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Zimbrean PC, Rubman S, Andacoglu O, Bakhai D, Clifton E, Deng Y, Doshi M, Emamaullee J, Gan G, Holmes R, Jaber L, Jackson WE, Joyce M, Kalil R, Kumar V, Laflen J, Lentine KL, Prashar R, Winder GS, Yadav A, Liapakis A. Psychosocial evaluation of living liver donors-State of current practices in the United States. Liver Transpl 2024; 30:505-518. [PMID: 37861339 DOI: 10.1097/lvt.0000000000000288] [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: 05/13/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
We surveyed living donor liver transplant programs in the United States to describe practices in the psychosocial evaluation of living donors focused on (1) composition of psychosocial team; (2) domains, workflow, and tools of the psychosocial assessment; (3) absolute and relative mental health-related contraindications to donation; and (4) postdonation psychosocial follow-up. We received 52 unique responses, representing 33 of 50 (66%) of active living donor liver transplant programs. Thirty-one (93.9%) provider teams included social workers, 22 (66.7%) psychiatrists, and 14 (42.4%) psychologists. Validated tools were rarely used, but domains assessed were consistent. Respondents rated active alcohol (93.8%), cocaine (96.8%), and opioid (96.8%) use disorder, as absolute contraindications to donation. Active suicidality (97%), self-injurious behavior (90.9%), eating disorders (87.9%), psychosis (84.8%), nonadherence (71.9%), and inability to cooperate with the evaluation team (78.1%) were absolute contraindications to donation. There were no statistically significant differences in absolute psychosocial contraindications to liver donation between geographical areas or between large and small programs. Programs conduct postdonation psychosocial follow-up (57.6%) or screening (39.4%), but routine follow-up of declined donors is rarely conducted (15.8%). Psychosocial evaluation of donor candidates is a multidisciplinary process. The structure of the psychosocial evaluation of donors is not uniform among programs though the domains assessed are consistent. Psychosocial contraindications to living liver donation vary among the transplant programs. Mental health follow-up of donor candidates is not standardized.
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Affiliation(s)
- Paula C Zimbrean
- Departments of Psychiatry and Surgery (Transplant), Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan Rubman
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Oya Andacoglu
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Darshit Bakhai
- Department of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Erin Clifton
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, Connecticut, USA
| | - Mona Doshi
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Juliet Emamaullee
- Department of Surgery, Keck Medicine of USC/Children's Hospital-Los Angeles, Los Angeles, California, USA
| | - Geliang Gan
- Yale Center for Analytical Sciences, New Haven, Connecticut, USA
| | - Rachel Holmes
- Department of Psychiatry, Indiana University, Indianapolis, Indiana, USA
| | - Lana Jaber
- Department of Surgery, California Pacific Medical Center, San Francisco, California, USA
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, University of Colorado, Aurora, Colorado, USA
| | - Michael Joyce
- Department of Social Work, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Roberto Kalil
- Department of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennie Laflen
- Department of Surgery, St. Louis University School of Medicine, St. Louis, Missouri, USA
| | - Krista L Lentine
- Department of Internal Medicine, SM Health Saint Louis University Hospital, St. Louis, Missouri, USA
| | - Rohini Prashar
- Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Gerald S Winder
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Anju Yadav
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Thakker PU, Temple DM, Minnick C, Ponzi D, Badlani G, Hemal A, Doares W, Webb C, McCracken E, Orlando G, Jay C, Farney A, Stratta RJ. Continuous flow local anesthetic wound infusion for post-operative analgesia following kidney transplantation. Clin Transplant 2024; 38:e15305. [PMID: 38567895 DOI: 10.1111/ctr.15305] [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: 12/05/2023] [Revised: 01/27/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Some patients with end stage renal disease are or will become narcotic-dependent. Chronic narcotic use is associated with increased graft loss and mortality following kidney transplantation. We aimed to compare the efficacy of continuous flow local anesthetic wound infusion pumps (CFLAP) with patient controlled analgesia pumps (PCA) in reducing inpatient narcotic consumption in patients undergoing kidney transplantation. MATERIALS AND METHODS In this single-center, retrospective analysis of patients undergoing kidney transplantation, we collected demographic and operative data, peri-operative outcomes, complications, and inpatient oral morphine milligram equivalent (OME) consumption. RESULTS Four hundred and ninety-eight patients underwent kidney transplantation from 2020 to 2022. 296 (59%) historical control patients received a PCA for postoperative pain control and the next 202 (41%) patients received a CFLAP. Median age [53.5 vs. 56.0 years, p = .08] and BMI [29.5 vs. 28.9 kg/m2, p = .17] were similar. Total OME requirement was lower in the CFLAP group [2.5 vs. 34 mg, p < .001]. Wound-related complications were higher in the CFLAP group [5.9% vs. 2.7%, p = .03]. Two (.9%) patients in the CFLAP group experienced cardiac arrhythmia due to local anesthetic toxicity and required lipid infusion. CONCLUSIONS Compared to PCA, CFLAP provided a 93% reduction in OME consumption with a small increase in the wound-related complication rate. The utility of local anesthetic pumps may also be applicable to patients undergoing any unilateral abdominal or pelvic incision.
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Affiliation(s)
- Parth U Thakker
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Davis M Temple
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Caroline Minnick
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Dominick Ponzi
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Gopal Badlani
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Ashok Hemal
- Department of Urology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - William Doares
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Christopher Webb
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Emily McCracken
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Giuseppe Orlando
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Colleen Jay
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Alan Farney
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Robert J Stratta
- Section of Transplantation, Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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Givens RC. Racial disparities across multiple stages of the deceased organ donation process. Am J Transplant 2024:S1600-6135(24)00068-6. [PMID: 38211654 DOI: 10.1016/j.ajt.2023.12.024] [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: 09/25/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
Pervasive structural violence causes higher organ failure rates among Black Americans and an excess of Black potential deceased organ donors. Underuse of Black donors would exacerbate organ shortages that disproportionately harm Black transplant candidates. This study investigates racial differences in transit between distinct donation steps among 132 968 potential donors across 557 hospitals and 6 organ procurement organizations (OPOs) from 2015 through 2021. Multilevel multistate modeling with patient covariates and OPO random effects shows adjusted likelihoods (95% confidence interval) of non-Black versus Black patients transitioning from OPO referral to approach of 1.39 (1.35, 1.44), approach to authorization: 1.64 (1.56, 1.72), authorization to procurement: 1.10 (1.04, 1.16), and procurement to transplant: 1.00 (0.95, 1.06). Overall organ utilization rates for Black, Latino, White, and other OPO referrals were 5.89%, 8.18%, 6.79%, and 5.24%, respectively. Adjusting for patient covariates and hospital and OPO random effects, multilevel logistic models estimated that compared with Black patients, Latino, White, and other patients had odds ratios of organ utilization of 1.81 (1.61, 2.03), 3.19 (2.91, 3.50), and 1.24 (1.05, 1.47), respectively. Nationwide in 2022, donor conversion disparities likely lost more than 1700 donors-two-thirds of whom would have been Black. Achieving racial equity for transplant candidates will require reducing racial disparities in organ donation.
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Affiliation(s)
- Raymond C Givens
- Department of Medicine, Emory University School of Medicine, Emory University, Atlanta, Georgia, 30322, USA.
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Matar AJ, Magliocca JF, Kitchens WH. Successful Liver Transplantation from a Deceased Donor After Ethylene Glycol Ingestion: A Case Report and Review of the Literature of Organ Donation from Poisoned Donors. Transplant Proc 2022; 54:128-134. [PMID: 34972567 DOI: 10.1016/j.transproceed.2021.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022]
Abstract
Despite the increase in deceased organ donation over the past ten years, the gap between patients awaiting transplant and available organs continues to widen. Deceased donors secondary to acute fatal poisonings represent less than 1% of all organ donors. Organs from poisoned donors have largely been discarded due to concerns of toxin transmission and poor organ function as well as the paucity of data that exists regarding this donor population. Here, we report a case of a 40-year-old male who underwent successful liver re-transplantation from a donor who died following ethylene glycol ingestion. To our knowledge this case report is the first to describe successful re-transplantation from an ethylene glycol-poisoned donor. We also provide a comprehensive review of the literature describing organ donation from poisoned donors.
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Affiliation(s)
- Abraham J Matar
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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