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Spardy J, Concepcion J, Yeager M, Andrade R, Braun H, Elkbuli A. National Analysis of Recent Trends in Organ Donation and Transplantation in the United States: Toward Optimizing Care Delivery and Patient Outcomes. Am Surg 2023; 89:5201-5209. [PMID: 36423909 DOI: 10.1177/00031348221135776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION In 2021, over 100 000 people were awaiting solid organ transplantation, yet only 44 634 transplants were performed. The aim of this study is to evaluate trends in donor availability, waitlist additions, and transplants performed in the United States from 2001 to 2021. METHODS This was a retrospective analysis to evaluate trends in donor availability, waitlist additions, and solid organ transplants for the 4 most common organs requiring transplants (kidney, liver, heart, and lung) between 2001 and 2021 according to OPTN data. RESULTS Between 2001 and 2021, the overall number of transplants performed, donors available, and waitlist additions increased by 71%, 61%, and 54%, respectively. The number of kidney transplant waitlist additions significantly increased compared to other organs (P < .001). For each kidney transplant performed, there was a 2.25 increase in waitlist additions throughout the study period (P < .001). For each liver and heart transplant performed, there was a .92 and .80 increase in waitlist additions, respectively (P < .001). Lung transplants increased the most by 138% and there was an increase in waitlist additions for every transplant by 1.0 (P < .001). CONCLUSION There was an absolute increase in the annual number of transplants, donor recruitment, and patients added to the waitlist between 2001 and 2021. Kidney transplant waitlist additions are increasing at a rate outpacing the rates of donor recruitment and transplantation.
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Affiliation(s)
- Jeffrey Spardy
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | | | - Matthew Yeager
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ryan Andrade
- A.T. Still University School of Osteopathic Medicine, Mesa, AZ, USA
| | - Hillary Braun
- Department of Surgery, Zuckerberg General Hospital and Trauma Center, San Francisco, CA, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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Parija S, Chakraborty K, Sahu DP. A study on knowledge, attitude, and practice about eye donation among medical students and healthcare professionals at a tertiary hospital in Eastern India. Indian J Ophthalmol 2023; 71:3513-3520. [PMID: 37870016 PMCID: PMC10752322 DOI: 10.4103/ijo.ijo_2554_22] [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: 10/03/2022] [Revised: 06/27/2023] [Accepted: 07/17/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To assess and analyze the rate of knowledge, attitude, and practice patterns about eye donation among medical and healthcare professionals in a tertiary care hospital in eastern India. Methods This was a cross-sectional, descriptive study conducted on medical students, resident doctors, and nursing and paramedical staff at a tertiary institute in the year 2020. A pretested, structured questionnaire consisting of 28 questions in the three subsections based on knowledge and awareness, attitudes and beliefs, and practice patterns mainly willingness to donate eyes by pledging, was noted. All the responses were individually scored, and the total scores were calculated. Univariate analysis was done to find out the factors that had a positive or negative influence on the knowledge and willingness about eye donation. Results Around 270 participants responded to this survey. The majority of the respondents (206, 76.3%) were below 30 years and 64.4% were males. Awareness about eye donation was 95.6% but a willingness to pledge was observed in 51.5% of participants. The total practice score was lower among nonmedicos compared with medicos (3.33 ± 1.22 vs 3.74 ± 0.64), (P < 0.001). On univariate analysis, the Crude Odds Ratio with a 95% confidence interval was 25.787 (5.18-128.33) in the occupational category (P < 0.001). Conclusion The study reported an adequate knowledge level among doctors and healthcare workers. The practice pattern among the nursing staff and paramedical workers needs to be improved as they can play a pivotal role in strengthening the hospital corneal retrieval program. They can also be the key messengers during public awareness campaigns for eye donations in our country.
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Affiliation(s)
- Sucheta Parija
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Koyel Chakraborty
- Department of Ophthalmology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Dinesh Prasad Sahu
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Marcon AR, Wagner DN, Rachul C, Weiss MJ. Analyzing online public commentary responding to the announcement of deemed consent organ donation legislation in the Canadian province of Nova Scotia. PLoS One 2022; 17:e0278983. [PMID: 36520833 PMCID: PMC9754165 DOI: 10.1371/journal.pone.0278983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The Canadian province of Nova Scotia recently became the first jurisdiction in North America to pass deemed consent organ donation legislation. The announcement of this legislation generated substantial online discussion, which we analyzed to provide insights on public perception. METHODS We performed directed content analysis on 2663 user-generated comments appearing on two widely-shared Canadian Broadcasting Company (CBC) articles published online in April 2019. We determined levels of support and opposition in comments and described the specific rhetoric used for doing so. We also performed one-way ANOVA and Pearson chi-square tests to determine how the comments were being received and engaged by other users. RESULTS A range of commentary was present in both support and opposition to the changes in legislation. There were more negative than positive comments, and negative commentary generated more replies. Positive comments were received more positively by other users while negative comments were received more negatively. The total sum of negative comments was greatly influenced by a small number of very active participants. Negative commentary focused more on broad concepts and principles related to government, power, and individual rights rather than specific issues in the Nova Scotian context. Substantial issues of trust in the government and healthcare system were evident. CONCLUSIONS There were strong positive and negative sentiments expressed in the comments, but the total sum of negativity in the comments was significantly influenced by a small number of commentators. Analysis on the presumed consent concerns can be helpful to inform public outreach efforts.
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Affiliation(s)
- Alessandro R. Marcon
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada
| | - Darren N. Wagner
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada
| | - Christen Rachul
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MN, Canada
| | - Matthew J. Weiss
- FRCPC, Transplant Québec, Montréal, QC, Canada
- CHU de Québec, Université Laval Research Centre, Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Université Laval, Québec, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
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Łabuś W, Kitala D, Navarro A, Klama-Baryła A, Kraut M, Sitkowska A, Smętek W, Kamiński A. The urgent need to achieve an optimal strategic stock of human allogeneic skin graft materials in case of a mass disaster in Poland. Cell Tissue Bank 2022; 23:863-885. [PMID: 35355193 PMCID: PMC8967378 DOI: 10.1007/s10561-022-10001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 02/27/2022] [Indexed: 12/03/2022]
Abstract
A burn is a sudden injury which immediate or long-term consequences may be life-threatening for the patient. A mass disaster event may involve large numbers of severely burned patients. Patients of this type typically have a limited area of healthy, unburned skin from which an autologous split thickness skin graft could be collected. In a clinical situation of this type, it is necessary to use a particular skin substitute. Non-viable allogeneic human skin graft materials might be considered as the most suitable skin substitutes in the treatment of such patients. At present, Poland does not have a sufficient supply of human allogeneic skin graft materials to meet the needs arising from a sudden and unforeseen mass disaster. This study involved an analysis of selected mass disasters. From this an estimate was made from a verified casualty profile of the necessary minimum stock of human allogeneic skin graft materials. An insufficient amount of skin results from an inadequate number of skin donors, which in turn results from the current tissue donation system. Therefore, a proposal has been made for the organizational, legal and systemic changes required to improve the situation in Polish transplantology, with particular emphasis on skin donation. In order to achieve a strategic stock of human skin grafts, a tissue collecting transplantation team should be organized. The rights and obligations of the non-physician transplant team member should be extended. Proposals have been made for awareness campaigns (adverts, posters etc.) and educational schemes (educational video, lectures during transplant coordinator training, etc.). Finally, a proposal has been made for possible methods to deal with the logistic management of the allogeneic skin stock. The required, essential stock of human allogeneic skin in the event of a mass disaster has been estimated at 600,000 cm2.
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Affiliation(s)
- Wojciech Łabuś
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | - Diana Kitala
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | | | - Agnieszka Klama-Baryła
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | - Małgorzata Kraut
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | - Anna Sitkowska
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
| | - Wojciech Smętek
- Tissue Bank, Dr Stanisław Sakiel Centre for Burn Treatment, ul. Jana Pawła II 2, 41-100 Siemianowice Śląskie, Poland
- Warsaw University of Technology, Warsaw, Poland
| | - Artur Kamiński
- Department of Transplantology and Central Tissue Bank, Medical University of Warsaw, Warsaw, Poland
- National Centre for Tissue and Cell Banking, Warsaw, Poland
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Molina-Pérez A, Rodríguez-Arias D, Delgado J. Differential impact of opt-in, opt-out policies on deceased organ donation rates: a mixed conceptual and empirical study. BMJ Open 2022; 12:e057107. [PMID: 36441113 PMCID: PMC9462118 DOI: 10.1136/bmjopen-2021-057107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To increase postmortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the direct impact of consent policy defaults per se on deceased organ recovery rates when considering the role of the family in the decision-making process. This study does not take into account any indirect effects of defaults, such as potential psychological and behavioural effects on individuals and their relatives. DESIGN Based on previous work regarding consent policies, we created a conceptual model of the decision-making process for deceased organ recovery that included any scenario that could be directly influenced by opt-in or opt-out policies. We then applied this model to internationally published data of the consent process to determine how frequently policy defaults could apply. MAIN OUTCOME MEASURES We measure the direct impact that opt-in and opt-out policies have per se on deceased organ recovery. RESULTS Our analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. They only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The direct impact of consent policy defaults is typically circumscribed to a range of 0%-5% of all opportunities for organ recovery. Our study also shows that the intervention of the family improves organ retrieval under opt-in but hinders it under opt-out. CONCLUSIONS This study may warn policy makers that, by emphasising the need to introduce presumed consent to increase organ recovery rates, they might be overestimating the influence of the default and underestimating the power granted to families.
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Affiliation(s)
- Alberto Molina-Pérez
- Instituto de Estudios Sociales Avanzados (IESA), Consejo Superior de Investigaciones Científicas (CSIC), Cordoba, Spain
- FiloLab-UGR Scientific Unit of Excellence, Department of Philosophy 1, University of Granada, Granada, Spain
- Ethical, Legal and Psychosocial Aspects of Transplantation (ELPAT), European Society for Organ Transplantation, Padua, Italy
| | - David Rodríguez-Arias
- FiloLab-UGR Scientific Unit of Excellence, Department of Philosophy 1, University of Granada, Granada, Spain
- Ethical, Legal and Psychosocial Aspects of Transplantation (ELPAT), European Society for Organ Transplantation, Padua, Italy
| | - Janet Delgado
- FiloLab-UGR Scientific Unit of Excellence, Department of Philosophy 1, University of Granada, Granada, Spain
- Ethical, Legal and Psychosocial Aspects of Transplantation (ELPAT), European Society for Organ Transplantation, Padua, Italy
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Senanayake S, Healy H, McPhail SM, Baboolal K, Kularatna S. Cost-Effectiveness and Budget Impact Analysis of Implementing a 'Soft Opt-Out' System for Kidney Donation in Australia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:769-779. [PMID: 35843996 PMCID: PMC9385789 DOI: 10.1007/s40258-022-00747-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION There is a severe shortage of donor organs globally. There is growing interest in understanding how a 'soft opt-out' organ donation system could help bridge the supply and demand gap for donor organs. This research aims to estimate the cost-effectiveness and budget impact of implementing a 'soft opt-out' organ donation system for kidney donation. METHODS A decision-analytic model was developed to estimate the incremental costs from a health system's perspective, quality-adjusted life-years (QALYs), and death averted of people who have kidney failure, comparing a 'soft opt-out' organ donation system to an 'opt-in' system. This study analysed three scenarios where the 'soft opt-out' system generated a 20%, 30%, and 40% increase in deceased organ donation rates over 20 years. A 5-year time horizon was adopted for the budget impact analysis. RESULTS A 20% increase in organ donation rates could have a cost saving of 650 million Australian dollars (A$) and a 10,400-QALY gain. A 20% increase would avert more than 1500 deaths, while a 40% increase would avert 3200 deaths over a time horizon of 20 years. Over the first 5 years, a 20% increase would have a net saving of A$53 million, increasing to A$106 million if the donation rate increases by 40%. CONCLUSION A 'soft opt-out' organ donation system would return a cost saving for the healthcare system, a net gain in QALYs, and prevention of a significant number of deaths. Advantageous budgetary impact is important, but understanding the aversion for a 'soft opt-out' system in Australia is also important and remains a priority for further research.
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Affiliation(s)
- Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Helen Healy
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, Brisbane, QLD, 4059, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Keshwar Baboolal
- Royal Brisbane Hospital for Women, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, Brisbane, QLD, 4059, Australia
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Rajan T, Amin SO, Davis K, Finkle N, Glick N, Kahlon B, Martinusen D, Pederson K, Samanta R, Tarakji A, Stigant C. Redesigning Kidney Care for the Anthropocene: A New Framework for Planetary Health in Nephrology. Can J Kidney Health Dis 2022; 9:20543581221116215. [PMID: 35966172 PMCID: PMC9364184 DOI: 10.1177/20543581221116215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Climate change is one of the greatest threats to human health in the 21st century. The human health impacts of climate change contribute to approximately 1 in 4 deaths worldwide. Health care itself is responsible for approximately 5% of annual global greenhouse gas (GHG) emissions. Canada is a recent signatory of the 26th United Nations Climate Change Conference (COP26) health agreement that is committed to developing low carbon and climate resilient health systems. Kidney care services have a substantial environmental impact and there is opportunity for the kidney care community to climate align clinical care. We introduce a framework of redesigned kidney care and describe examples of low carbon kidney disease management strategies to expand our duty of care to the environment which completes the triple bottom line of optimal patient outcomes and cost effectiveness in the Anthropocene.
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Affiliation(s)
- Tasleem Rajan
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Syed Obaid Amin
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Regina, Canada
| | - Keefe Davis
- Division of Pediatric Kidney Health, Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Neil Finkle
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Naomi Glick
- Division of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Bhavneet Kahlon
- Division of Nephrology, Department of Medicine, University of Calgary, AB, Canada
| | - Dan Martinusen
- Faculty of Pharmaceutical Sciences, The University of British Columbia and Pharmacy Services, Island Health, Victoria, Canada
| | - Kristen Pederson
- Division of Nephrology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada
| | - Ratna Samanta
- Division of Nephrology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Ahmad Tarakji
- Division of Nephrology, Department of Medicine, McMaster University, Kitchener, ON, Canada
| | - Caroline Stigant
- Division of Nephrology, Island Health Authority, Department of Medicine, University of British Columbia, Vancouver, Canada
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Marcon AR, Wagner DN, Giles C, Isenor C. Web-Based Perspectives of Deemed Consent Organ Donation Legislation in Nova Scotia: Thematic Analysis of Commentary in Facebook Groups. JMIR INFODEMIOLOGY 2022; 2:e38242. [PMID: 37113450 PMCID: PMC9987187 DOI: 10.2196/38242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 04/29/2023]
Abstract
Background The Canadian province of Nova Scotia recently became the first jurisdiction in North America to implement deemed consent organ donation legislation. Changing the consent models constituted one aspect of a larger provincial program to increase organ and tissue donation and transplantation rates. Deemed consent legislation can be controversial among the public, and public participation is integral to the successful implementation of the program. Objective Social media constitutes key spaces where people express opinions and discuss topics, and social media discourse can influence public perceptions. This project aimed to examine how the public in Nova Scotia responded to legislative changes in Facebook groups. Methods Using Facebook's search engine, we searched for posts in public Facebook groups using the terms "deemed consent," "presumed consent," "opt out," or "organ donation" and "Nova Scotia," appearing from January 1, 2020, to May 1, 2021. The finalized data set included 2337 comments on 26 relevant posts in 12 different public Nova Scotia-based Facebook groups. We conducted thematic and content analyses of the comments to determine how the public responded to the legislative changes and how the participants interacted with one another in the discussions. Results Our thematic analysis revealed principal themes that supported and critiqued the legislation, raised specific issues, and reflected on the topic from a neutral perspective. Subthemes showed individuals presenting perspectives through a variety of themes, including compassion, anger, frustration, mistrust, and a range of argumentative tactics. The comments included personal narratives, beliefs about the government, altruism, autonomy, misinformation, and reflections on religion and death. Content analysis revealed that Facebook users reacted to popular comments with "likes" more than other reactions. Comments with the most reactions included both negative and positive perspectives about the legislation. Personal donation and transplantation success stories, as well as attempts to correct misinformation, were some of the most "liked" positive comments. Conclusions The findings provide key insights into perspectives of individuals from Nova Scotia on deemed consent legislation, as well as organ donation and transplantation broadly. The insights derived from this analysis can contribute to public understanding, policy creation, and public outreach efforts that might occur in other jurisdictions considering the enactment of similar legislation.
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Affiliation(s)
- Alessandro R Marcon
- Health Law Institute Faculty of Law University of Alberta Edmonton, AB Canada
| | - Darren N Wagner
- Health Law Institute Faculty of Law University of Alberta Edmonton, AB Canada
| | - Carly Giles
- Health Law Institute Faculty of Law University of Alberta Edmonton, AB Canada
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Leung KK, Kim A, Hansen BE, Lilly L, Selzner N, Patel K, Bhat M, Hirschfield GM, Galvin Z. The Impact of Primary Liver Disease and Social Determinants in a Mixed Donor Liver Transplant Program: A Single-Center Analysis. Liver Transpl 2021; 27:1733-1746. [PMID: 34092028 DOI: 10.1002/lt.26195] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/16/2021] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
Organ allocation in liver transplantation (LT) remains imperfect. Periodic center reviews ensure programs transparently evaluate the impact of practice on access to transplantation, reflecting, in particular, patient (primary disease, social determinants) and program (deceased versus live donation) factors. Adult Ontario residents waitlisted for first LT at Toronto General Hospital from November 2012 to May 2019 were reviewed. Analyses were performed between distance to transplant center, income, education level, population density and primary liver disease, with LT, deceased donor liver transplant (DDLT), living donor liver transplant (LDLT), and delisting. Of 1735 listed patients, 549 were delisted (32%), while 1071 were transplanted (62%), with 819 DDLT recipients (76%) and 252 LDLT recipients (24%), while 115 (7%) remained actively listed at data census. On univariate analysis, DDLT recipients lived 30% closer (median 39.7 versus 60.6 km; P < 0.001), lived in more populous areas (median 8501.0 versus 6868.5 people in a 1-km radius; P < 0.001), and resided in households that annually earned 10% less (median $92,643.17 versus $102,820.89 Canadian dollars; P < 0.001) compared with LDLT recipients. These findings with population density and income differences between DDLT versus LDLT receival remained significant on multivariate modeling even when accounting for primary liver disease. Primary liver disease was a statistically significant factor on multivariate analyses in LT receival (P = 0.001) as well as DDLT versus LDLT receival (P < 0.001). Of patients listed for end-stage liver disease, more patients with autoimmune cholestatic liver diseases received LDLT (34%-41%) than DDLT (27%-30%); this contrasted with patients with noncholestatic diseases LDLT (8%-19%) versus DDLT (37%-59%) receival (P < 0.001). Review of transplant allocation in a large mixed-donor North American liver transplant program demonstrates how patient social determinants and primary liver disease etiology continue to be significantly associated with ultimate transplantation.
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Affiliation(s)
- Kristel K Leung
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Audrey Kim
- Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Bettina E Hansen
- Institute of Health Policy, Management and Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada.,Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Les Lilly
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Nazia Selzner
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Keyur Patel
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.,Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mamatha Bhat
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Gideon M Hirschfield
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Zita Galvin
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Multi-Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
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Bakhschai B, Blasczyk R. Dürfen im Ausland unter der Widerspruchsregelung gewonnene Organe nach deutschem Transplantationsrecht in Deutschland verwendet werden? TRANSFUSIONSMEDIZIN 2021. [DOI: 10.1055/a-1521-8068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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da Silva Clemente Pinho R, Nogueira da Costa Santos CM, Resende Figueiredo Duarte IM. Presumed post-mortem donors: the degree of information among university students. BMC Med Ethics 2021; 22:139. [PMID: 34656108 PMCID: PMC8520635 DOI: 10.1186/s12910-021-00707-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organ transplantation represents the most effective and acceptable therapy for end-stage organ failure. However, its frequent practice often leads to a shortage of organs worldwide. To solve this dilemma, some countries, such as Portugal, have switched from an opt-in to an opt-out system, which has raised concerns about respect for individual autonomy. We aimed to evaluate whether young university students are aware of this opt-out system so that they can make informed, autonomous and conscious decisions, as well as to identify the factors that determine a positive attitude toward post-mortem organ donation. METHODS An observational, cross-sectional study was developed and a questionnaire was administered to first-year students from six faculties of the University of Porto. RESULTS Of the 841 participants, 60% were unaware that Portugal had adopted an opt-out system. Among the informed individuals, their main sources of information included social media, internet, and family. Furthermore, only 48% of all participants agreed with the current opt-out system. Female sex (p = 0.049; OR 1.393), knowledge of the law (p < 0.001; OR 4.749) and family being the primary source of information (p < 0.001; OR 2.855) were independent factors associated with a positive attitude toward post-mortem organ donation law. CONCLUSIONS There is a significant lack of knowledge among young university students regarding the presumed post-mortem organ donation law and how it works. Female sex, having family as a primary source of information and being aware of the presumed post-mortem organ donation law are the strongest independent factors that determine a positive attitude toward the opt-out system.
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Affiliation(s)
| | - Cristina Maria Nogueira da Costa Santos
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto - Centre for Research in Health Technologies and Information Systems (CINTESIS), Porto, Portugal
| | - Ivone Maria Resende Figueiredo Duarte
- Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto - Centre for Research in Health Technologies and Information Systems (CINTESIS), Porto, Portugal
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Marmamula S, Priya R, Varada R, Keeffe JE. Awareness on Eye Donation in the North-eastern State of Tripura, India - The Tripura Eye Survey. Ophthalmic Epidemiol 2021; 29:460-464. [PMID: 34308774 DOI: 10.1080/09286586.2021.1953537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To determine the awareness on eye donation and willingness to pledge eyes for donation among the population aged ≥40 years in the northeastern state of Tripura, India. Methods: A population-based cross-sectional study was carried out among 2,500 participants. The investigators conducted a detailed interview on awareness of eye donation and willingness to pledge eyes for donation. 'Awareness' was defined as having heard about eye donation. Those who reported awareness of eye donation were asked a question on willingness to pledge their eyes. Results: A total of 2,440/2,500 (97.6%) participants responded to the questionnaire. Among these, 1,216 (49.8%) participants were men, and 859 (35.2%) had no education. The mean age of the participants was 54.7 years (standard deviation:12.1 years). Overall, 61.4% (95% CI:59.5-63.4; n = 1,499) reported awareness of eye donation; of those only 3.8% (95% CI:2.9-4.9; n = 57) were willing to pledge their eyes for donation. On multivariable analyses, the odds of awareness were higher among those who had school education (OR:2.12; 95% CI: 1.73-2.56) or higher education (OR:11.79; 95% CI:7.35-18.93). Deformity associated with eye donation (n = 327;76.9%) followed by religious reasons (n = 63; 14.8%) and a belief that those who donate eye are 'born blind in the next birth' (n = 23; 5.4%) were the main reasons for lack of willingness to pledge their eyes for donation. Conclusions: Although the awareness regarding eye donation was satisfactory, there was lack of willingness to pledge eyes for donation. There is a need for focussed information, education, and communication campaigns to encourage eye donation in Tripura.
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Affiliation(s)
- Srinivas Marmamula
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India.,Brien Holden Institute of Optometry and Vision Science, L V Prasad Eye Institute, Hyderabad, India.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Ruchi Priya
- Indian Institute of Public Health,Public Health Foundation of India, Hyderabad, India
| | - Rajashekar Varada
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Jill E Keeffe
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
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Behavioral Economics: A Primer and Applications to the UN Sustainable Development Goal of Good Health and Well-Being. REPORTS 2021. [DOI: 10.3390/reports4020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Behavioral economics (BE) is a relatively new field within economics that incorporates insights from psychology that can be harnessed to improve economic decision making with the potential to enhance good health and well-being of individuals and societies, the third of the United Nations Sustainable Development Goals. While some of the psychological principles of economic decision making were described as far back as the 1700s by Adam Smith, BE emerged as a discipline in the 1970s with the groundbreaking work of psychologists Daniel Kahneman and Amos Tversky. We describe the basic concepts of BE, heuristics (decision-making shortcuts) and their associated biases, and the BE strategies framing, incentives, and economic nudging to overcome these biases. We survey the literature to identify how BE techniques have been employed to improve individual choice (focusing on childhood obesity), health policy, and patient and healthcare provider decision making. Additionally, we discuss how these BE-based efforts to improve health-related decision making can lead to sustaining good health and well-being and identify additional health-related areas that may benefit from including principles of BE in decision making.
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Etheredge HR. Assessing Global Organ Donation Policies: Opt-In vs Opt-Out. Risk Manag Healthc Policy 2021; 14:1985-1998. [PMID: 34012308 PMCID: PMC8128443 DOI: 10.2147/rmhp.s270234] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/20/2021] [Indexed: 12/17/2022] Open
Abstract
This paper argues that there is little difference between opt-in and opt-out organ donation systems for increasing donor numbers when used in isolation. Independently diverting to an opt-out system confers no obvious advantage and can harm efforts to bolster donations. Rather, it is essential to address barriers to organ donation on several levels along with a switch in system. Moreover, for many countries, it may be more beneficial to adequately capacitate the donation system already in place, rather than entertain a significant change with its attendant resource requirements. For decades, the international transplant community has been involved in vigorous debate as to the merits of moving from default opt-in systems to opt-out policies to grow organ donor numbers and better meet the ever-increasing demand for lifesaving transplants. Opt-out is certainly en vogue, with Wales, England and Nova Scotia recently switching over, Scotland due to become opt-out in March 2021 and Northern Ireland and Canada seriously considering a similar move. Thanks to several countries making the switch from opt-in to opt-out over the last 20-30 years, there are sets of robust longitudinal data that aid in analysing the efficacy of donation systems. However, these data are often contradictory and largely inconclusive, suggesting other factors may be in play. This paper reviews some emerging trends in opt-in versus opt-out organ donation policies and considers recent data that elucidates some of the main contentions across each. Ethical frameworks underpinning donation systems, such as informed consent, trust and transparency, are discussed in detail. Substantial time is also devoted to opt-in vs opt-out systems in developing countries, which tend to be excluded from many analyses, and where the challenges faced are magnified by socio-economic constraints. This constitutes a major gap in recently published literature, as developing countries often lag far behind their developed counterparts in donor and transplant numbers.
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Affiliation(s)
- Harriet Rosanne Etheredge
- Wits Donald Gordon Medical Centre, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Steve Biko Centre for Bioethics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Silva E Silva V, Schirmer J, Roza BD, de Oliveira PC, Dhanani S, Almost J, Schafer M, Tranmer J. Defining Quality Criteria for Success in Organ Donation Programs: A Scoping Review. Can J Kidney Health Dis 2021; 8:2054358121992921. [PMID: 33680483 PMCID: PMC7897821 DOI: 10.1177/2054358121992921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background Well-established performance measures for organ donation programs do not fully address the complexity and multifactorial nature of organ donation programs such as the influence of relationships and organizational attributes. Objective To synthesize the current evidence on key organizational attributes and processes of international organ donation programs associated with successful outcomes and to generate a framework to categorize those attributes. Design Scoping Review using a mixed methods approach for data extraction. Setting Databases included PubMed, CINAHL, Embase, LILACS, ABI Business ProQuest, Business Source Premier, and gray literature (organ donation association websites, Google Scholar-first 8 pages), and searches for gray literature were performed, and relevant websites were perused. Sample Organ donation programs or processes. Methods We systematically searched the literature to identify any research design, including text and opinion papers and unpublished material (research data, reports, institutional protocols, government documents, etc). Searches were completed on January 2018, updated it in May 2019, and lastly in March 2020. Title, abstracts, and full texts were screened independently by 2 reviewers with disagreements resolved by a third. Data extraction followed a mixed method approach in which we extracted specific details about study characteristics such as type of research, year of publication, origin/country of study, type of journal published, and key findings. Studies included considered definitions and descriptions of success in organ donation programs in any country by considering studies that described (1) attributes associated with success or effectiveness, (2) organ donation processes, (3) quality improvement initiatives, (4) definitions of organ donation program effectiveness, (5) evidence-based practices in organ donation, and (6) improvements or success in such programs. We tabulated the type and frequency of the presence or absence of reported improvement quality indicators and used a qualitative thematic analysis approach to synthesize results. Results A total of 84 articles were included. Quantitative analysis identified that most of the included articles originated from the United States (n = 32, 38%), used quantitative approaches (n = 46, 55%), and were published in transplant journals (n = 34, 40.5%). Qualitative analysis revealed 16 categories that were described as positively influencing success/effectiveness of organ donation programs. Our thematic analysis identified 16 attributes across the 84 articles, which were grouped into 3 categories influencing organ donation programs' success: context (n = 39, 46%), process (n = 48, 57%), and structural (n = 59, 70%). Limitations Consistent with scoping review methodology, the methodological quality of included studies was not assessed. Conclusions This scoping review identified a number of factors that led to successful outcomes. However, those factors were rarely studied in combination representing a gap in the literature. Therefore, we suggest the development and reporting of primary research investigating and measuring those attributes associated with the performance of organ donation programs holistically. Trial Registration Not applicable.
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Affiliation(s)
| | | | | | | | - Sonny Dhanani
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Joan Almost
- School of Nursing, Queen's University, Kingston, ON, Canada
| | - Markus Schafer
- Department of Sociology, University of Toronto, ON, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, Kingston, ON, Canada
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16
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Organ donation in the US and Europe: The supply vs demand imbalance. Transplant Rev (Orlando) 2020; 35:100585. [PMID: 33071161 DOI: 10.1016/j.trre.2020.100585] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
Organ donation and transplantation remain the best and most cost-effective clinical solution for end-stage organ failure. Several agencies across the US and Europe provide legislative, regulatory, and humanitarian services to generate smoother applications in all transplantation processes and donor-recipient relationships. US and European statistics present nine types of grafts, with kidneys being the most transplanted organ worldwide. However, organ shortage, religion, underrepresented minority groups, difficulties in obtaining consent, lack of understanding, and general ethical concerns present challenging barriers to organ donation, reflecting the complexity of graft procurement and allocation. Breaking down these barriers to reduce the organ-supply imbalance requires an appropriate multifaceted approach. Some of the key areas include increasing the potential donor pool and consent rates, apt organ allocation, and improving organ health. Additionally, suitable policies and standardized guidelines for both donors and recipients, alongside educational initiatives, are needed to ensure patient safety and global awareness. Looking forward, novel and effective research plans and initiatives are needed if we are to avoid a colossal supply-demand gap.
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Early identification using the referral system prolonged the time to onset for hepatic encephalopathy after diagnosing severe acute liver injury. Sci Rep 2020; 10:17280. [PMID: 33057105 PMCID: PMC7560720 DOI: 10.1038/s41598-020-74466-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/01/2020] [Indexed: 12/26/2022] Open
Abstract
In 2004, we implemented a referral system for patients with acute liver injury (ALI) based on an established formula that estimates the risk of progression to acute live failure (ALF); however, the benefits of the system for patients with severe acute liver injury (SLI) remain unclear. We have evaluated the clinical significance of the referral system for SLI patients. Patients with ALI/SLI who were consecutively and prospectively listed on the system between 2004 and 2018 were analyzed. Of the 371 ALI/SLI/ALF patients on the system, 124 satisfied the criteria for SLI; 34 of these 124 progressed to SLI after registration. Multivariate analysis using age, sex, AST, ALT, creatinine, total bilirubin, prothrombin, presence of hepatic encephalopathy (HE), and SLI at registration revealed that HE was associated with high mortality. Among the 23 patients who developed HE, five who progressed to SLI after registration showed an increased time to HE development compared with patients who had SLI at the time of registration. However, there was no significant difference in survival time after HE development. We concluded that early identification of SLI patients using the referral system increased the time from SLI diagnosis to HE development.
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18
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Smits JM, Gottlieb J, Verschuuren E, Evrard P, Hoek R, Knoop C, Lang G, Kwakkel-van Erp JM, Vos R, Verleden G, Rondelet B, Hoefer D, Langer F, Schramm R, Hoetzenecker K, van Kessel D, Luijk B, Seghers L, Deuse T, Buhl R, Witt C, Strelniece A, Green D, de Vries E, Laufer G, Van Raemdonck D. Impact of donor lung quality on post-transplant recipient outcome in the Lung Allocation Score era in Eurotransplant - a historical prospective study. Transpl Int 2020; 33:544-554. [PMID: 31984577 PMCID: PMC7216955 DOI: 10.1111/tri.13582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/02/2019] [Accepted: 01/20/2020] [Indexed: 12/21/2022]
Abstract
The aim of this study was to investigate whether there is an impact of donation rates on the quality of lungs used for transplantation and whether donor lung quality affects post-transplant outcome in the current Lung Allocation Score era. All consecutive adult LTx performed in Eurotransplant (ET) between January 2012 and December 2016 were included (N = 3053). Donors used for LTx in countries with high donation rate were younger (42% vs. 33% ≤45 years, P < 0.0001), were less often smokers (35% vs. 46%, P < 0.0001), had more often clear chest X-rays (82% vs. 72%, P < 0.0001), had better donor oxygenation ratios (20% vs. 26% with PaO2 /FiO2 ≤ 300 mmHg, P < 0.0001), and had better lung donor score values (LDS; 28% vs. 17% with LDS = 6, P < 0.0001) compared with donors used for LTx in countries with low donation rate. Survival rates for the groups LDS = 6 and ≥7 at 5 years were 69.7% and 60.9% (P = 0.007). Lung donor quality significantly impacts on long-term patient survival. Countries with a low donation rate are more oriented to using donor lungs with a lesser quality compared to countries with a high donation rate. Instead of further stretching donor eligibility criteria, the full potential of the donor pool should be realized.
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Affiliation(s)
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in End-stage and Obstructive Disease (Breath), German Centre for Lung Research (DZL), Hannover, Germany
| | - Erik Verschuuren
- Department of Pulmonary Medicine and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Patrick Evrard
- Department of Intensive Care, Centre Hospitalier Universitaire Université Catholique de Louvain, Namur Godinne, Belgium
| | - Rogier Hoek
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christiane Knoop
- Department of Respiratory Medicine, Hôpital Erasme, Brussels, Belgium
| | - György Lang
- Department of Thoracic Surgery, University Hospital, Vienna, Austria
| | - Johanna M Kwakkel-van Erp
- Department of Respiratory Medicine, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Robin Vos
- Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Geert Verleden
- Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium
| | - Benoit Rondelet
- Department of Thoracic Surgery, Centre Hospitalier Universitaire Université Catholique de Louvain, Namur Godinne, Belgium
| | - Daniel Hoefer
- Department of Thoracic and Cardiovascular Surgery, University Hospital Innsbruck, Innsbruck, Austria
| | - Frank Langer
- Department of Thoracic and Cardiovascular Surgery, University Hospital Saarland, Homburg, Germany
| | - Rene Schramm
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeyenhausen, Germany
| | | | - Diana van Kessel
- Department of Respiratory Medicine, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Bart Luijk
- Division of Heart and Lungs, Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard Seghers
- Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tobias Deuse
- Department of Thoracic and Cardiovascular Surgery, University Hospital Eppendorf, Hamburg, Germany
| | - Roland Buhl
- Department of Respiratory Medicine, University Hospital Mainz, Mainz, Germany
| | - Christian Witt
- Department of Respiratory Medicine, University Hospital Charité, Berlin, Germany
| | - Agita Strelniece
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Dave Green
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Erwin de Vries
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Guenter Laufer
- Department of Cardiac Surgery, University Hospital Vienna, Vienna, Austria
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospital Gasthuisberg, Leuven, Belgium
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DeRoos LJ, Marrero WJ, Tapper EB, Sonnenday CJ, Lavieri MS, Hutton DW, Parikh ND. Estimated Association Between Organ Availability and Presumed Consent in Solid Organ Transplant. JAMA Netw Open 2019; 2:e1912431. [PMID: 31577360 PMCID: PMC6777259 DOI: 10.1001/jamanetworkopen.2019.12431] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Presumed consent, or an opt-out organ transplant policy, has been adopted by many countries worldwide to increase organ donation. The implication of such a policy for transplants in the United States is uncertain, however. OBJECTIVE To simulate the potential implications of a presumed consent policy in the United States. DESIGN, SETTING, AND PARTICIPANTS In a decision analytical model, a simulation model was developed using cohort data from January 1, 2004, to December 31, 2014, in the Organ Procurement and Transplantation Network Standard Transplant Analysis and Research files. All US patients (n = 524 359) who were on the waiting list for at least 1 solid organ and all deceased organ donors during the study period were included in the analyses. All data and statistical analyses were performed from January 30, 2019, to July 31, 2019. MAIN OUTCOMES AND MEASURES Increase in the organs available for donation and life-years gained associated with a 5%, 15%, or 25% increase in deceased donors, based on the published changes from a presumed consent policy. RESULTS This study considered 524 359 unique candidates (aged ≥18 years; 320 908 [61.2%] male) for a solid organ transplant from January 1, 2004, to December 31, 2014. With a base case scenario of a 5% presumed consent-associated increase in donors, the removals (owing to death or illness) from the waiting list for all organs would have an associated 3.2% to 10.4% mean reduction, depending on the random or ideal allocation of new organs to patients on the waiting list. Sensitivity analyses showed that waiting list removals could be decreased up to 52%; however, this reduction was not enough to completely eliminate waiting list removals during the study period. The biggest estimated increases in annual life-years gained associated with a presumed consent policy were in kidney transplant candidates (95% CIs by deceased donor increase: 5% increase, 3440-3466 years; 15% increase, 10 321-10 399 years; 25% increase, 17 201-17 332 years) and liver transplant candidates (95% CIs by deceased donor increase: 5% increase, 898-905 years; 15% increase, 2693-2714 years; 25% increase, 4448-4523 years). Adoption of a presumed consent policy could result in a 4295-year (95% CI, 4277-4313 years) to 11 387-year (95% CI, 11 339-11 435 years) increase in life-years, accounting for the survival advantages associated with a transplant. CONCLUSIONS AND RELEVANCE In this study, presumed consent was estimated to be associated with modest but important improvement in the number of organ transplants and increases in life-years gained for patients awaiting an organ transplant. Further consideration and even debate about the ethical and public policy implications of a presumed consent policy are warranted.
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Affiliation(s)
- Luke J. DeRoos
- Industrial and Operations Engineering, University of Michigan, Ann Arbor
| | - Wesley J. Marrero
- Industrial and Operations Engineering, University of Michigan, Ann Arbor
| | - Elliot B. Tapper
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor
| | | | - Mariel S. Lavieri
- Industrial and Operations Engineering, University of Michigan, Ann Arbor
| | - David W. Hutton
- Industrial and Operations Engineering, University of Michigan, Ann Arbor
- School of Public Health, University of Michigan, Ann Arbor
| | - Neehar D. Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor
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Wragg NM, Burke L, Wilson SL. A critical review of current progress in 3D kidney biomanufacturing: advances, challenges, and recommendations. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0218-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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21
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Affiliation(s)
- Ghideon Ezaz
- Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michelle Lai
- Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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