCs. The content of the focus groups was analyzed using the qualitative thematic method. RESULTS KTRs reported that the experience of being offered a kidney could be difficult because of the circumstances of the offer and unpreparedness to participate in the discussion. Both KTRs and TCs trusted the medical expertise. Age and having experience with dialysis could influence the decision to accept an offer. In order to engage in the discussion, patients wanted to obtain estimates of expected graft survival. Patients did not express interest for a web-based calculator for patient use, but expected transplant physicians to summarize and explain the information that would impact graft survival time. CONCLUSION TCs and KTRs wanted to be involved in the decision to accept a deceased donor kidney. Tools that can help physicians communicate the risks and benefits of accepting an offer could improve patient participation in the decision-making process.
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Affiliation(s)
- Myriam Khalili
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Héloïse Cardinal
- Faculty of Medicine, Université de Montréal, Montreal, Canada.,Department of Medicine, Centre de recherche du CHUM, Montreal, Canada.,Department of Medicine, Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | | | - Marie-Chantal Fortin
- Faculty of Medicine, Université de Montréal, Montreal, Canada.,Department of Medicine, Centre de recherche du CHUM, Montreal, Canada.,Department of Medicine, Canadian Donation and Transplantation Research Program, Edmonton, Canada
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10
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The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice. Transplant Direct 2021; 7:e782. [PMID: 34712782 PMCID: PMC8547922 DOI: 10.1097/txd.0000000000001238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/02/2021] [Indexed: 01/18/2023] Open
Abstract
Background The risk of disease transmission from nonstandard risk donors (NSRDs) is low, and outcomes are similar or better relative to transplants performed with standard criteria donors. However, NSRDs have posed new ethical challenges to the informed consent (IC) process. Based on the shared decision-making model, coinciding with the 3 main timings of the IC process ([1] pretransplant assessments and waiting list registration, [2] time on the waiting list, and [3] time of the organ offer), we put forward a model (3-T Model) to summarize the knowledge on IC for NSRDs and to deliver conceptual and practical support to transplant providers on this emergent issue. Methods We searched PubMed and analyzed data from our area to provide evidence and ethical arguments to promote standardization of the timing of patient information, degree of patient participation, and disclosure of donor risk factors throughout the 3 stages of the time continuum leading to the potential acceptance of NSRDs. Results Each of the 3 timings carries special ethical significance and entails well-defined duties for transplant providers relative to patient involvement and information of the benefits and risks associated with NSRDs. Based on our framework, experience, and interpretation of the literature, we put forward a list of recommendations to combine standardization (ie, timing, content, and degree of patient participation) and individualization of IC. Conclusions The 3-T Model may enable the prevention of physicians' arbitrariness and the promotion of patient-centered care. Future studies will assess the effectiveness of the 3-T Model in transplant clinical practice.
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Alkhaldi MS, Alshuaibi AA, Alshahran SS, Koppolu P, Abdelrahim RK, Swapna LA. Perception, Knowledge, and Attitude of Individuals from Different Regions of Saudi Arabia toward Dental Implants and Bone Grafts. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2021; 13:S575-S579. [PMID: 34447156 PMCID: PMC8375783 DOI: 10.4103/jpbs.jpbs_533_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 11/04/2022] Open
Abstract
Aim The aim of this study was to assess the perception, knowledge, and attitude of individuals from different regions of Saudi Arabia toward dental implants and bone grafts. Material and Methods An online, self-oriented, and cross-sectional-based questionnaire with 21 items was given to 1622 individuals from different regions of Saudi Arabia. The questionnaire recorded the perception, knowledge, and attitude of participants and their agreement or rejection of dental implants and various kinds of bone grafts. The responses were compared with age, sex, and educational level. Descriptive statistical analysis was performed for the collected data and P < 0.05 was considered statistically significant. Results Most of the males (35.8%) and females (39.8%) reported that the major source of data regarding dental implants is friends and families. Majority of the participants (approximately 75% males and 73% females) support the idea that dental implants last for lifetime, whereas majority of the participants (approximately 49% males and 56% females) displayed their unawareness regarding materials used for dental implants. The overall acceptance rates of participants for autografts, alloplasts, xenografts from the cow, xenografts from the horse, and allografts were 40%, 15.9%, 2.5%, 2.2%, and 1.6%, respectively. Conclusion The expense of dental implants was considered the foremost reason for avoiding the procedure. Most of the participants think that fixed dental prostheses last longer than removable prosthesis. Autograft was the most accepted bone graft, whereas allograft was the least accepted bone graft over the responded participants.
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Affiliation(s)
- Malak Sultan Alkhaldi
- Department of Dental Intern, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Abrar Ali Alshuaibi
- Department of Dental Intern, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Shamoukh Safar Alshahran
- Department of Dental Intern, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Pradeep Koppolu
- Department of Preventive Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Rawa Kamal Abdelrahim
- Department of Preventive Dental Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
| | - Lingam Amara Swapna
- Department of Surgical and Diagnostic Sciences, College of Dentistry, Dar Al Uloom University, Riyadh, Kingdom of Saudi Arabia
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12
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Designing a Liver Transplant Patient and Family Decision Support Tool for Organ Offer Decisions. Transplant Direct 2021; 7:e695. [PMID: 33937520 PMCID: PMC8081471 DOI: 10.1097/txd.0000000000001140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/21/2021] [Accepted: 01/31/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND For liver transplant candidates on the waiting list, deciding to accept a donor organ with known or potential risk factors can be stressful and can lead to declined offers. Current education for patients and family often takes place during transplant evaluations and can be overwhelming and result in low retention and poor understanding of donor quality. METHODS In the first phase, we sought to understand provider experiences when counseling patients about donor risks and donor offers. We conducted interviews and focus groups with liver transplant providers at 1 local center and at a national clinician conference. Twenty providers participated: 15 hepatologists and 5 surgeons. The provider feedback was used to create an initial outline of content that is consistent with decision support frameworks. In a second phase, graphic design collaborators created mockups of a patient-friendly tool. We reviewed mockups with 4 transplant coordinators and 9 liver transplant candidates for feedback on clarity and utility to prepare for an organ offer. Patient responses allowed a comparison of perceived readiness to receive an offer call before and after viewing mockups. RESULTS We identified themes relating to the offer process, repetition and timing of education, and standardization and tailoring of content. The results indicated a gap in available education after the evaluation session, and information specific to offer decisions is needed. Patient feedback emphasized the need to review the offer process before a real offer. CONCLUSIONS Patients and providers responded favorably to a patient tool addressing existing gaps in education while waiting for a donor offer. Additional patient, family, and provider feedback will guide the development of an interactive tool to prepare patients and families for an offer decision.
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Tan EK, Koh YX, Kee T, Juhari JB, Tan TE, Sim DKL, Ho AYL, Krishnan L, Tee PS, Krishnamoorthy TL, Goh BKP, Tan BH, Chung SJ, Phua GC, Jeyaraj PR. Waitlisted Transplant Candidates' Attitudes and Concerns Toward Transplantation During COVID-19. Ann Transplant 2020; 25:e926992. [PMID: 33289727 PMCID: PMC7735226 DOI: 10.12659/aot.926992] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background In solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients, coronavirus disease 2019 (COVID-19) can contribute to a severe clinical course and an increased risk of death. Thus, patients awaiting a SOT or HSCT face the dilemma of choosing between a life-saving treatment that presents a significant threat of COVID-19 and the risk of waitlist dropout, progression of disease, or mortality. The lack of established literature on COVID-19 complicates the issue as patients, particularly those with inadequate health literacy, may not have the resources needed to navigate these decisions. Material/Methods We conducted a standardized phone survey of patients awaiting SOT or HSCT to assess the prevalence of inadequate health literacy and attitudes toward transplant during the COVID-19 pandemic. Results Seventy-one patients completed the survey, with a response rate of 84.5%. Regardless of health literacy, most waitlisted candidates recognized that the current pandemic is a serious situation affecting their care and that COVID-19 poses a significant risk to their health. Despite the increased risks, most patients reported they would choose immediate transplantation if there was no foreseeable end to the pandemic, and especially if the medical urgency did not permit further delay. There were no differences in responses across the patient waitlist groups for heart, kidney, liver, and stem cell transplant. Conclusions These findings can help transplant centers decide how transplantation services should proceed during this pandemic and can be used to educate patients and guide discussions about informed consent for transplant during the COVID-19 pandemic.
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Affiliation(s)
- Ek Khoon Tan
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Ye Xin Koh
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Terence Kee
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore.,Department of Renal Medicine Singapore General Hospital, Singapore, Singapore
| | | | - Teing Ee Tan
- National Heart Center, Singapore, Singapore.,Department of Cardiothoracic Surgery, Singapore General Hospital, Singapore, Singapore
| | - David Kheng Leng Sim
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore.,Department of Cardiology, Singapore General Hospital, Singapore, Singapore
| | - Aloysius Yew Leng Ho
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore.,Department of Cardiology, Singapore General Hospital, Singapore, Singapore
| | | | - Ping Sing Tee
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Thinesh Lee Krishnamoorthy
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore.,Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Brian Kim Poh Goh
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
| | - Ban Hock Tan
- SingHealth Duke-NUS Transplant Centre,, Singapore, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Shimin Jasmine Chung
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Ghee Chee Phua
- SingHealth Duke-NUS Transplant Centre, Singapore, Singapore.,Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Prema Raj Jeyaraj
- Department of Hepato-Pancreato-Biliary and Transplant Surgery, SinghealthSingapore General Hospital, Singapore, Singapore.,SingHealth Duke-NUS Transplant Centre, Singapore, Singapore
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14
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Romanos GE, Romanos EB, Alqahtani F, Alqahtani M, Javed F. "Religious Belief": An Undervalued Ethical Inclusion Criterion for Clinical Trials on Bone Grafting Procedures. JOURNAL OF RELIGION AND HEALTH 2020; 59:2928-2934. [PMID: 31154591 DOI: 10.1007/s10943-019-00851-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of the present review was to assess randomized controlled trials (RCTs) on bone grafting procedures that included religious belief as an eligibility criterion. Indexed databases were searched up to and including February 2019 using different search strategies. In strategy 1, the following terms were used: (a) belief; (b) bone graft; (c) faith; (d) inclusion; (e) exclusion; (f) eligibility; (g) criteria; (h) randomized clinical trial; (i) religion; and (j) xenograft. In strategy 2, the following terms were used in addition to those used in strategy 1: Xenografts AND oral surgery OR xenografts AND maxillofacial OR xenografts AND dental implants. These searches were filtered using the terms "Randomized clinical trial" and "human studies". The initial search yielded 3932 studies. Filtration of results using the terms "Randomized clinical trial" and "human studies" showed 0 studies. Evaluation of patients' religious beliefs seems to be undervalued in RCTs related to the placement of xenografts. This is an essential and ethical criterion that should be taken into consideration prior to inclusion of participants and signing the informed consent form for RCTs related to the placement of bone grafts.
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Affiliation(s)
- Georgios E Romanos
- Department of Periodontology, Stony Brook University, Stony Brook, NY, USA
- Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, Stony Brook, NY, 11794, USA
| | | | - Fawaz Alqahtani
- Department of Prosthodontics, College of Dentistry, Prince Sattam Bin Abdul-Aziz University, Al-Kharj, 11942, Saudi Arabia
| | - Mana Alqahtani
- Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Fawad Javed
- Department of Periodontology, Stony Brook University, Stony Brook, NY, USA.
- Laboratory for Periodontal-, Implant-, Phototherapy (LA-PIP), School of Dental Medicine, Stony Brook University, Stony Brook, NY, 11794, USA.
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15
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Neuberger J, Callaghan C. Organ utilization - the next hurdle in transplantation? Transpl Int 2020; 33:1597-1609. [PMID: 32935386 DOI: 10.1111/tri.13744] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
Nonutilization of organs from consented deceased donors remains a significant factor in limiting patient access to transplantation. Critical to reducing waste is a clear understanding of why organs are not used: accurate metrics are essential to identify the extent and causes of waste but use of these measures as targets or comparators between units/jurisdictions must be done with caution as focus on any one measure may result in unintended adverse consequences. Comparison between centres or countries may be misleading because of variation in definitions, patient or graft characteristics. Two of the most challenging areas to improve appropriate deceased donor organ utilization are appetite for risk and lack of validated tools to help identify an organ that will function appropriately. Currently, the implanting surgeon is widely considered to be accountable for the use of a donated organ so guidelines must be clear to allow and support sensible decisions and recognition that graft failure or inadvertent disease transmission are not necessarily attributable to poor decision-making. Accepting an organ involves balancing risk and benefit for the potential recipient. Novel technologies such as machine perfusion may allow for more robust guidance as to the functioning of the organ.
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Affiliation(s)
| | - Chris Callaghan
- Department of Nephrology and Transplantation, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital and the Evelina London Children's Hospital, London, UK
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16
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Shinkunas LA, Klipowicz CJ, Carlisle EM. Shared decision making in surgery: a scoping review of patient and surgeon preferences. BMC Med Inform Decis Mak 2020; 20:190. [PMID: 32787950 PMCID: PMC7424662 DOI: 10.1186/s12911-020-01211-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background Many suggest that shared decision-making (SDM) is the most effective approach to clinical counseling. It is unclear if this applies to surgical decision-making-especially regarding urgent, highly-morbid operations. In this scoping review, we identify articles that address patient and surgeon preferences toward SDM in surgery. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) to develop our protocol. Medline, EMBASE, and Cochrane databases were searched from inception through 11.2017. Title/abstract review identified peer-reviewed, empirical articles that addressed patient/surgeon preferences toward SDM in surgery. Identified articles underwent full review by two independent investigators. We addressed the following questions: (1) What is known from existing empirical evidence about patients’ and/or surgeons’ surgical decision-making preferences? (2) Why might patients and/or surgeons prefer SDM? (3) Does acuity of intervention impact surgical decision-making preferences? Outcome measures included study methods, surgical specialty, diagnosis, study location/setting, type/number of subjects, acuity of intervention, surgeon/patient decision-making preferences, and factors associated with favoring SDM. Data was analyzed in Microsoft Excel. Results 20,359 articles were identified with 4988 duplicates, yielding 15,371 articles for title/abstract review. 74 articles were included in final analysis. 68% of articles discussed oncologic decision-making. 46% of these focused on breast cancer. 92% of articles included patients, 22% included surgeons. 75% of articles found surgeons favored SDM, 25% demonstrated surgeons favored surgeon guidance. 54% of articles demonstrated patients favored SDM, 35% showed patients favored surgeon guidance, 11% showed patients preferred independent decision-making. The most common factors for patients favoring SDM included female gender, higher education, and younger age. For surgeons, the most common factors for favoring SDM included limited evidence for a given treatment plan, multiple treatment options, and impact on patient lifestyle. No articles evaluated decision-making preferences in an emergent setting. Conclusions There has been limited evaluation of patient and surgeon preferences toward SDM in surgical decision-making. Generally, patients and surgeons expressed preference toward SDM. None of the articles evaluated decision-making preferences in an emergent setting, so assessment of the impact of acuity on decision-making preferences is limited. Extension of research to complex, emergent clinical settings is needed.
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Affiliation(s)
- Laura A Shinkunas
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, USA
| | | | - Erica M Carlisle
- Program in Bioethics and Humanities, University of Iowa Carver College of Medicine, Iowa City, USA. .,Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA.
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17
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Godown J, Schumacher KR, Butler A, Chapman G, Dipchand AI, Kaslow WW, Bearl DW, Kirk R. Patients and their family members prioritize post-transplant survival over waitlist survival when considering donor hearts for transplantation. Pediatr Transplant 2020; 24:e13589. [PMID: 31562687 DOI: 10.1111/petr.13589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 07/31/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
Abstract
Heart transplant providers often focus on post-transplant outcomes when making donor decisions, potentially at the expense of higher waitlist mortality. This study aimed to assess public opinion regarding the selection of donor hearts and the balance between pre- and post-transplant risk. The authors generated a survey to investigate public opinion regarding donor acceptance. The survey was shared freely online across social media platforms in April-May 2019. A total of 718 individuals responded to the survey, with an equal distribution between patients and family members. Respondents consistently favored post-transplant outcomes over waitlist outcomes. About 83.9% of respondents favored a hospital with longer waitlist times, worse waitlist outcomes, but excellent post-transplant survival over a hospital with short waitlist times, a high waitlist survival, and inferior post-transplant survival. This preference was no different between pediatric and adult populations (P = .7), patient and family members (P = .935), or those with a pre- vs post-transplant perspective (P = .985). Patients and their family members consistently favor improved post-transplant survival over waitlist survival when considering the risks of accepting a donor organ. These findings suggest that current practice patterns of donor selection align with the opinions of patients and family members with heart failure or who have undergone heart transplantation.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Kurt R Schumacher
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | | | | | - Anne I Dipchand
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Whitney W Kaslow
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - David W Bearl
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Richard Kirk
- Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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18
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Cardinal H, Ballesteros Gallego F, Affdal A, Fortin MC. Canadian transplant nephrologists' perspectives on the decision-making process for accepting or refusing a kidney from a deceased organ donor. Clin Transplant 2020; 34:e13793. [PMID: 31989699 DOI: 10.1111/ctr.13793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/07/2020] [Accepted: 01/21/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Kidney transplantation is the best treatment for patients with end-stage renal disease. The decision to accept a kidney from a deceased donor can be a difficult one, especially when organs from high KDPI (>85%) donors are offered. This study aims to capture the perspectives of transplant nephrologists (TNs) on the decision-making process when an organ is offered. METHODS Fifteen Canadian TNs took part in semi-structured interviews between December 2017 and April 2018. The interviews were digitally recorded, transcribed, and analyzed using the thematic analysis method. RESULTS The decision to accept a deceased-donor kidney offer is a medical one for the participants. However, transplant candidates could be involved when the offered kidney is from a donor with a KDPI >85% or increased infectious risk donor. The TNs' past experience, comprehensive data on the donor, and education of the transplant candidate could facilitate the decision-making process. A decision aid could also facilitate the decision-making process, but different concerns should be addressed. CONCLUSION Although accepting a deceased-donor organ offer is often viewed as an opportunity for shared decision-making, participants in this study viewed the decision to accept or refuse an offer as a medical decision with little room for patient participation.
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Affiliation(s)
- Héloïse Cardinal
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, QC, Canada.,Université de Montréal, Montréal, QC, Canada
| | - Fabian Ballesteros Gallego
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, QC, Canada
| | | | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, QC, Canada.,Université de Montréal, Montréal, QC, Canada
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19
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Wu TH, Wang YC, Cheng CH, Lee CF, Wu TJ, Chou HS, Chan KM, Lee WC. Outcomes associated with the intention of loco-regional therapy prior to living donor liver transplantation for hepatocellular carcinoma. World J Gastrointest Surg 2020; 12:17-27. [PMID: 31984121 PMCID: PMC6943093 DOI: 10.4240/wjgs.v12.i1.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/06/2019] [Accepted: 11/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Loco-regional therapy for hepatocellular carcinoma (HCC) during the period awaiting liver transplantation (LT) appears to be a logical approach to reduce the risk of tumor progression and dropout in the waitlist. Living donor LT (LDLT) offers a flexible timing for transplantation providing timeframe for well preparation of transplantation.
AIM To investigate outcomes in relation to the intention of pre-transplantation loco-regional therapy in LDLT for HCC patients.
METHODS A total of 308 consecutive patients undergoing LDLTs for HCC between August 2004 and December 2018 were retrospectively analyzed. Patients were grouped according to the intention of loco-regional therapy prior to LT, and outcomes of patients were analyzed and compared between groups.
RESULTS Overall, 38 patients (12.3%) were detected with HCC recurrence during the follow-up period after LDLT. Patients who were radiologically beyond the University of California at San Francisco criteria and received loco-regional therapy as down-staging therapy had significant inferior outcomes to other groups for both recurrence-free survival (RFS, P < 0.0005) and overall survival (P = 0.046). Moreover, patients with defined profound tumor necrosis (TN) by loco-regional therapy had a superior RFS (5-year of 93.8%) as compared with others (P = 0.010).
CONCLUSION LDLT features a flexible timely transplantation for patient with HCC. However, the loco-regional therapy prior to LDLT does not seem to provide benefit unless a certain effect in terms of profound TN is noted.
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Affiliation(s)
- Tsung-Han Wu
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Yu-Chao Wang
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Chih-Hsien Cheng
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Chen-Fang Lee
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Ting-Jung Wu
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Hong-Shiue Chou
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
| | - Kun-Ming Chan
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
- Department of Organs Transplantation Institute, Chang Gung University College of Medicine, Taoyun 33305, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
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20
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Petrini C, Trapani S, Riva L, Floridia G, Gainotti S, Lombardini L, Masiero L, Rizzato L, Costa AN. Organ Transplantation From Nonstandard Risk Donors: Midway Between Rigid and Flexible Rules. Transplant Proc 2019; 51:2856-2859. [PMID: 31606186 DOI: 10.1016/j.transproceed.2019.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/17/2019] [Indexed: 10/25/2022]
Abstract
In order to bridge the gap between available organs and patients needing transplants, donor selection criteria for donors are increasingly being extended; the possibility of using organs from nonstandard risk donors has been introduced in many countries. This clearly poses considerable ethical issues that should be analyzed and taken into consideration by the competent bodies and institutions. In this article, we illustrate the Italian situation regarding the possibility of using organs from anti-hepatitis C virus (HCV) and HCV RNA-positive donors (anti-HCV+ve) in negative recipients (healthy subjects who have never come into contact with the hepatitis C virus) in light of the availability of new direct-acting antiviral drugs (DAAs) for hepatitis C treatment. We discuss the motivations behind the both favorable opinions of the Ethics Committee of the Italian National Institute of Health (Istituto Superiore di Sanità) and the Italian National Bioethics Committee (Comitato Nazionale per la Bioetica) discussing the main implications from an ethical point of view.
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Affiliation(s)
- Carlo Petrini
- Unità di Bioetica, Istituto Superiore di Sanità, via Giano della Bella, Rome, Italy; Comitato Nazionale per la Bioetica, Presidenza del Consiglio dei Ministri, via della Mercede, Rome, Italy.
| | - Silvia Trapani
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, via Giano della Bella, Italy
| | - Luciana Riva
- Unità di Bioetica, Istituto Superiore di Sanità, via Giano della Bella, Rome, Italy
| | - Giovanna Floridia
- Unità di Bioetica, Istituto Superiore di Sanità, via Giano della Bella, Rome, Italy
| | - Sabina Gainotti
- Unità di Bioetica, Istituto Superiore di Sanità, via Giano della Bella, Rome, Italy
| | - Letizia Lombardini
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, via Giano della Bella, Italy
| | - Lucia Masiero
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, via Giano della Bella, Italy
| | - Lucia Rizzato
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, via Giano della Bella, Italy
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21
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Humar SS, Liu J, Pinzon N, Kumar D, Bhat M, Lilly L, Selzner N. Attitudes of Liver Transplant Candidates Toward Organs From Increased-Risk Donors. Liver Transpl 2019; 25:881-888. [PMID: 30947392 DOI: 10.1002/lt.25467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/17/2019] [Indexed: 12/13/2022]
Abstract
Increased-risk donor (IRD) organs make up a significant proportion of the deceased organ donor pool but may be declined by patients on the waiting list for various reasons. We conducted a survey of patients awaiting a liver transplant to determine the factors leading to the acceptance of an IRD organ as well as what strategies could increase the rate of acceptance. Adult liver transplant candidates who were outpatients completed a survey of 51 questions on a 5-point Likert scale with categories related to demographics, knowledge of IRDs, and likelihood of acceptance. A total of 150 transplant candidates completed the survey (age 19-80 years). Male patients constituted 67.3%. Many patients (58.7%) had postsecondary education. Only 23.3% of patients had a potential living donor, and 58/144 (40.3%) were not optimistic about receiving an organ in the next 3 months. The overall IRD organ acceptance rate was 41.1%, whereas 26.2% said they would decline an IRD organ. Women were more likely to accept an IRD organ (54.3% versus 34.7%; P = 0.02). Those who had a college education or higher tended to have lower IRD organ acceptability (28.3% versus 47.4%; P = 0.07). Acceptability also increased as the specified transmission risk of human immunodeficiency virus or hepatitis C virus decreased (P < 0.001). Patients were also more likely to accept an IRD organ if they were educated on the benefits of IRD organs (eg, knowledge that an IRD organ was of better quality increased overall acceptance from 41.1% to 63.3%; P < 0.001). Our survey provides insight into liver transplant candidates who would benefit from greater education on IRD organs. Strategies targeting specific educational points are likely to increase acceptability.
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Affiliation(s)
- Sapna S Humar
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jingqian Liu
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Natalia Pinzon
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Deepali Kumar
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mamatha Bhat
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Les Lilly
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nazia Selzner
- Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
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22
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Mitchell E, Loomes KM, Squires RH, Goldberg D. Variability in acceptance of organ offers by pediatric transplant centers and its impact on wait-list mortality. Liver Transpl 2018; 24:803-809. [PMID: 29506323 DOI: 10.1002/lt.25048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022]
Abstract
Recent data have suggested that pediatric patients wait-listed for a liver transplantation frequently have liver offers declined. However, factors associated with liver offer decisions and center-level variability in practice patterns have not been explored. We evaluated United Network for Organ Sharing data on all match runs from May 1, 2007 to December 31, 2015 in which the liver was offered to ≥1 pediatric patient; the transplant recipient was ranked in the first 40 positions for the organ offer; and the donor was brain-dead and <50 years of age. We used multilevel mixed effects models to evaluate factors associated with organ offer acceptance, among-center variability, and the association between center-level acceptance and wait-list mortality. There were 4088 unique pediatric patients during the study period, comprising 27,094 match runs. Initial Model for End-Stage Liver Disease or Pediatric End-Stage Liver Disease score, history of exception points, recipient region, rank on match run, and geographic share type were all associated with probability of offer acceptance. There was significant among-center variation (P < 0.001) in adjusted liver offer acceptance rates, accounting for donor, recipient, and match-related factors (adjusted acceptance rates: median, 8.9%; range, 5.1%-14.6%). Center-level acceptance rates were associated with wait-list mortality, with a >10% increase in the risk of wait-list mortality for every 1% decrease in a center's adjusted liver offer acceptance rate (odds ratio, 1.10; 95% confidence interval, 1.01-1.19). In conclusion, there is significant among-center variability in liver offer acceptance rates for pediatric patients that is not explained by donor and recipient factors. A center's liver acceptance behavior significantly impacts whether a pediatric patient will be transplanted or die on the waiting list. Liver Transplantation 24 803-809 2018 AASLD.
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Affiliation(s)
- Ellen Mitchell
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Kathleen M Loomes
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert H Squires
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA
| | - David Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
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23
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Flores A, Asrani SK. The donor risk index: A decade of experience. Liver Transpl 2017; 23:1216-1225. [PMID: 28590542 DOI: 10.1002/lt.24799] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023]
Abstract
In 2006, derivation of the donor risk index (DRI) highlighted the importance of donor factors for successful liver transplantation. Over the last decade, the DRI has served as a useful metric of donor quality and has enhanced our understanding of donor factors and their impact upon recipients with hepatitis C virus, those with low Model for End-Stage Liver Disease (MELD) score, and individuals undergoing retransplantation. DRI has provided the transplant community with a common language for describing donor organ characteristics and has served as the foundation for several tools for organ risk assessment. It is a useful tool in assessing the interactions of donor factors with recipient factors and their impact on posttransplant outcomes. However, limitations of statistical modeling, choice of donor factors, exclusion of unaccounted donor and geographic factors, and the changing face of the liver transplant recipient have tempered its widespread use. In addition, the DRI was derived from data before the MELD era but is currently being applied to expand the donor pool while concurrently meeting the demands of a dynamic allocation system. A decade after its introduction, DRI remains relevant but may benefit from being updated to provide guidance in the use of extended criteria donors by accounting for the impact of geography and unmeasured donor characteristics. DRI could be better adapted for recipients with nonalcoholic fatty liver disease by examining and including recipient factors unique to this population. Liver Transplantation 23 1216-1225 2017 AASLD.
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Affiliation(s)
- Avegail Flores
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
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24
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Kamran S, Conti F, Pomey MP, Baron G, Calmus Y, Vidal-Trecan G. Patients’ preferences in transplantation from marginal donors: results of a discrete choice experiment. Transpl Int 2017; 30:589-602. [DOI: 10.1111/tri.12944] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/08/2016] [Accepted: 02/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Sara Kamran
- Public Health Ward: Quality and Risk Management; Paris left University Hospitals; Assistance Publique - Hôpitaux de Paris; Paris France
- Doctoral School of Public Health (EDSP); Paris France
| | - Filomena Conti
- Centre de Transplantation Hépatique; Pitié Salpêtrière Hospital; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Marie-Pascale Pomey
- Department of Health Administration; Institut de Recherche en Santé Publique; Université de Montréal; Montréal QC Canada
| | - Gabriel Baron
- UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité left (CRESS); METHODS Team; INSERM; Paris France
- Centre d’Épidémiologie Clinique; Hôpital Hôtel Dieu; Assistance Publique des Hôpitaux de Paris; Paris France
| | - Yvon Calmus
- Centre de Transplantation Hépatique; Pitié Salpêtrière Hospital; Assistance Publique - Hôpitaux de Paris; Paris France
| | - Gwenaëlle Vidal-Trecan
- Public Health Ward: Quality and Risk Management; Paris left University Hospitals; Assistance Publique - Hôpitaux de Paris; Paris France
- UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité left (CRESS); METHODS Team; INSERM; Paris France
- Department of Public Health; Medical School; Paris Descartes University; Paris France
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25
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Bruzzone P, Balla A, Quaresima S, Seitaj A, Intini G, Giannarelli D, Paganini AM. Comparison of Two Questionnaires on Informed Consent in "Marginal" Donor Liver. Transplant Proc 2017; 48:359-61. [PMID: 27109955 DOI: 10.1016/j.transproceed.2015.12.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 12/30/2015] [Indexed: 11/25/2022]
Abstract
The necessity of liver donors has contributed to overcoming the traditional criteria and to propose new ones for the acceptance of livers for transplantation. For this reason expanded or extended criteria donation (ECD) or even overextended criteria for marginal or high-risk organ donors have been developed. Ethical, Legal and Psychological Aspects of Organ Transplantation (ELPAT) and European Liver and Intestine Transplant Association (ELITA) - European Liver Transplantation Registry (ELTR) coordinated the distribution of a previously reported questionnaire that was sent to 53 European liver transplant centers. Criteria were divided based on the response rate. Donor criteria such as steatosis and serum sodium >165 mmol/L, as well as recipient criteria such as previous history of cancer, were not considered contraindications to transplantation in more than 60% of cases. Criteria such as ICU (intensive care unit) stay, body mass index >30, serum bilirubin >3 mg/dL, and HIV infection or critical illness were not considered adequate for transplantation in 30% to 59% of cases. On the other hand, there was no agreement on other extended liver donor and recipient criteria, such as age up to 80 years, serum glutamic oxaloacetic transaminase >90 U/L, serum glutamic pyruvic transaminase >105 U/L, high-risk sex practices, drug users, patients older than 65 years, and patients younger than 65 years, respectively. Criteria such as serum sodium could not be considered ECD criteria. In conclusion, development of more studies and inclusion of more liver transplantation centers are required to confirm these data.
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Affiliation(s)
- P Bruzzone
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University, Rome, Italy.
| | - A Balla
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University, Rome, Italy
| | - S Quaresima
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University, Rome, Italy
| | - A Seitaj
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University, Rome, Italy
| | - G Intini
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University, Rome, Italy
| | | | - A M Paganini
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University, Rome, Italy
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Fernández RF, Bucchi C, Navarro P, Beltrán V, Borie E. Bone grafts utilized in dentistry: an analysis of patients' preferences. BMC Med Ethics 2015; 16:71. [PMID: 26486125 PMCID: PMC4618514 DOI: 10.1186/s12910-015-0044-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 07/14/2015] [Indexed: 11/30/2022] Open
Abstract
Background Many procedures currently require the use of bone grafts to replace or recover bone volume that has been resorbed. However, the patient’s opinion and preferences must be taken into account before implementing any treatment. Researchers have focused primarily on assessing the effectiveness of bone grafts rather than on patients' perceptions. Thus, the aim of this study was to explore patients' opinions regarding the different types of bone grafts used in dental treatments. Methods One hundred patients were randomly chosen participated in the study. A standardized survey of 10 questions was used to investigate their opinions regarding the different types of bone grafts used in dental treatments. Descriptive statistics were calculated for the different variables, and absolute frequencies and percentages were used as summary measures. A value of p <0.05 was selected as the threshold for statistical significance. Results The highest rate of refusal was observed for allografts and xenografts. The grafts with the lowest rates of refusal were autologous grafts (3 %) and alloplastics (2 %). No significant differences were found between the various types of bone grafts in the sociodemographic variables or the refusal/acceptance variable. Similarly, no significant relations were observed between a specific religious affiliation and the acceptance/refusal rates of the various types of graft. Conclusions Allografts and xenografts elicited the highest refusal rates among the surveyed patients, and autologous bone and alloplastics were the most accepted bone grafts. Moreover, no differences were found in the sociodemographic variables or religious affiliations in terms of the acceptance/refusal rates of the different bone grafts.
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Affiliation(s)
- Ramón Fuentes Fernández
- Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Manuel Montt #112, 4781176, Temuco, Chile.
| | - Cristina Bucchi
- Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Manuel Montt #112, 4781176, Temuco, Chile.
| | - Pablo Navarro
- Mathematics and Statistic Department, Universidad de La Frontera, Temuco, Chile.
| | - Víctor Beltrán
- Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Manuel Montt #112, 4781176, Temuco, Chile.
| | - Eduardo Borie
- Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Manuel Montt #112, 4781176, Temuco, Chile. .,Department of Dental Materials and Prosthodontics, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Thiessen C, Gordon EJ, Reese PP, Kulkarni S. Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Nonmaleficence and Autonomy. Am J Transplant 2015; 15:2314-23. [PMID: 25868787 DOI: 10.1111/ajt.13272] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 01/25/2023]
Abstract
Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes.
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Affiliation(s)
- C Thiessen
- Department of Surgery, Section of Organ Transplantation & Immunology, Yale University School of Medicine, New Haven, CT
| | - E J Gordon
- Comprehensive Transplant Center, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - P P Reese
- Renal-Electrolyte and Hypertension Division, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - S Kulkarni
- Department of Surgery, Section of Organ Transplantation & Immunology, Yale University School of Medicine, New Haven, CT
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28
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den Dries SO, Porte RJ. Reply: To PMID 24863055. Liver Transpl 2015; 21:141-2. [PMID: 25348089 DOI: 10.1002/lt.24031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/19/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Sanna Op den Dries
- Section of Hepatopancreatobiliary Surgery and Liver Transplantation, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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29
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Volk ML. Patient preferences about organ offers in liver transplantation. Liver Transpl 2015; 21:140-1. [PMID: 25332159 DOI: 10.1002/lt.24026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 01/12/2023]
Affiliation(s)
- Michael L Volk
- Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI
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