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Le Dorze M, Barthélémy R, Lesieur O, Audibert G, Azais MA, Carpentier D, Cerf C, Cheisson G, Chouquer R, Degos V, Fresco M, Lambiotte F, Mercier E, Morel J, Muller L, Parmentier-Decrucq E, Prin S, Rouhani A, Roussin F, Venhard JC, Willig M, Vernay C, Chousterman B, Kentish-Barnes N. Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences. BMC Med Ethics 2024; 25:110. [PMID: 39385217 DOI: 10.1186/s12910-024-01093-1] [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: 02/16/2024] [Accepted: 08/23/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND The development of controlled donation after circulatory death (cDCD) is both important and challenging. The tension between end-of-life care and organ donation raises significant ethical issues for healthcare professionals in the intensive care unit (ICU). The aim of this prospective, multicenter, observational study is to better understand ICU physicians' and nurses' experiences with cDCD. METHODS In 32 ICUs in France, ICU physicians and nurses were invited to complete a questionnaire after the death of end-of-life ICU patients identified as potential cDCD donors who had either experienced the withdrawal of life-sustaining therapies alone or with planned organ donation (OD(-) and OD( +) groups). The primary objective was to assess their anxiety (State Anxiety Inventory STAI Y-A) following the death of a potential cDCD donor. Secondary objectives were to explore potential tensions experienced between end-of-life care and organ donation. RESULTS Two hundred six ICU healthcare professionals (79 physicians and 127 nurses) were included in the course of 79 potential cDCD donor situations. STAI Y-A did not differ between the OD(-) and OD( +) groups for either physicians or nurses (STAI Y-A were 34 (27-38) in OD(-) vs. 32 (27-40) in OD( +), p = 0.911, for physicians and 32 (25-37) in OD(-) vs. 39 (26-37) in OD( +), p = 0.875, for nurses). The possibility of organ donation was a factor influencing the WLST decision for nurses only, and a factor influencing the WLST implementation for both nurses and physicians. cDCD experience is perceived positively by ICU healthcare professionals overall. CONCLUSIONS cDCD does not increase anxiety in ICU healthcare professionals compared to other situations of WLST. WLST and cDCD procedures could further be improved by supporting professionals in making their intentions clear between end-of-life support and the success of organ donation, and when needed, by enhancing communication between ICU physician and nurses. TRIAL REGISTRATION This research was registered in ClinicalTrials.gov (Identifier: NCT05041023, September 10, 2021).
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Affiliation(s)
- Matthieu Le Dorze
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.
- INSERM, MASCOT, U942, Université Paris Cité, Paris, France.
- INSERM, CESP, U1018, Université Paris-Saclay, UVSQ, Villejuif, France.
| | - Romain Barthélémy
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
- INSERM, MASCOT, U942, Université Paris Cité, Paris, France
| | - Olivier Lesieur
- Médecine Intensive Réanimation, CH La Rochelle, La Rochelle, France
| | - Gérard Audibert
- Department of Anaesthesia and Intensive Care, CHRU, Nancy, France
| | - Marie-Ange Azais
- Médecine Intensive Réanimation, CHD Vendée, La Roche-Sur-Yon, France
| | - Dorothée Carpentier
- Department of Medical Intensive Care, Rouen University Hospital, Rouen, France
| | - Charles Cerf
- Department of Intensive Care, Foch Hospital, Suresnes, France
| | - Gaëlle Cheisson
- Département d'anesthésie Réanimation Chirurgicale - Coordination Des Prélèvements d'organes Et de Tissus - Hôpital de Bicêtre - GHU Paris Saclay - APHP, Kremlin-Bicêtre, France
| | - Renaud Chouquer
- Medical and Surgical Intensive Care, Annecy Hospital, Annecy, France
| | - Vincent Degos
- APHP, Department of Anesthesia, Critical Care and Peri-Operative Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
- Clinical Research Group ARPE, Sorbonne University, Paris, France
- INSERM UMR 1141, PROTECT, Paris, France
| | - Marion Fresco
- Department of Anesthesia and Critical Care Medicine, Hôpital Laënnec, CHU Nantes, Nantes, France
| | - Fabien Lambiotte
- Service de Réanimation Polyvalente, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Emmanuelle Mercier
- Médecine Intensive Et Réanimation, CHU de Tours, CRICS-TRIGGERSEP Network, Tours, France
| | - Jérôme Morel
- Département d'anesthésie Et Réanimation, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | - Laurent Muller
- Department of Anaesthesiology and Intensive Care, Pain and Emergency Medicine, Nîmes University Hospital, Nîmes, France
- UR UM 103 IMAGINE, Faculty of Medicine, University of Montpellier, Nîmes, France
| | - Erika Parmentier-Decrucq
- Intensive Care Unit and Hyperbaric Center, Lille University Hospital, 59037, Lille Cedex, Lille, France
| | - Sébastien Prin
- CHU Dijon-Bourgogne, Service de Médecine Intensive Et Réanimation, Coordination Hospitalière de Prélèvement d'organes Et de Tissus, Dijon, France
| | - Armine Rouhani
- Service d'Anesthésie Réanimation Chirurgicale, CHU Nantes, Nantes, France
| | - France Roussin
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
- INSERM, MASCOT, U942, Université Paris Cité, Paris, France
| | | | - Mathieu Willig
- Departement of Anesthesiology and Intensive Care Medecine, Dijon University Hospital, Dijon, France
| | - Catherine Vernay
- Medical and Surgical Intensive Care, Annecy Hospital, Annecy, France
| | - Benjamin Chousterman
- Department of Anesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France
- INSERM, MASCOT, U942, Université Paris Cité, Paris, France
| | - Nancy Kentish-Barnes
- Famiréa Research Group, Medical Intensive Care Unit, APHP, Hospital Saint-Louis, Paris, France
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Grossi AA, Cabrini L, Redaelli P, Manfrin E, DE Min F, Donato MA, Cardillo M, Picozzi M. Cognitive and non-cognitive factors affecting decision-making about deceased organ donation in Italy: a systematic review. Minerva Anestesiol 2024; 90:931-938. [PMID: 38922284 DOI: 10.23736/s0375-9393.24.18098-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Decision-making about organ donation (OD) is influenced by interrelated cognitive and non-cognitive factors. The identification of these factors in the general population and among healthcare professionals (HCP) in Italy are key ethical and scientific requirements to inform targeted communication and policy-making interventions, and to promote decision-making processes that are truly informed. EVIDENCE ACQUISITION A systematic review of articles published between January 1, 1999, and January 31, 2024 was performed by searching four databases using these terms: "organ donation" AND (attitude OR opinion OR knowledge OR awareness OR intention OR beliefs OR norms OR perception) AND (Italy OR Italian). The reference sections of included articles were scrutinized for additional references. EVIDENCE SYNTHESIS Most respondents (lay citizens and HCPs) were in favor of OD, but many (mainly but not exclusively lay citizens) would not authorize OD in the event of death of a family member. Lack of knowledge about OD and the gap between demand and supply of organs, fear of body mutilation, doubts about the criteria for brain death diagnosis, doubts about the wishes of the deceased family member, and distrust towards medical doctors and the healthcare system were the most commonly reported reasons, confirming that cognitive and non-cognitive factors are at play. CONCLUSIONS The majority of the Italian population supports OD, but cognitive and non-cognitive barriers are present even among HCPs. Communication campaigns, encouraging family discussions about OD, providing better education for HCPs (including medical and nursing students), and making it easier to sign OD cards may promote informed decision-making and possibly increase consent rates.
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Affiliation(s)
- Alessandra A Grossi
- Department of Biotechnologies and Life Sciences, Center for Clinical Ethics, University of Insubria, Varese, Italy -
- Department of Human Sciences, Innovation and Territory, University of Insubria, Varese, Italy -
| | - Luca Cabrini
- Department of Biotechnologies and Life Sciences, Center for Clinical Ethics, University of Insubria, Varese, Italy
- Unit of General and Neurosurgical Intensive Care, Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | - Pietro Redaelli
- Specialization School in Legal Medicine, University of Insubria, Varese, Italy
| | - Elia Manfrin
- Specialization School in Legal Medicine, University of Insubria, Varese, Italy
| | - Federica DE Min
- Local Organ Procurement Organization, ASST Sette Laghi, Varese, Italy
| | - Maria A Donato
- Local Organ Procurement Organization, ASST Sette Laghi, Varese, Italy
| | - Massimo Cardillo
- Italian National Transplant Center, National Institute of Health, Rome, Italy
| | - Mario Picozzi
- Department of Biotechnologies and Life Sciences, Center for Clinical Ethics, University of Insubria, Varese, Italy
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Murphy NB, Shemie SD, Capron A, Truog RD, Nakagawa T, Healey A, Gofton T, Bernat JL, Fenton K, Khush KK, Schwartz B, Wall SP. Advancing the Scientific Basis for Determining Death in Controlled Organ Donation After Circulatory Determination of Death. Transplantation 2024:00007890-990000000-00733. [PMID: 38637919 DOI: 10.1097/tp.0000000000005002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
In controlled organ donation after circulatory determination of death (cDCDD), accurate and timely death determination is critical, yet knowledge gaps persist. Further research to improve the science of defining and determining death by circulatory criteria is therefore warranted. In a workshop sponsored by the National Heart, Lung, and Blood Institute, experts identified research opportunities pertaining to scientific, conceptual, and ethical understandings of DCDD and associated technologies. This article identifies a research strategy to inform the biomedical definition of death, the criteria for its determination, and circulatory death determination in cDCDD. Highlighting knowledge gaps, we propose that further research is needed to inform the observation period following cessation of circulation in pediatric and neonatal populations, the temporal relationship between the cessation of brain and circulatory function after the withdrawal of life-sustaining measures in all patient populations, and the minimal pulse pressures that sustain brain blood flow, perfusion, activity, and function. Additionally, accurate predictive tools to estimate time to asystole following the withdrawal of treatment and alternative monitoring modalities to establish the cessation of circulatory, brainstem, and brain function are needed. The physiologic and conceptual implications of postmortem interventions that resume circulation in cDCDD donors likewise demand attention to inform organ recovery practices. Finally, because jurisdictionally variable definitions of death and the criteria for its determination may impede collaborative research efforts, further work is required to achieve consensus on the physiologic and conceptual rationale for defining and determining death after circulatory arrest.
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Affiliation(s)
- Nicholas B Murphy
- Departments of Medicine and Philosophy, Western University, London, ON, Canada
| | - Sam D Shemie
- Division of Critical Care Medicine, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
- System Development, Canadian Blood Services, Ottawa, ON, Canada
| | - Alex Capron
- Gould School of Law and Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Robert D Truog
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - Thomas Nakagawa
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
| | - Andrew Healey
- Ontario Health (Trillium Gift of Life Network), Toronto, ON, Canada
- Divisions of Emergency and Critical Care Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - James L Bernat
- Department of Neurology, Dartmouth Geisel School of Medicine, Hanover, NH
| | - Kathleen Fenton
- Advanced Technologies and Surgery Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bryanna Schwartz
- Heart Development and Structural Diseases Branch, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
- Division of Cardiology, Children's National Hospital, Washington, DC
| | - Stephen P Wall
- Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
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Febrero B, Almela-Baeza J, Ros-Madrid I, Iniesta M, Martínez-Alarcón L, Ramírez P. Attitude of the Older Population Toward Controlled Asystole Donation. Transplant Proc 2023; 55:2250-2252. [PMID: 37775403 DOI: 10.1016/j.transproceed.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/29/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Studies about the knowledge of and attitude toward new lines of organ donation in a group of older people are important due to the increase in older organ donors. OBJECTIVES To analyze the attitude of citizens over 65 years of age in southeastern Spain toward controlled asystole donation (CAD) and to determine the psycho-social profile that influences this attitude. METHODS The study population consisted of citizens over 65 years of age. A representative sample was obtained in southeastern Spain (N = 420). A questionnaire about attitudes toward CAD was used, detailing in the questionnaire that this is a type of donation from people who have died of circulatory and respiratory criteria after the limitation of life support treatment. Several psychosocial variables were also taken into account. Statistical analysis included the χ2 test and multivariate analysis. RESULTS The completion rate was 84% (n = 351). Favorable attitude toward organ donation and transplantation (ODT) was 98% (n = 344) overall, and CAD was viewed favorably by 45% (n = 158). The psychosocial variables that influenced attitude toward CAD were mainly having received a talk about ODT (odds ratio [OR] 5.6), knowing the opinion of one's partner (OR 7.95), acceptance of cremation (OR 1.09), and acceptance of autopsy (OR 3.002). CONCLUSIONS The attitude of older people toward CAD is unfavorable despite a willingness to support ODT in general. This attitude is influenced by variables of social and family dialogue about ODT, attitude to body manipulation, and having received information about ODT.
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Affiliation(s)
- Beatriz Febrero
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
| | - Javier Almela-Baeza
- Faculty of Communication and Documentation, University of Murcia, Murcia, Spain.
| | | | - María Iniesta
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
| | - Laura Martínez-Alarcón
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
| | - Pablo Ramírez
- General Surgery Service, Virgen de la Arrixaca University Hospital, Murcia, Spain; Instituto Murciano de Investigaciones Biosanitaria IMIB-Arrixaca, Murcia, Spain; Department of Surgery, Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Murcia, Murcia, Spain
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Murphy N, Weijer C, Debicki D, Laforge G, Norton L, Gofton T, Slessarev M. Ethics of non-therapeutic research on imminently dying patients in the intensive care unit. JOURNAL OF MEDICAL ETHICS 2023; 49:311-318. [PMID: 35728941 PMCID: PMC10176359 DOI: 10.1136/medethics-2021-107953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 05/23/2022] [Indexed: 05/14/2023]
Abstract
Non-therapeutic research with imminently dying patients in intensive care presents complex ethical issues. The vulnerabilities of the imminently dying, together with societal disquiet around death and dying, contribute to an intuition that such research is beyond the legitimate scope of scientific inquiry. Yet excluding imminently dying patients from research hinders the advancement of medical science to the detriment of future patients. Building on existing ethical guidelines for research, we propose a framework for the ethical design and conduct of research involving the imminently dying. To enable rapid translation to practice, we frame the approach in the form of eight ethical questions that researchers and research ethics committees ought to answer prior to conducting any research with this patient population. (1) Does the study hypothesis require the inclusion of imminently dying patients? (2) Are non-therapeutic risks and burdens minimised consistent with sound scientific design? (3) Are the risks of these procedures no more than minimal risk? (4) Are these non-therapeutic risks justified insofar as they are reasonable in relation to the anticipated benefits of the study? (5) Will valid informed consent be obtained from an authorised surrogate decision maker? (6) How will incidental findings be handled? (7) What additional steps are in place to protect families and significant others of research participants? (8) What additional steps are in place to protect clinical staff and researchers? Several ethical challenges hinder research with imminently dying patients. Nonetheless, provided adequate protections are in place, non-therapeutic research with imminently dying patients is ethically justifiable. Applying our framework to an ongoing study, we demonstrate how our question-driven approach is well suited to guiding investigators and research ethics committees.
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Affiliation(s)
- Nicholas Murphy
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Philosophy, Western University, London, Ontario, Canada
| | - Charles Weijer
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Philosophy, Western University, London, Ontario, Canada
- Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Derek Debicki
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Geoffrey Laforge
- Brain and Mind Institute, Western University, London, Ontario, Canada
- Department of Psychology, Western University, London, Ontario, Canada
| | - Loretta Norton
- Department of Psychology, King's University College at Western University, London, Ontario, Canada
| | - Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Marat Slessarev
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Brain and Mind Institute, Western University, London, Ontario, Canada
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Gofton T, Dhanani S, Meade M, Boyd JG, Chamberlain E, Chandler J, Chassé M, Scales NB, Choi YH, D'Aragon F, Debicki D, English S, Fantaneanu TA, Kramer AH, Kromm J, Murphy N, Norton L, Singh J, Smith MJ, Weijer C, Shemie S, Bentall TC, Campbell E, Slessarev M. Neurologic Physiology after Removal of Therapy (NeuPaRT) study: study protocol of a multicentre, prospective, observational, pilot feasibility study of neurophysiology after withdrawal of life-sustaining measures. BMJ Open 2023; 13:e073643. [PMID: 37105694 PMCID: PMC10152060 DOI: 10.1136/bmjopen-2023-073643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION In donation after circulatory determination of death, death is declared 5 min after circulatory arrest. This practice assumes, but does not explicitly confirm, permanent loss of brain activity. While this assumption is rooted a strong physiological rationale, paucity of direct human data regarding temporal relationship between cessation of brain activity and circulatory arrest during the dying process threatens public and healthcare provider trust in deceased organ donation. METHODS AND ANALYSIS In this cohort study, we will prospectively record cerebral and brainstem electrical activity, cerebral blood flow velocity and arterial blood pressure using electroencephalography (EEG), brainstem evoked potentials, transcranial doppler and bedside haemodynamic monitors in adult patients undergoing planned withdrawal of life sustaining measures in the intensive care units at five hospital sites for 18 months. We will use MATLAB to synchronise waveform data and compute the time of cessation of each signal relative to circulatory arrest. Our primary outcome is the feasibility of patient accrual, while secondary outcomes are (a) proportion of patients with complete waveform recordings and data transfer to coordinating site and (b) time difference between cessation of neurophysiological signals and circulatory arrest. We expect to accrue 1 patient/site/month for a total of 90 patients. ETHICS AND DISSEMINATION We have ethics approval from Clinical Trials Ontario (protocol #3862, version 1.0, date 19 January 2022.) and the relevant Research Ethics Board for each site. We will obtain written informed consent from legal substitute decision makers. We will present study results at research conferences including donor family partner forum and in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05306327.
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Affiliation(s)
- Teneille Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sonny Dhanani
- Pediatric Critical Care, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Maureen Meade
- Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - John Gordon Boyd
- Departments of Neurology and Critical Care, Queen's University, Kingston, Ontario, Canada
| | | | | | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de Montréal, Montréal, Québec, Canada
| | - Nathan B Scales
- Dynamical Analysis Laboratory, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Derek Debicki
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Shane English
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tadeu A Fantaneanu
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Andreas H Kramer
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julie Kromm
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicholas Murphy
- Philosophy and Medicine, Western University, London, Ontario, Canada
| | - Loretta Norton
- Department of Psychology, King's University College at Western University, London, Ontario, Canada
| | - Jeffrey Singh
- Interdepartmental Division of Critical Care Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Maxwell J Smith
- School of Health Studies, Faculty of Health Sciences and Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Charles Weijer
- Department of Philosophy, Western University, London, Ontario, Canada
| | - Sam Shemie
- Pediatric Intensive Care, McGill University, Montreal, Québec, Canada
| | - Tracey C Bentall
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Eileen Campbell
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Marat Slessarev
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Lennon C, Harvey D, Goldstein PA. Ethical considerations for theatre teams in organ donation after circulatory determination of death. Br J Anaesth 2023; 130:502-507. [PMID: 36801100 DOI: 10.1016/j.bja.2023.01.018] [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: 07/27/2022] [Revised: 12/20/2022] [Accepted: 01/15/2023] [Indexed: 02/18/2023] Open
Abstract
Transplant surgery is an area that gives rise to a number of ethical considerations. As medicine continues to expand the boundaries of what is technically possible, we must consider the ethical implications of our interventions, not solely on patients and society, but also on those asked to provide that care. Here, we consider physician participation in procedures required to provide patient care in the context of the ethical convictions held by the physician, with an emphasis on organ donation after circulatory determination of death. Strategies that can be used to mitigate any potential negative impact on the psychological well-being of members of the patient care team are considered.
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Affiliation(s)
| | - Dan Harvey
- National Health Service Blood & Transplant, UK; Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter A Goldstein
- Department of Anesthesiology, New York, NY, USA; Department of Medicine, New York, NY, USA; Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
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Araujo CAS, Siqueira MM. The Effect of Educational Initiatives on the Attitude and Knowledge of Health Care Professionals Regarding Organ Donation and Transplantation: An Integrative Literature Review. Transplant Proc 2023; 55:13-21. [PMID: 36609025 DOI: 10.1016/j.transproceed.2022.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/24/2022] [Accepted: 09/20/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND This integrative literature review synthesizes evidence on the effect of educational initiatives (EI) on the attitude and knowledge of health care professionals regarding organ donation and transplantation (ODT), and the EI effect considering the risks of the ODT process related to the professionals' attitudes and knowledge. METHODS This search included 8 databases, with search terms across 4 groups: ODT activities, health professionals, attitude/knowledge, and EI. We applied the PICO framework to select articles: Population - health care professionals; Intervention - any EI; Comparison - pre/post or intervention/control designs; and Outcomes - indicators of attitudes or knowledge toward ODT. After the appraisal of 2,221 citations, 21 studies were included in this review. RESULTS The EI varied to a great extent in terms of format (seminars, workshops, video lectures; online or in-person training), duration (from 15 minutes to 3 months), and the number of participants (from 12 to 1011). The effects reported were positive, increasing professionals' knowledge and attitude regarding the ODT process for all EI formats. Most articles (14; 67%) presented positive results with statistical significance for all indicators analyzed, and the remaining studies (7; 35%) reported statistical significance for some of the indicators analyzed. All EIs focused on donation or post-transplantation activities, lacking studies on the transplantation stage. CONCLUSIONS Results suggest that different types of EIs may positively affect the attitude and knowledge of health care professionals regarding the ODT process. This study provides an up-to-date overview of the main themes examined in this literature, highlighting critical knowledge gaps and methodological flaws.
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Affiliation(s)
- Claudia A S Araujo
- The Coppead Graduate School of Business, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Fundação Getulio Vargas's Sao Paulo School of Business Administration -FGV/EAESP, São Paulo, Brazil.
| | - Marina Martins Siqueira
- The Coppead Graduate School of Business, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Seshadri A, Cuschieri J, Kaups KL, Knowlton LM, Kutcher ME, Pathak A, Rappold J, Rinderknecht T, Stein DM, Young J, Michetti CP. Organ donation in the surgical ICU: an American Association for the Surgery of Trauma Critical Care Committee clinical consensus document. Trauma Surg Acute Care Open 2023; 8:e001107. [PMID: 37205276 PMCID: PMC10186482 DOI: 10.1136/tsaco-2023-001107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- Anupamaa Seshadri
- Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Joseph Cuschieri
- Surgery at ZSFG, University of California San Francisco, San Francisco, California, USA
| | - Krista L Kaups
- Department of Surgery, UCSF Fresno, Fresno, California, USA
| | | | - Matthew E Kutcher
- Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Abhijit Pathak
- Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Deborah M Stein
- Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Jason Young
- Surgery, University of Utah Health, Salt Lake City, Utah, USA
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10
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Gofton TE, Norton L, Laforge G, Gibson R, Debicki D, Althenayan E, Scales N, Beinum AV, Hornby L, Shemie S, Dhanani S, Slessarev M. Cerebral cortical activity after withdrawal of life-sustaining measures in critically ill patients. Am J Transplant 2022; 22:3120-3129. [PMID: 35822321 DOI: 10.1111/ajt.17146] [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: 01/10/2022] [Revised: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 01/25/2023]
Abstract
Establishing when cerebral cortical activity stops relative to circulatory arrest during the dying process will enhance trust in donation after circulatory determination of death. We used continuous electroencephalography and arterial blood pressure monitoring prior to withdrawal of life sustaining measures and for 30 min following circulatory arrest to explore the temporal relationship between cessation of cerebral cortical activity and circulatory arrest. Qualitative and quantitative EEG analyses were completed. Among 140 screened patients, 52 were eligible, 15 were enrolled, 11 completed the full study, and 8 (3 female, median age 68 years) were included in the analysis. Across participants, EEG activity stopped at a median of 78 (Q1 = -387, Q3 = 111) seconds before circulatory arrest. Following withdrawal of life sustaining measures there was a progressive reduction in electroencephalographic amplitude (p = .002), spectral power (p = .008), and coherence (p = .003). Prospective recording of cerebral cortical activity in imminently dying patients is feasible. Our results from this small cohort suggest that cerebral cortical activity does not persist after circulatory arrest. Confirmation of these findings in a larger multicenter study are needed to help promote stakeholder trust in donation after circulatory determination of death.
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Affiliation(s)
- Teneille E Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Loretta Norton
- Department of Psychology, King's University College at Western University, London, Ontario, Canada
| | - Geoffrey Laforge
- Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Raechelle Gibson
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Derek Debicki
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Western Institute for Neuroscience, Western University, London, Ontario, Canada
| | - Eyad Althenayan
- Department of Medicine/Critical Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Nathan Scales
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Laura Hornby
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sam Shemie
- Canadian Blood Services, Ottawa, Ontario, Canada.,Pediatric Intensive Care, McGill University Health Centre & Research Institute, Montreal, Quebec, Canada
| | - Sonny Dhanani
- Pediatric Critical Care, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Marat Slessarev
- Department of Psychology, King's University College at Western University, London, Ontario, Canada.,Department of Medicine/Critical Care, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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11
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Le Dorze M, Martouzet S, Cassiani-Ingoni E, Roussin F, Mebazaa A, Morin L, Kentish-Barnes N. "A Delicate balance"-Perceptions and Experiences of ICU Physicians and Nurses Regarding Controlled Donation After Circulatory Death. A Qualitative Study. Transpl Int 2022; 35:10648. [PMID: 36148004 PMCID: PMC9485469 DOI: 10.3389/ti.2022.10648] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022]
Abstract
Controlled donation after circulatory death (cDCD) is considered by many as a potential response to the scarcity of donor organs. However, healthcare professionals may feel uncomfortable as end-of-life care and organ donation overlap in cDCD, creating a potential barrier to its development. The aim of this qualitative study was to gain insight on the perceptions and experiences of intensive care units (ICU) physicians and nurses regarding cDCD. We used thematic analysis of in-depth semi-structured interviews and 6-month field observation in a large teaching hospital. 17 staff members (8 physicians and 9 nurses) participated in the study. Analysis showed a gap between ethical principles and routine clinical practice, with a delicate balance between end-of-life care and organ donation. This tension arises at three critical moments: during the decision-making process leading to the withdrawal of life-sustaining treatments (LST), during the period between the decision to withdraw LST and its actual implementation, and during the dying and death process. Our findings shed light on the strategies developed by healthcare professionals to solve these ethical tensions and to cope with the emotional ambiguities. cDCD implementation in routine practice requires a shared understanding of the tradeoff between end-of-life care and organ donation within ICU.
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Affiliation(s)
- Matthieu Le Dorze
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
- Université Paris-Saclay, UVSQ, INSERM, CESP, U1018, Villejuif, France
| | - Sara Martouzet
- Université de Tours, EA 7505 Éducation, Éthique et Santé, Tours, France
| | - Etienne Cassiani-Ingoni
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
| | - France Roussin
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
| | - Alexandre Mebazaa
- AP-HP, Hôpital Lariboisière, Department of Anesthesia and Critical Care Medicine, Paris, France
- Université de Paris, Inserm, UMRS 942 Mascot, Paris, France
| | - Lucas Morin
- INSERM CIC 1431, University Hospital of Besançon, Besançon, France
| | - Nancy Kentish-Barnes
- AP-HP, Saint Louis University Hospital, Famiréa Research Group, Medical Intensive Care Unit, Paris, France
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12
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Zheng K, Sutherland S, Hornby L, Shemie SD, Wilson L, Sarti AJ. Public Understandings of the Definition and Determination of Death: A Scoping Review. Transplant Direct 2022; 8:e1300. [PMID: 35415218 PMCID: PMC8989773 DOI: 10.1097/txd.0000000000001300] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 02/01/2023] Open
Abstract
Background. Advances in medicine and technology that have made it possible to support, repair, or replace failing organs challenge commonly held notions of life and death. The objective of this review is to develop a comprehensive description of the current understandings of the public regarding the meaning/definition and determination of death. Methods. This scoping review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Online databases were used to identify articles published from 2003 to 2021. Two reviewers (S.S. and K.Z.) screened the articles using predefined inclusion and exclusion criteria, extracted data for specific content variables, and performed descriptive examination. Complementary searches of reference lists complemented the final study selection. A search strategy using vocabulary of the respective databases was created, and criteria for the inclusion and exclusion of the articles were established. Results. Seven thousand four hundred twenty-eight references were identified. Sixty were retained for analysis, with 4 additional references added from complementary searches. A data extraction instrument was developed to iteratively chart the results. A qualitative approach was conducted to thematically analyze the data. Themes included public understanding/attitudes toward death and determination of death (neurological determination and cardiocirculatory determination of death), death and organ donation, public trust and legal variability, and media impacts. Conclusions. This review provides a current and comprehensive overview of the literature related to the general public’s understanding and attitudes toward death and death determination and serves to highlight the gaps in this topic.
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13
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Bauer T. A Systematic Review of Qualitative Studies Investigating Motives and Experiences of Recipients of Anonymous Gamete Donation. FRONTIERS IN SOCIOLOGY 2022; 7:746847. [PMID: 35252431 PMCID: PMC8889113 DOI: 10.3389/fsoc.2022.746847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
The decision to use an anonymous gamete donation in fertility treatment could have significant long-term psychological and social effects for all stakeholders involved. In light of the growing recognition of donor-conceived children's right to know their genetic parentage, this entails profound ethical implications. This review aims to carve out the full spectrum of recipients' motives and experiences related to donor anonymity which could serve as an analytical framework for future ethical and sociological research on issues of donor anonymity. This review was conducted following a seven-step approach for systematic reviews of empirical bioethics literature. The characteristics and quality of the studies included in this review were reported. Data analysis was conducted using qualitative content analysis and was informed by sociological functionalist theorizations of ignorance. The 53 studies selected showed a diverse spectrum of characteristics concerning date and country of study, methodology, family type of participants, sample size, and the timing of data collection in relation to the stage of treatment. A total of 22 categories of motives and experiences of recipients concerning donor anonymity were identified inductively and grouped into five main categories. Donor anonymity was identified as a eufunctional form of ignorance, by which the recipients experienced or intended to control, regulate, or protect inter-stakeholder relations. Interpreting recipients' motives and experiences concerning donor anonymity as a form of ignorance directed toward particular stakeholders helps reframe the discourse on donor anonymity. It is a fruitful approach that can be refined further and applied in future research. This review identified possible directions for future investigations on motives for donor anonymity: the need for more thorough inquiries into the change in recipients' preferences over time, such as in the form of longitudinal studies and research on the perspective of non-biological parents.
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Affiliation(s)
- Tobias Bauer
- Faculty of Humanities and Social Sciences, Kumamoto University, Kumamoto, Japan
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14
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Editorial: cardiovascular anaesthesiology. Curr Opin Anaesthesiol 2022; 35:1-4. [PMID: 34932519 DOI: 10.1097/aco.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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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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16
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Singh A, Scales A, Mildner R. Fifteen-minute consultation: Paediatric organ and tissue donation. Arch Dis Child Educ Pract Ed 2021; 106:200-205. [PMID: 32847806 DOI: 10.1136/archdischild-2019-318457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/12/2020] [Accepted: 07/19/2020] [Indexed: 11/04/2022]
Abstract
This article explores ways in which paediatricians can help increase awareness and embed organ and tissue donation in the end-of-life care process. This can save patient lives on the organ transplant waiting list, many of whom currently die prematurely. The information benefits multidisciplinary staff including doctors, nurses and allied professionals to (1) recognise triggers for making referral to the specialist nurse for organ donation in order to make timely assessment for suitability for organ and/or tissue donation, (2) plan a multidisciplinary approach for families to make decisions for the gift of life and (3) help provide on-going support to families and staff.
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Affiliation(s)
- Anju Singh
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Angie Scales
- NHS Blood and Transplant, NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
| | - Reinout Mildner
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,NHS Blood and Transplant Organ Donation and Transplantation Directorate, Bristol, UK
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17
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Ghavam A, Thompson NE, Lee J. Comparison of pediatric brain-dead donors to donation after circulatory death donors in the United States. Pediatr Transplant 2021; 25:e13926. [PMID: 33326666 DOI: 10.1111/petr.13926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/13/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
In pediatrics, an increasing need for transplantable organs exists. This study aimed to describe the epidemiology of pediatric deceased donors in the United States. This retrospective observational study utilized data from the Organ Procurement and Transplantation Network (OPTN) from 2000 to 2015. Patients were stratified based on method of organ donation. Demographic variables and mechanism of death were then compared. A total of 14,481 deceased pediatric organ donors, donation after brain death (DBD) and donation after circulatory death (DCD), were included in the study, of which 8% were DCD donors. A significant difference (p<0.001) existed between the two donor groups with respect to ethnicity and mechanism of death. The annual trend of DCD and DBD donors showed an inverse relationship. During the 15-year study period the number of DBD donors decreased from 985 to 785 per year while DCD donors increased from 15 to 146 per year. As well, overall organs transplanted per year decreased from 3,475 to 3,117 over the 15-year study period. Significant differences exist between pediatric DBD donors and DCD donors, specifically with respect to ethnicity and mechanism of death. The number of pediatric DBD donors is decreasing while the number of pediatric DCD is slowly rising, making it increasingly important to be able to characterize these donors to better identify eligible DCD donors to optimize organ utilization.
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Affiliation(s)
- Ahmeneh Ghavam
- Division of Critical Medicine, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | - Nathan E Thompson
- Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
| | - Jane Lee
- Division of Special Needs, Department of Pediatrics, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, WI, USA
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18
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Washburn L, Galván NTN, Moolchandani P, Price MB, Rath S, Ackah R, Myers KA, Wood RP, Parsons S, Brown RP, Ranova E, Goss M, Rana A, Goss JA. Survey of public attitudes towards imminent death donation in the United States. Am J Transplant 2021; 21:114-122. [PMID: 32633023 DOI: 10.1111/ajt.16175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 01/25/2023]
Abstract
Imminent death donation (IDD) is described as living organ donation prior to a planned withdrawal of life-sustaining care in an imminently dying patient. Although IDD was ethically justified by United Network for Organ Sharing, the concept remains controversial due to presumed lack of public support. The aim of this study was to evaluate the public's attitudes towards IDD. A cross-sectional survey was conducted of US adults age >18 years (n = 2644). The survey included a case scenario of a patient with a devastating brain injury. Responses were assessed on a 5-point Likert scale. Results showed that 68% - 74% of participants agreed or strongly agreed with IDD when posed as a general question and in relation to the case scenario. Participants were concerned about "recovery after a devastating brain injury" (34%), and that "doctors would not try as hard to save a patient's life" (33%). Only 9% of participants would be less likely to trust the organ donation process. In conclusion, our study demonstrates strong public support for IDD in the case of a patient with a devastating brain injury. Notably, participants were not largely concerned with losing trust in the organ donation process. These results justify policy change towards imminent death donation.
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Affiliation(s)
- Laura Washburn
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | | | - Priyanka Moolchandani
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew B Price
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Smruti Rath
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - Ruth Ackah
- Department of Surgery, Ohio State University, Columbus, Ohio, USA
| | | | | | | | | | | | - Matthew Goss
- McGovern Medical School at UT Health, Houston, Texas, USA
| | - Abbas Rana
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
| | - John A Goss
- Division of Abdominal Transplantation, Baylor College of Medicine, Houston, Texas, USA
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19
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Naghavi N, Mubarik MS, Rasiah R, Sharif Nia H. Prioritizing Factors Affecting Deceased Organ Donation in Malaysia: Is a New Organ Donation System Required? Int J Gen Med 2020; 13:641-651. [PMID: 32982381 PMCID: PMC7507418 DOI: 10.2147/ijgm.s253372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The gap between the demand and the supply of human organs for transplantation is on the rise in Malaysia, despite the efforts of governments to promote donor registration. Factors affecting willingness to donate are contextual and vary from country to country. This research mainly focuses on the selection of most suitable organ donation system through factors affecting willingness to donate in Malaysia. The objectives of this study are to prioritize those factors acting as the pillars of the organ donation system and further to select the most suitable organ donation system for Malaysia. Patients and Methods The data were collected from 35 experts by using a bipolar questionnaire. The study applied an analytical hierarchal process (AHP) for prioritization factors contributing to willingness to donate and then selection of a suitable organ donation system based on prioritized factors. Results Based on the AHP results, it is evident that donation perception (0.36) has the highest priority in influencing organ donation rates, followed by socioeconomic status (0.32), demographic factors (0.23), and financial incentives (0.09). Further, our results challenge the existing opt-in donation system in Malaysia and present a presumptive approach as a suitable system for increasing deceased donation rate in Malaysia. Presumptive approach promotes the role of health-care professionals in securing the family consent. Conclusion This approach is a person-oriented rather than process-oriented strategy and it relies on designated requesters' skills to evoke altruism among bereaved families. Based on results, the authors recommended that relevant government agencies focus on training nurses to discuss donation with bereaved families and raising public awareness.
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Affiliation(s)
- Navaz Naghavi
- Faculty of Business & Law, Taylor's Business School, Taylor's University, Lakeside Campus, Subang Jaya 47500, Selangor, Malaysia
| | - Muhammad Shujaat Mubarik
- Faculty of Business Administration & Social Sciences, Mohammad Ali Jinnah University, Karachi 7500, Pakistan
| | - Rajah Rasiah
- Asia-Europe Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Hamid Sharif Nia
- Department of Nursing, Mazandaran University of Medical Science, Sari, Iran
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20
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Sandiumenge A, Lomero Martinez MDM, Sánchez Ibáñez J, Seoane Pillado T, Montaña-Carreras X, Molina-Gomez JD, Llauradó-Serra M, Dominguez-Gil B, Masnou N, Bodi M, Pont T. Online education about end-of-life care and the donation process after brain death and circulatory death. Can we influence perception and attitudes in critical care doctors? A prospective study. Transpl Int 2020; 33:1529-1540. [PMID: 32881149 DOI: 10.1111/tri.13728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 11/28/2022]
Abstract
Impact of training on end-of-life care (EOLC) and the deceased donation process in critical care physicians' perceptions and attitudes was analysed. A survey on attitudes and perceptions of deceased donation as part of the EOLC process was delivered to 535 physicians working in critical care before and after completion of a online training programme (2015-17). After training, more participants agreed that nursing staff should be involved in the end-of-life decision process (P < 0.001) and that relatives should not be responsible for medical decisions (P < 0.001). Postcourse, more participants considered 'withdrawal/withholding' as similar actions (P < 0.001); deemed appropriate the use of pre-emptive sedation in all patients undergoing life support treatment adequacy (LSTA; P < 0.001); and were favourable to approaching family about donation upon LSTA agreement, as well as admitting them in the intensive care unit (P < 0.001) to allow the possibility of donation. Education increased the number of participants prone to initiate measures to preserve the organs for donation before the declaration of death in patients undergoing LSTA (P < 0.001). Training increased number of positive terms selected by participants to describe donation after brain and circulatory death. Training programmes may be useful to improve physicians' perception and attitude about including donation as part of the patient's EOLC.
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Affiliation(s)
- Alberto Sandiumenge
- Department of Donor and Transplant, Transplant Coordination, Clinical Research/Epidemiology In Pneumonia and Sepsis (CRIPS), Vall d´Hebrón University Hospital, Barcelona, Spain
| | | | | | - Teresa Seoane Pillado
- Preventive Medicine and Public Health Unit, Department of Health Sciences, University of A Coruña-INIBIC, A Coruña, Spain
| | | | | | - Mireia Llauradó-Serra
- Nursing Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | | | - Nuria Masnou
- Department of Organ Donation and Transplantation, University Hospital Girona Dr Josep Trueta, Girona, Spain
| | - Maria Bodi
- Critical Care Department, Pere Virgili Research Institute, Joan XXIII University Hospital, Rovira i Virgili University, Tarragona, Spain
| | - Teresa Pont
- Department of Donor and Transplant, Transplant Coordination, Clinical Research/Epidemiology In Pneumonia and Sepsis (CRIPS), Vall d´Hebrón University Hospital, Barcelona, Spain
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21
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Wilkinson D, Butcherine E, Savulescu J. The Equivalence Thesis: Why Timers Do Not Successfully Resuscitate the Acts/Omissions and Withdrawal/Withholding Debate. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:W6-W9. [PMID: 30994421 DOI: 10.1080/15265161.2019.1579604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | | | - Julian Savulescu
- c Oxford Uehiro Centre for Practical Ethics, University of Melbourne
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22
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Pediatric donation after circulatory determination of death (pDCD): A narrative review. Paediatr Respir Rev 2019; 29:3-8. [PMID: 29716830 DOI: 10.1016/j.prrv.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/13/2018] [Indexed: 01/30/2023]
Abstract
Pediatric donation after circulatory death (pDCD) is an established pathway for organ donation. It remains, however, a relatively rare event worldwide, and most clinicians outside of the pediatric intensive care unit (PICU) are unfamiliar with it. The goal of this review is to introduce the processes and concepts of pDCD. While most children die in circumstances that would not allow pDCD, many children that die after withdrawal of life sustaining therapy (WLST) may be eligible for donation of some organs. The potential benefits of this practice to patients on the wait list are well known, but donation can also be an opportunity to honor a patient's or family's desire to altruistically improve the lives of others. Offering the possibility of donation requires careful attention to ethical principles to ensure that conflicts of interest are avoided and that the family is free to make an independent, fully informed decision. Doing so allows families and decision makers the autonomy to decide if donation is something they wish to incorporate into end-of-life care.
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23
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Molina-Pérez A, Rodríguez-Arias D, Delgado-Rodríguez J, Morgan M, Frunza M, Randhawa G, Reiger-Van de Wijdeven J, Schiks E, Wöhlke S, Schicktanz S. Public knowledge and attitudes towards consent policies for organ donation in Europe. A systematic review. Transplant Rev (Orlando) 2019; 33:1-8. [DOI: 10.1016/j.trre.2018.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/21/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022]
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24
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Lee YY, Ranse K, Silvester W, Mehta A, Van Haren F. Attitudes and self-reported end-of-life care of Australian and New Zealand intensive care doctors in the context of organ donation after circulatory death. Anaesth Intensive Care 2018; 46:488-497. [PMID: 30189823 DOI: 10.1177/0310057x1804600510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The incidence of organ donation after circulatory death (DCD) in Australia and New Zealand (ANZ) has steadily increased in recent years. Intensive care doctors are vital to the implementation of DCD and healthcare professionals' attitudes to DCD can influence their participation. In order to determine ANZ intensive care doctors' attitudes to DCD, to explore if demographic characteristics influence attitude to DCD and to assess if attitude to DCD can predict palliative prescription rationale at the end of life of DCD donors, a cross-sectional online survey was distributed to ANZ intensive care doctors and responses collected between 29 April and 10 June 2016. Exploratory factor analysis was used to define various attributes of attitude to DCD. Results were subjected to comparative statistical analyses to examine the relation between demographic data and attitude to DCD. Multiple regression models were used to examine if attitude to DCD could predict intensive care doctors' palliative prescription rationales at the end of life of DCD donors. One hundred and sixty-one intensive care doctors responded to the survey with 69.4% having worked in intensive care for ten years or more. Respondents responded positively to the support of and perceived importance of DCD in helping those who would benefit from the donations (constructive attributes)(mean composite factor score = 3.84, standard deviation [SD] 0.83), they positively perceived that conducive and facilitative orchestration of DCD helps families cope (mean composite factor score = 3.94, SD 0.72) and that they would manage a DCD donor similar to any patient at the end of their life (mean score = 3.94, SD 0.72). Respondents responded negatively to having concerns that the circulatory death of potential DCD donors does not occur within the specified time frame (mean score = 2.28, SD 1.02). There was an association between organ donation professional education courses, familiarity with national guidelines and positive attitudes to certain attributes of attitude to DCD. Regression models demonstrated the attitude to DCD may predict intensive care doctors' palliative medication prescription rationales at the end of life of the DCD donor. Intensive care doctors in ANZ adopt a morally neutral attitude to DCD where they recognise the importance of organ donation, and support and conduct DCD as a part of good end-of-life care.
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Affiliation(s)
| | | | | | - A Mehta
- Associate Lecturer, Research School of Finance, Actuarial Studies & Statistics, Australian National University, Canberra, Australian Capital Territory
| | - Fmp Van Haren
- Adjunct Professor, University of Canberra; Canberra, Australian Capital Territory
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Lomero-Martínez MM, Jiménez-Herrera MF, Bodí-Saera MA, Llauradó-Serra M, Masnou-Burrallo N, Oliver-Juan E, Sandiumenge-Camps A. Decision-making in end of life care. Are we really playing together in the same team? ENFERMERIA INTENSIVA 2018; 29:158-167. [PMID: 29785938 DOI: 10.1016/j.enfi.2018.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/07/2017] [Accepted: 01/05/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Limitation of life-sustaining treatment is increasingly common in critical care units, and controlled donation after circulatory death is starting to be included as an option within patient care plans. Lack of knowledge and misunderstandings can place a barrier between healthcare professionals. OBJECTIVE To determine the perceptions, knowledge and attitudes of physicians and nurses working in intensive care units regarding Limitation of life-sustaining treatment and controlled donation after circulatory death. DESIGN, SETTINGS AND PARTICIPANTS Cross-sectional study carried out in 13 Spanish hospitals by means of an ad hoc questionnaire. METHODS Contingency tables, Pearson's chi-squared test, Student's t-test and the Mann-Whitney u-test were used to carry out descriptive, bivariate and multivariate statistical analyses of responses. RESULTS Although Limitation of life-sustaining treatment is a widespread practice, the survey revealed that nurses feel excluded from the development of protocols and the decision-making process, whilst the perception of physicians is that they have greater knowledge of the topic, and decisions are reached in consensus. CONCLUSIONS Multi-disciplinary training programmes can help critical healthcare providers to work together with greater coordination, thus benefitting patients and their next of kin by providing excellent end-of-life care.
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Affiliation(s)
- M M Lomero-Martínez
- Departamento de Enfermería, Universidad Rovira i Virgili, Campus Catalunya, Tarragona, España
| | - M F Jiménez-Herrera
- Departamento de Enfermería, Universidad Rovira i Virgili, Campus Catalunya, Tarragona, España.
| | - M A Bodí-Saera
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, CIBERES, Tarragona, España
| | - M Llauradó-Serra
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | | | - E Oliver-Juan
- Hospital Universitario de Bellvitge , L'Hospitalet de Llobregat, Barcelona, España
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Rodrigue JR, Luskin R, Nelson H, Glazier A, Henderson GV, Delmonico FL. Measuring Critical Care Providers' Attitudes About Controlled Donation After Circulatory Death. Prog Transplant 2018; 28:142-150. [PMID: 29558878 DOI: 10.1177/1526924818765821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Unfavorable attitudes and insufficient knowledge about donation after cardiac death among critical care providers can have important consequences for the appropriate identification of potential donors, consistent implementation of donation after cardiac death policies, and relative strength of support for this type of donation. The lack of reliable and valid assessment measures has hampered research to capture providers' attitudes. Design and Research Aims: Using stakeholder engagement and an iterative process, we developed a questionnaire to measure attitudes of donation after cardiac death in critical care providers (n = 112) and examined its psychometric properties. Exploratory factor analysis, internal consistency, and validity analyses were conducted to examine the measure. RESULTS A 34-item questionnaire consisting of 4 factors (Personal Comfort, Process Satisfaction, Family Comfort, and System Trust) provided the most parsimonious fit. Internal consistency was acceptable for each of the subscales and the total questionnaire (Cronbach α > .70). A strong association between more favorable attitudes overall and knowledge ( r = .43, P < .001) provides evidence of convergent validity. Multivariable regression analyses showed that white race ( P = .002) and more experience with donation after cardiac death ( P < .001) were significant predictors of more favorable attitudes. CONCLUSION Study findings support the utility, reliability, and validity of a questionnaire for measuring attitudes in critical care providers and for isolating targets for additional education on donation after cardiac death.
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Affiliation(s)
- James R Rodrigue
- 1 Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | | | | | - Galen V Henderson
- 2 Harvard Medical School, Boston, MA, USA.,3 New England Donor Services, Waltham, MA, USA.,4 Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Francis L Delmonico
- 2 Harvard Medical School, Boston, MA, USA.,3 New England Donor Services, Waltham, MA, USA.,5 Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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Lomero MDM, Jiménez-Herrera MF, Llaurado-Serra M, Bodí MA, Masnou N, Oliver E, Sandiumenge A. Impact of training on intensive care providers' attitudes and knowledge regarding limitation of life-support treatment and organ donation after circulatory death. Nurs Health Sci 2018; 20:187-196. [PMID: 29297983 DOI: 10.1111/nhs.12400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/15/2017] [Accepted: 10/19/2017] [Indexed: 01/10/2023]
Abstract
The limitation of life-sustaining treatment is common practice in critical care units, and organ donation after circulatory death has come to be included as an option within this care plan. Lack of knowledge and misunderstandings can raise barriers between health-care providers (e.g., confusion about professional roles, lack of collaboration, doubts about the legality of the process, and not respecting patients' wishes in the decision-making process). The aim of the present study was to determine the knowledge and attitudes of intensive care physicians and nurses before and after a multidisciplinary online training program. A cross-sectional study was performed, and comparisons between the two groups were made using a χ2 -test for categorical data and unpaired t-test or Mann-Whitney rank sum test for continuous data according to its distribution. Training benefited both professional categories, helping nurses to be more open-minded and willing to collaborate, while physicians became more aware of nurses' presence and the need to collaborate with them.
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Affiliation(s)
| | | | | | - María A Bodí
- Intensive Care Unit, University Hospital of Tarragona, Health Research Institute Pere Virgili, Tarragona, Spain
| | - Nuria Masnou
- Donor Coordination Unit, University Hospital Dr. Josep Trueta, Girona, Spain
| | - Eva Oliver
- Donor Coordination Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Alberto Sandiumenge
- Donor Coordination Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Syversen TB, Sørensen DW, Foss S, Andersen MH. Donation after circulatory death - an expanded opportunity for donation appreciated by families. J Crit Care 2017; 43:306-311. [PMID: 28968526 DOI: 10.1016/j.jcrc.2017.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Torgunn Bø Syversen
- Division of Emergencies and Critical Care, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Dag Wendelbo Sørensen
- Division of Emergencies and Critical Care, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Stein Foss
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
| | - Marit Helen Andersen
- Division of Surgery, Inflammatory Diseases and Transplantation, Oslo University Hospital, Post Box 4950, Nydalen, 0424 Oslo, Norway.
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Siminoff LA, Alolod GP, Wilson-Genderson M, Yuen EYN, Traino HM. A Comparison of Request Process and Outcomes in Donation After Cardiac Death and Donation After Brain Death: Results From a National Study. Am J Transplant 2017; 17:1278-1285. [PMID: 27753206 PMCID: PMC5395358 DOI: 10.1111/ajt.14084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/22/2016] [Accepted: 10/08/2016] [Indexed: 01/25/2023]
Abstract
Available literature points to healthcare providers' discomfort with donation after cardiac death (DCD) and their perception of public reluctance toward the procedure. Using a national sample, we report on the communication content of actual DCD and donation after brain death (DBD) approaches by organ procurement organization (OPO) requesters and compare family decision makers' (FDMs') experiences of both modalities. We recruited 1601 FDMs using a validated protocol; 347 (21.7%) were of potential DCD donors. Semistructured telephone interviews yielded FDMs' sociodemographic data, donation attitudes, assessment of approach, final outcomes, and substantiating reasons. Initial analysis consisted of bivariate analyses. Multilevel mixture models compared groups representing authorization outcome and DCD/DBD status. No significant differences in family authorization were found between DCD and DBD cases. Statistically significant associations were found between sociodemographic characteristics and authorization, with white FDMs more likely to authorize DCD or DBD than black FDMs. FDMs of both modalities had similar evaluations of requester skills, topics discussed, satisfaction, and refusal reasons. The findings suggest that the DCD/DBD distinction may not be notable to families. We recommend the use of similar approach strategies and communication skills and the development of education campaigns about the public's acceptance of DCD.
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Affiliation(s)
- L A Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - G P Alolod
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - M Wilson-Genderson
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - E Y N Yuen
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - H M Traino
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
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Adebayo OW, Gonzalez-Guarda RM. Factors Associated With HIV Testing in Youth in the United States: An Integrative Review. J Assoc Nurses AIDS Care 2016; 28:342-362. [PMID: 27993497 DOI: 10.1016/j.jana.2016.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/21/2016] [Indexed: 10/20/2022]
Abstract
We used an integrative review to synthesize existing literature on the factors associated with HIV testing by youth ages 13 to 24 years in the United States. PubMed, CINAHL, PsycINFO, and Google Scholar were systematically searched and 44 original research studies met our criteria. A directed qualitative content analysis was conducted to integrate findings according to the personal, relationship, community, and society levels of the social-ecological model. Female gender, African American race, age, and physical illness were some of the factors more consistently associated with HIV testing. Modifiable factors such as fear, drug use, poor condom use, partner communication, and multiple sexual partners were also noted as influencing HIV testing in youth. Our integrative review revealed gaps in the literature that need further exploration, particularly in the area of community and society influences on HIV testing for youth. Implications for research, practice, and policy are discussed.
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Predicting Donor Death: Early Changes in Oxygen Saturation After Withdrawal of Support Predict Successful Donation During Donation After Circulatory Death. Transplant Proc 2016; 48:1887-92. [DOI: 10.1016/j.transproceed.2016.02.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 02/18/2016] [Indexed: 11/15/2022]
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Black K, Miller K, Beck G, Moser M. What information about donation after circulatory death is available on the Internet for potential donor families? Clin Transplant 2016; 30:934-9. [DOI: 10.1111/ctr.12767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Kristin Black
- College of Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - Katherine Miller
- College of Medicine; University of Saskatchewan; Saskatoon SK Canada
| | - Gavin Beck
- Saskatchewan Renal Transplant Program; University of Saskatchewan; Saskatoon SK Canada
| | - Michael Moser
- Saskatchewan Renal Transplant Program; University of Saskatchewan; Saskatoon SK Canada
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Organ donation in adults: a critical care perspective. Intensive Care Med 2016; 42:305-315. [DOI: 10.1007/s00134-015-4191-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 12/13/2015] [Indexed: 10/22/2022]
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34
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Mercado-Martínez FJ, Padilla-Altamira C, Díaz-Medina B, Sánchez-Pimienta C. Views of health care personnel on organ donation and transplantation: A literature review. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-07072015003842014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The purpose of this study was to review the empirical studies on health personnel's views towards organ donation and transplantation. A scoping review was carried out in English, Portuguese and Spanish. The search was conducted in eight databases, and two search engines. Four groups of descriptors were used. The period covered was 1985 to 2013. Frequency and content analysis was performed. Two hundred forty-eight articles were selected, out of 316 identified. The literature is temporally and geographically clustered. Quantitative studies predominate. The studies prioritized the perspective of medical and nursing personnel over other actors, such as directors and organ donation coordinators. Health personnel's attitudes toward deceased organ donation was the most examined topic. In conclusion, a growing quantitative literature analyzes the perspective of physicians and nurses with regard to deceased organ donation and transplantation.
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Shah SK, Kasper K, Miller FG. A narrative review of the empirical evidence on public attitudes on brain death and vital organ transplantation: the need for better data to inform policy. JOURNAL OF MEDICAL ETHICS 2015; 41:291-6. [PMID: 24769621 DOI: 10.1136/medethics-2013-101930] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Vital organ transplantation is premised on 'the dead donor rule': donors must be declared dead according to medical and legal criteria prior to donation. However, it is controversial whether individuals diagnosed as 'brain dead' are really dead in accordance with the established biological conception of death-the irreversible cessation of the functioning of the organism as a whole. A basic understanding of brain death is also relevant for giving valid, informed consent to serve as an organ donor. There is therefore a need for reliable empirical data on public understanding of brain death and vital organ transplantation. We conducted a review of the empirical literature that identified 43 articles with approximately 18,603 study participants. These data demonstrate that participants generally do not understand three key issues: (1) uncontested biological facts about brain death, (2) the legal status of brain death and (3) that organs are procured from brain dead patients while their hearts are still beating and before their removal from ventilators. These data suggest that, despite scholarly claims of widespread public support for organ donation from brain dead patients, the existing data on public attitudes regarding brain death and organ transplantation reflect substantial public confusion. Our review raises questions about the validity of consent for vital organ transplantation and suggests that existing data are of little assistance in developing policy proposals for organ transplantation from brain dead patients. New approaches to rigorous empirical research with educational components and evaluations of understanding are urgently needed.
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Affiliation(s)
- Seema K Shah
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Kenneth Kasper
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Franklin G Miller
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
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Camut S, Baumann A, Dubois V, Ducrocq X, Audibert G. Non-therapeutic intensive care for organ donation. Nurs Ethics 2014; 23:191-202. [DOI: 10.1177/0969733014558969] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Purpose: Providing non-therapeutic intensive care for some patients in hopeless condition after cerebrovascular stroke in order to protect their organs for possible post-mortem organ donation after brain death is an effective but ethically tricky strategy to increase organ grafting. Finding out the feelings and opinion of the involved healthcare professionals and assessing the training needs before implementing such a strategy is critical to avoid backlash even in a presumed consent system. Participants and methods: A single-centre opinion survey of healthcare professionals was conducted in 2013 in the potentially involved wards of a French University Hospital: the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Unit and the Emergency Department. A questionnaire with multiple-choice questions and one open-ended question was made available in the different wards between February and May 2013. Ethical considerations: The project was approved by the board of the Lorraine University Diploma in Medical Ethics. Results: Of a total of 340 healthcare professionals, 51% filled the form. Only 21.8% received a specific education on brain death, and only 18% on potential donor’s family approach and support. Most healthcare professionals (93%) think that non-therapeutic intensive care is the continuity of patient’s care. But more than 75% of respondents think that the advance patient’s consent and the consent of the family must be obtained despite the presumed consent rule regarding post-mortem organ donation in France. Conclusion: The acceptance by healthcare professionals of non-therapeutic intensive care for brain death organ donation seems fairly good, despite a suboptimal education regarding brain death, non-therapeutic intensive care and families’ support. But they ask to require previously expressed patient’s consent and family’s approval. So, it seems that non-therapeutic intensive care should only remain an ethically sound mean of empowerment of organ donors and their families to make post-mortem donation happen as a full respect of individual autonomy.
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Affiliation(s)
| | - Antoine Baumann
- University Hospital, France; Ethos EA 7299, Université de Lorraine, France; Comité de Réflexion Ethique Nancéien Hospitalo-Universitaire, France
| | - Véronique Dubois
- University Hospital, France; Comité de Réflexion Ethique Nancéien Hospitalo-Universitaire, France
| | - Xavier Ducrocq
- University Hospital, France; Ethos, EA 7299, Université de Lorraine, France; Comité de Réflexion Ethique Nancéien Hospitalo-Universitaire, France
| | - Gérard Audibert
- University Hospital, France; Comité de Réflexion Ethique Nancéien Hospitalo-Universitaire, France
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How Can We Maximize the Potential of Donation After Circulatory Death?*. Crit Care Med 2014; 42:2301-2. [DOI: 10.1097/ccm.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Implementation intentions as a strategy to increase the notification rate of potential ocular tissue donors by nurses: a clustered randomized trial in hospital settings. Nurs Res Pract 2014; 2014:921263. [PMID: 25132990 PMCID: PMC4124222 DOI: 10.1155/2014/921263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/09/2014] [Accepted: 06/18/2014] [Indexed: 11/18/2022] Open
Abstract
Aim. The purpose of this study is to evaluate the impact, among nurses in hospital settings, of a questionnaire-based implementation intentions intervention on notification of potential ocular tissue donors to donation stakeholders. Methods. This randomized intervention was clustered at the level of hospital departments with two study arms: questionnaire-based implementation intentions intervention and control. In the intervention group, nurses were asked to plan specific actions if faced with a number of barriers when reporting potential ocular donors. The primary outcome was the potential ocular tissue donors' notification rate before and after the intervention. Analysis was based on a generalized linear model with an identity link and a binomial distribution. Results. We compared outcomes in 26 departments from 5 hospitals, 13 departments per condition. The implementation intentions intervention did not significantly increase the notification rate of ocular tissue donors (intervention: 23.1% versus control: 21.1%; χ (2) = 1.14, 2; P = 0.56). Conclusion. A single and brief implementation intentions intervention among nurses did not modify the notification rate of potential ocular tissue donors to donation stakeholders. Low exposure to the intervention was a major challenge in this study. Further studies should carefully consider a multicomponent intervention to increase exposure to this type of intervention.
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Douville F, Godin G, Vézina-Im LA. Organ and tissue donation in clinical settings: a systematic review of the impact of interventions aimed at health professionals. Transplant Res 2014; 3:8. [PMID: 24628967 PMCID: PMC4003858 DOI: 10.1186/2047-1440-3-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 02/25/2014] [Indexed: 11/21/2022] Open
Abstract
In countries where presumed consent for organ donation does not apply, health professionals (HP) are key players for identifying donors and obtaining their consent. This systematic review was designed to verify the efficacy of interventions aimed at HPs to promote organ and tissue donation in clinical settings. CINAHL (1982 to 2012), COCHRANE LIBRARY, EMBASE (1974 to 2012), MEDLINE (1966 to 2012), PsycINFO (1960 to 2012), and ProQuest Dissertations and Theses were searched for papers published in French or English until September 2012. Studies were considered if they met the following criteria: aimed at improving HPs’ practices regarding the donation process or at increasing donation rates; HPs working in clinical settings; and interventions with a control group or pre-post assessments. Intervention behavioral change techniques were analyzed using a validated taxonomy. A risk ratio was computed for each study having a control group. A total of 15 studies were identified, of which only 5 had a control group. Interventions were either educational, organizational or a combination of both, and had a weak theoretical basis. The most common behavior change technique was providing instruction. Two sets of interventions showed a significant risk ratio. However, most studies did not report the information needed to compute their efficacy. Therefore, interventions aimed at improving the donation process or at increasing donation rates should be based on sound theoretical frameworks. They would benefit from more rigorous evaluation methods to ensure good knowledge translation and appropriate organizational decisions to improve professional practices.
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Affiliation(s)
- Frédéric Douville
- Institut universitaire de cardiologie et de pneumologie de Québec, 2725, chemin Sainte-Foy, Room Y-3495, Quebec, (Quebec) G1V 4G5, Canada.
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Abstract
The debate about exactly when a person dies can benefit from distinguishing the strict biological concept of death from the medical standards for determining death.
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Racine E. Defining death without science? A pragmatic rebuttal. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:41-43. [PMID: 25046299 DOI: 10.1080/15265161.2014.925157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Eric Racine
- a Institut de recherches cliniques de Montreal (IRCM)
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Abstract
PURPOSE OF REVIEW Donor shortage has forced transplant teams to explore new methods to increase the potential donor pool. Donation after circulatory death (DCD) has opened new perspectives and could be a valuable option to expand the brain-dead donors. The purpose of this review is to provide an overview of current practice and to identify remaining questions related to ethical and medical issues that should be further addressed in the future. RECENT FINDINGS Recent findings demonstrate acceptable outcomes after DCD kidney and lung transplantation but inferior graft survival for liver transplantation. The impact and importance of the agonal phase following withdrawal of treatment in controlled DCD is increasingly recognized. Premortem interventions are currently under debate related to preservation strategies or comfort therapy. New preservation strategies using in-situ/in-vivo extracorporeal membrane oxygenation or ex-vivo machine perfusion have large potential in the future. Finally, organizations and institutions are reporting more uniform guidelines related to declaration of death and DCD organ procurement. SUMMARY DCD donation has regained much attention during the last decade and is now part of standard clinical practice albeit this type of donation should not be regarded as an equally acceptable alternative for donation after brain death. It will be important to further explore the potential of DCD, to monitor the long-term outcomes and to further optimize the quality of these grafts. Development and implementation of uniform guidelines will be necessary to guarantee the clinical use of these donor pools.
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Affiliation(s)
- James L Bernat
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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45
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Coad L, Carter N, Ling J. Attitudes of young adults from the UK towards organ donation and transplantation. Transplant Res 2013; 2:9. [PMID: 23683554 PMCID: PMC3663783 DOI: 10.1186/2047-1440-2-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/04/2013] [Indexed: 11/20/2022] Open
Abstract
Background This study examines the attitudes of young British adults towards donating their own organs and those of their family members. Methods An opportunity sample of 119 participants (65 female) completed an attitude questionnaire. Results Most participants were in favour of donation though substantially fewer had signed up to the organ donation register. A minority of participants was aware of the proposed opt-out system for donation. Conclusions The results from this study corroborate and extend previous work in that more participants were prepared to receive an organ than donate one. Knowing someone who had donated an organ was associated with a more positive attitude towards donation. Implications for policy are discussed.
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Affiliation(s)
- Laura Coad
- Department of Pharmacy, Health & Wellbeing, University of Sunderland, Sunderland SR1 3SD, UK.
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Acceptance of Circulatory Determination of Death and Donation. Crit Care Med 2013; 41:933-4. [DOI: 10.1097/ccm.0b013e31827c0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Circulatory-respiratory or brain tests are widely accepted for definition and determination of death, but have several controversial issues. Both determinations have been stimulated by organ donation, but must be valid independently of this process. Current controversies in brain death include whether the definition is conceptually coherent, whether the whole-brain or brainstem criterion is correct, whether one neurological examination or two should be required, and when to conduct the examination following therapeutic hypothermia. Controversies about the circulatory determination of death include the minimum duration of asystole that is sufficient for death to be declared, and whether the distinction between permanent and irreversible cessation of circulatory functioning is important. In addition, the goal of organ donation raises issues such as the optimal way to time and conduct the request conversation with family members of the patient, and whether the Dead Donor Rule should be abandoned.
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Affiliation(s)
- James L Bernat
- Neurology Department, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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