Perception of Transplant Coordinator Regarding Relatives' Attitude Toward Tissue Donation Request

A Web Application for Reporting Eye Donors: Idea, Development and Doctor's Opinion

BACKGROUND

Obtaining corneas in a country of 38 million, Poland, is extremely inefficient. In Poland, about 1000 corneas are transplanted annually, of which over 500 come from multi-organ donations. To our knowledge, such a low percentage of donations is in the absence of reporting of potential corneal donors. There is no computer system in our country for tissue donor reporting. The aim of the work is to present an innovative application developed for this purpose.

MATERIAL AND METHODS

It was a cross-sectional, observational study. The questionnaires were collected from doctors who had access to the app.

RESULTS

Almost all participants (47/52) answered that they would use this app if it was available in the hospital, 46 acknowledged that the application could encourage doctors to report tissue donors, and 48 confirmed it should be integrated with the IT system of hospitals and should be available in all of them.

CONCLUSION

Despite advances in medicine and technology and increased awareness of organ donation and transplantation, the gap between supply and demand is constantly growing. Due to the large number of patients awaiting corneal transplants in Poland, it is necessary to introduce changes aimed at improving this situation. The newly developed app may contribute to increasing donor reporting.

The role of motivational and legal contexts in understanding support for tissue donation across 27 European countries

BACKGROUND

There is a mismatch between attitudinal support for tissue donation and its translation into behavioural action (i.e. become registered donor). The legal and motivational context around tissue donation may contribute to better understanding of this mismatch.

METHODS

Data were extracted from the Eurobarometer 82.2 survey (2014). Data included socio-demographic characteristics, motivations underlying attitudes to tissue donation and the legal context within which donation was considered (opt-in and opt-out consent). The sample was partitioned based on contextual information and seemingly unrelated bivariate probit regressions were used to explore the relationship between passive and active support for tissue donation.

RESULTS

Approximately 56% of 25 879 respondents stated a willingness to donate tissue after death (passive support) and 9.1% reported that they were a registered donor (active support). We found evidence of unobserved heterogeneity between active and passive support across contexts. Our findings suggest that contexts in which altruistic motives can be supported by self-interest may increase the probability of converting passive to active support. Factors associated with increased support for tissue donation included: higher levels of education; good knowledge of the healthcare system; confidence in the safety of tissue donation; readiness to be a tissue recipient and knowing a recipient of donated tissue.

CONCLUSIONS

Our findings demonstrate the value of examining active and passive support for tissue donation together within specific contexts. This more nuanced approach affords clearer insights that may help to guide policy makers confronted with apparently conflicting evidence around strategies intended to promote organ and tissue donation.

Emotional experiences of health professionals in organ procurement and transplantation. A systematic review

INTRODUCTION

The objective was to explore, discuss and synthesize the emotional experiences of health professionals during the process of organ procurement and transplantation.

METHODS

A systematic review was made in Medline, Science Direct and the Virtual Library of the Andalusian Public Health System, selecting 16 original articles for inclusion in the review, with qualitative evaluation and narrative synthesis.

RESULTS

The results revealed the main use of qualitative methodology, and 4emergent themes were identified: working in organ procurement and transplantation; the transition of professional roles; emotional experiences; and, coping strategies and emotional management. This systematic review revealed the complex and diverse character of professionals' emotional experiences as well as the importance of the interpersonal relationship.

CONCLUSIONS

Intense emotional experiences related to the sense of responsibility, the work challenge and coping strategies based on reward searching explained important contradictions and tensions about professional roles and functions, especially during the donation interview.

Organ and Tissue Donations for Transplants in the Macroregional North of Paraná, Brazil

BACKGROUND

Few studies have analyzed the results of the organ and tissue donation process for transplants.

OBJECTIVES

To analyze donations of organs and tissues for transplants in the Macroregional North of Paraná.

MATERIAL AND METHODS

Cross-sectional and retrospective study, using data from 7383 death certificates of eligible donors notified in 2015 by 16 hospitals accredited to the Organ Procurement Organization. The data were analyzed using the prevalence ratio (PR) and the Wald test.

RESULTS

Among the 934 eligible donors, the prevalence of effective donations was 23.4% (219) Among the 582 organs and tissues donated, corneas were predominant. Organs became available for donation from younger individuals (PR = 0.992), due to brain death (PR = 2.482), notified by the type III Intra-Hospital Organ and Tissue Donation Commissions for Transplants (PR = 2.016), which took place in intensive care units (PR = 1.471). The relatives interviewed were the partners and/or children (PR = 0.469), and the interviews were held by the nurse (PR = 1.324).

CONCLUSION

Effective donations were able to take place through proper organizational structure and trained human resources, highlighting the role of the nurse in the optimization of the organ and tissue donation process for transplants.

Relatives' Perception After Tissue Donation Experience: Results of a Postdonation Phone Survey

INTRODUCTION

Postmortem tissue donation (TD) requires the establishment of strategies for family approach to clearly explain the characteristics of multi-tissue donation. In a tertiary university hospital with a long tradition of tissue generation, we designed a survey to be applied to tissue donor families to evaluate global hospital care, care from Transplant Coordinators (TC), quality and content of information given about TD, experience, and motivations after TD process.

METHODOLOGY

A prospective phone survey of 10 multiple-choice items was conducted to all TD relatives that agreed to donate one or more tissues.

RESULTS

From the 166 calls made to TD relatives, 75 (45%) were answered: 50 were cornea donors and 25 were multiple-tissues donors. None of the relatives denied participating, the rest were not found. No statistical differences in demographical variables were found between both types of TD. The hospital and TC care perception, the quality of the given information about the processes of TD, the postdonation experiences in terms of procedures, and the impression about body appearance for relatives regardless of the type of donation, corneas or multiple tissues, were evaluated as good or very good for most of the TD relatives. Our study showed that 83% of the family members would agree to donate again; 40% of the relatives were surprised to be offered the option to donate; 10% did not know if they would donate again. Solidarity was the leading reason for TD.

CONCLUSION

The relatives' perception of care is a critical component of the quality evaluation of the TD process. The global evaluation results support our strategies for family approach.

Trend Analysis of Organ and Tissue Donation for Transplantation

BACKGROUND

The goal of this study was to identify the tendency toward donations of tissue and organs from donors with brain death between 2001 and 2016 as registered by an organ procurement organization in São Paulo City.

METHODS

This quantitative, retrospective, exploratory study encompassed all Tissue and Organ Donation Terms signed between 2001 and 2016. A logistic regression model was applied to verify whether there was an upward or downward trend in donation.

RESULTS

After statistical analysis, a significant change trend was identified in skin, bones, valve, vessel, heart, lung, and pancreas donations, indicating an increase in the donation rate through the years. The donation rate did not show changes over the years for donations of liver, kidneys, and corneas.

CONCLUSIONS

The decision-making process regarding organ and tissue donation is restricted not only to the dilemma of whether to donate but another question then arises as well: which organs and tissues are to be donated? The discrepancy between the authorization for organ donation and the authorization for tissue donation, as well as the option for one or another organ and/or tissue, must be thoroughly examined because these factors directly affect the number of transplants and acquirements effectively accomplished. These factors may be related to explaining to one's relatives aspects of the surgery, body reassembling, and usage of such organs and/or tissues. They may also be related to the lack of knowledge concerning organ donation and the symbolism represented by the organ and/or tissue, among other factors.

Specific demographic factors could predict deceased potential cornea donors: A retrospective study from Beijing Tongren Hospital Eye Bank

Compared with evident cornea donors (ECDs), deceased potential cornea donors (DPCDs) have no obvious donor identifications to reference, which causes many eligible cornea tissues to be wasted. The demographic characteristics of DPCDs might be different from those of ECDs owing to the following different features: donation consent provided by relatives and willingness to donate before death. Thus, the aim of this study is to reveal the demographic characteristics of DPCDs by comparing DPCDs and ECDs.The demographic factors of 138 donors (both DPCDs and ECDs) were collected from the Beijing Tongren Hospital Eye Bank database and analyzed. To differentiate DPCDs from ECDs using the above-mentioned features, we interviewed the relatives of the donors by telephone. The relatives' attitudes toward cornea donation and their suggestions for our donation service were also acquired during the interview. Two logistic regressions were performed to reveal the demographic factors influencing the 2 features and indicate DPCDs.The donors had certain demographic characteristics (elderly, secondary, or tertiary education level, central district resident), and the most frequent cause of death for the donors was a malignant tumor (n = 56, 43.1%). All the relatives had positive attitudes toward cornea donations, and they hoped to increase publicity efforts to encourage more people to donate and establish more convenient and efficient access for cornea donation. In univariate regressions, age (P = .004, >50 years: odds ratio [OR] = 6.89, 95% confidence interval [CI]: 1.82-26.05), marital status (P = .043, divorced: OR = 9.00,95% CI: 1.33-60.80) significantly influenced relative consent, whereas age (P = .001, >50 years: OR = 15.00, 95% CI: 3.00-74.98), and family address (P = .001, central district: OR = 1) were significant factors influencing the willingness to donate before death. In multivariate regression, age (P = .021, >50 years: OR = 8.14, 95% CI: 1.37-48.41) was the only significant factor influencing relative consent. Similarly, age (P = .02, >50 years: OR = 7.55, 95% CI: 1.21-47.25) was the only factor influencing willingness to donate before death.In conclusion, specific demographic factors could indicate DPCDs and might reveal directions and methods for cornea donation coordination in the future.

"Effective" Requesting: A Scoping Review of the Literature on Asking Families to Consent to Organ and Tissue Donation

BACKGROUND

Families are often asked to consent to the donation of their deceased relative's organs or tissues. These end-of-life conversations are important because they affect consent rates as well as the psychological impact of the decision for families. This scoping review of the literature on requesting family consent was prepared to support of the development of leading practice recommendations for end-of-life conversations with families of potential donors. A scoping review maps research activity in a field across a range of commentary and empirical study designs but does not attempt meta-synthesis of empirical data or quality assessment.

METHODS

We performed a scoping review of the peer-reviewed literature from January 2000 to February 2015 on the questions of what constitutes an "effective" request and the factors that affect consent rates and family satisfaction with their decision and the process. This review includes a final set of 168 articles addressing (a) whether, when, and how to ask families for consent to donation or (b) characteristics of families or decedents that affect families' decisions or family satisfaction with their decisions.

RESULTS

Six main themes were identified: (1) the objectives of requesting and encouraging family consent to donation, (2) the effect of the donation decision on family well-being, (3) the process of requesting family consent, (4) the impact of the quality of the care for the deceased and for the family, (5) the content and manner of the request for family consent, and (6) the characteristics of the family and deceased that affect the request for family consent.

CONCLUSION

This scoping review found that there is a large literature on how to modify the process and manner of the request to increase family consent rates. Another important line of inquiry focuses on the psychological impact of the decision on the family. Although a scoping review does not attempt to synthesize results or draw evidence-based conclusions, the literature generally supports the intuitive expectations that compassionate and respectful care for the deceased and family, listening for and addressing family concerns, and an attitude to donation that is positive (but not solely procurement-focused) and is best for both consent rates and family well-being. Although the presumption is often that the primary objective of asking for family consent is to secure consent and donation, some ethical commentary on requesting consent emphasizes that this objective must be balanced with the parallel obligation to protect the psychological well-being of families. This places some constraints on the approaches used in family consent discussions.

Knowledge on Bone Banking among Participants in an Orthopaedic Conference: A Preliminary Survey

Despite increasing use of bone graft in Malaysia, there was still lack of data to quantify knowledge level on bone banking among orthopaedic community who are involved in transplantation related work. Therefore, a survey on awareness in tissue banking specifically bone banking, usage and choice of bone grafts was conducted. From 80 respondents, 82.5% were aware about tissue banking however only 12.5% knew of the existence of tissue banks in Malaysia. Femoral head was the bone allograft most often used as a substitute to autograft. Only 34.8% respondents preferred irradiated bone grafts whilst 46.9% preferred nonirradiated, indicating the need to educate the importance of radiation for sterilising tissues. Exhibition was the most preferred medium for awareness programme to disseminate information about bone banking in the orthopaedic community. The professional awareness is necessary to increase the knowledge on the use of bone graft, hence to increase bone transplantation for musculoskeletal surgeries in the country.

Fatores envolvidos na negativa da doação de tecido ósseo

Objetivo: Determinar as principais variáveis envolvidas na negativa da doação de tecido ósseo em familiares doadores de órgãos e a prevalência da doação desse tecido. Métodos: Trata-se de um estudo transversal, quantitativo. Foram estudadas variáveis referentes à solicitação da doação do tecido ósseo, compreendendo informações a respeito dos ossos que seriam captados, a reconstituição do corpo, os motivos que levaram à negativa da doação desse tecido, conhecimentos anteriores sobre doação e intencionalidade em ser doador. Resultados: Evidenciamos três fatores que influenciaram a negativa pelos familiares incluindo o desconhecimento sobre quais ossos seriam retirados (92,9%), como ocorreria a reconstituição destas estruturas (96,5%) e como se apresentaria o corpo após a captação. A prevalência de doadores de tecido ósseo foi de 17,2%. Conclusão: A decisão familiar de recusar a doação do tecido ósseo foi representada pelo desconhecimento do tema. A baixa prevalência foi devido à reduzida solicitação deste tipo de doação.