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Pérez-Blanco A, Acevedo M, Padilla M, Gómez A, Zapata L, Barber M, Martínez A, Calleja V, Rivero MC, Fernández E, Velasco J, Flores EM, Quindós B, Rodríguez ST, Virgós B, Robles JC, Nebra AC, Moya J, Trenado J, García N, Vallejo A, Herrero E, García Á, Rodríguez ML, García F, Lara R, Lage L, Gil FJ, Guerrero FJ, Meilán Á, Del Prado N, Fernández C, Coll E, Domínguez-Gil B. Assessing Outcomes of Patients Subject to Intensive Care to Facilitate Organ Donation: A Spanish Multicenter Prospective Study. Transpl Int 2024; 37:12791. [PMID: 38681973 PMCID: PMC11046399 DOI: 10.3389/ti.2024.12791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
Intensive Care to facilitate Organ Donation (ICOD) consists of the initiation or continuation of intensive care measures in patients with a devastating brain injury (DBI) in whom curative treatment is deemed futile and death by neurological criteria (DNC) is foreseen, to incorporate organ donation into their end-of-life plans. In this study we evaluate the outcomes of patients subject to ICOD and identify radiological and clinical factors associated with progression to DNC. In this first prospective multicenter study we tested by multivariate regression the association of clinical and radiological severity features with progression to DNC. Of the 194 patients, 144 (74.2%) patients fulfilled DNC after a median of 25 h (95% IQR: 17-44) from ICOD onset. Two patients (1%) shifted from ICOD to curative treatment, both were alive at discharge. Factors associated with progression to DNC included: age below 70 years, clinical score consistent with severe brain injury, instability, intracranial hemorrhage, midline shift ≥5 mm and certain types of brain herniation. Overall 151 (77.8%) patients progressed to organ donation. Based on these results, we conclude that ICOD is a beneficial and efficient practice that can contribute to the pool of deceased donors.
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Affiliation(s)
| | - María Acevedo
- Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Aroa Gómez
- Hospital Universitario Vall d’Hebrón, Barcelona, Spain
| | - Luis Zapata
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - María Barber
- Hospital Universitario de Navarra, Pamplona, Spain
| | | | | | - María C. Rivero
- Complejo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Julio Velasco
- Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | | | - Sergio T. Rodríguez
- Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Beatriz Virgós
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - José Moya
- Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Josep Trenado
- Hospital Universitario Mútua Terrasa, Barcelona, Spain
| | | | - Ana Vallejo
- Hospital Universitario de Araba, Vitoria-Gasteiz, Spain
| | | | - Álvaro García
- Complejo Asistencial Universitario, Salamanca, Spain
| | | | | | - Ramón Lara
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | | | - Ángela Meilán
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Cristina Fernández
- Hospital Clínico Universitario de Santiago, Instituto de Investigaciones Sanitarias de Santiago, Santiago, Spain
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2
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Dicks SG, Northam HL, van Haren FM, Boer DP. The bereavement experiences of families of potential organ donors: a qualitative longitudinal case study illuminating opportunities for family care. Int J Qual Stud Health Well-being 2023; 18:2149100. [PMID: 36469685 PMCID: PMC9731585 DOI: 10.1080/17482631.2022.2149100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To illuminate opportunities for care in the context of deceased organ donation by exploring pre-existing family and healthcare professional characteristics, in-hospital experiences, and ongoing adjustment through the lenses of grief theory, systems theory, meaning-making, narrative, and organ donation literature. METHOD Qualitative longitudinal case studies explored individual and family change in five Australian families who had consented to Donation after Circulatory Determination of Death at a single centre. Participants attended semi-structured interviews at four, eight, and twelve months after the death. FINDINGS Family values, pre-existing relationships, and in-hospital experiences influenced first responses to their changed lives, understanding of the patient's death, and ongoing family adjustment. Novel behaviour that was conguent with family values was required at the hospital, especially if the patient had previously played a key role in family decision-making. This behaviour and emerging interactional patterns were drawn into family life over the first year of their bereavement. RECOMMENDATIONS Training that includes lenses introduced in this study will enable healthcare professionals to confidently respond to individual and family psychosocial needs. CONCLUSION The lenses of grief theory and systems thinking highlight opportunities for care tailored to the unique in-hospital context and needs that emerge in the months that follow.
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Affiliation(s)
- Sean G. Dicks
- Department of Psychology, University of Canberra, Canberra, Australia
| | - Holly L. Northam
- Department of Nursing and Midwifery, University of Canberra, Canberra, Australia
| | | | - Douglas P. Boer
- Department of Psychology, University of Canberra, Canberra, Australia
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3
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Urquhart R, Kureshi N, Dirk J, Weiss M, Beed S. Nurse knowledge and attitudes towards organ donation and deemed consent: the Human Organ and Tissue Donation Act in Nova Scotia. Can J Anaesth 2023; 70:245-252. [PMID: 36456763 DOI: 10.1007/s12630-022-02372-4] [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: 02/18/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE In April 2019, the Human Organ and Tissue Donation Act (HOTDA) in Nova Scotia was modified to incorporate a deemed consent model. In this study, we sought to understand intensive care unit (ICU) and emergency department (ED) nurses' knowledge of and confidence around organ donation and transplantation, experiences with organ donors and recipients, attitudes toward organ donation and deemed consent, and perceived opportunities and barriers to a deemed consent approach in view of the legislative change. METHODS We sent an electronic, self-administered survey to all ICU and ED nurses in Nova Scotia. The survey queried respondents on their knowledge of, experience with, and attitudes around organ donation and HOTDA, and opportunities and barriers to the implementation of HOTDA in clinical practice. Survey results were analyzed using descriptive statistics. RESULTS One-hundred and ninety-four nurses responded to the survey. Nearly all (98%) supported organ donation, with 86% having signed an organ donor card to donate organs and/or tissues after death. A considerable majority (89%) also supported the new legislation. Nevertheless, a minority of respondents (13%) believed that deemed consent legislation would be considered a violation of the general principles of freedom and autonomy. The three most identified topics for ongoing training were coordination of the donation process (70%), clinical management of donors (70%), and family issues in decision-making (70%). CONCLUSION Intensive care unit and ED nurses had positive attitudes toward organ donation, including deemed consent model. The findings should inform educational initiatives in Nova Scotia and beyond to optimize organ donation processes and outcomes.
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Affiliation(s)
- Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Room 413, Centre for Clinical Research, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada.
| | - Nelofar Kureshi
- Division of Neurosurgery, QEII Health Sciences Centre and Dalhousie University, Halifax, NS, Canada
| | - Jade Dirk
- Department of Research & Innovation, Nova Scotia Health, Halifax, NS, Canada
| | - Matthew Weiss
- Transplant Québec, Montréal, QC, Canada.,Mère Enfant Soleil du CHU de Québec, Quebec, QC, Canada
| | - Stephen Beed
- Department of Critical Care, Dalhousie University, Halifax, NS, Canada
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4
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Lee DE, Kim H, Park KH, Park SY, Park SM, Jung YH, Jeong W, Park KH. Analysis of Factors Affecting Emergency Physicians' Attitudes toward Deceased Organ & Tissue Donation. J Korean Med Sci 2021; 36:e329. [PMID: 34931495 PMCID: PMC8688344 DOI: 10.3346/jkms.2021.36.e329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/27/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study aimed to investigate differences in knowledge, and attitudes toward deceased organ and tissue donation of emergency physicians. Additionally, we analyzed factors affecting the attitudes toward deceased organ and tissue donation. METHODS We conducted a survey of specialists and residents registered with the Korean Society of Emergency Medicine in December 2020. The respondents' sex, age, position, personal registration for organ donation, experience of soliciting organ donation, participation in related education, knowledge, and attitude about brain death organ donation, and attitude toward stopping life-sustaining treatments were investigated. According to the characteristics of the respondents (specialists or residents, experience and education on organ and tissue donation), their knowledge and attitude toward deceased organ donation were compared. Stepwise hierarchical multiple regression analysis was used to investigate the factors affecting the attitudes toward deceased organ and tissue donation. RESULTS Of the total 428 respondents, there were 292 emergency medicine specialists and 136 medical residents. Specialists and those who registered or wished to donate organs had higher knowledge and attitude scores regarding deceased organ and tissue donation. Those who had experience recommending organ and tissue donation more than 6 times had higher knowledge scores on deceased organ and tissue donation and higher overall scores in attitude. Those who received education from the Korean Organ Donation Agency had higher knowledge scores. Specialists, and those who wished to donate or had registered as organ donors and had a higher life-sustaining treatment attitude score and knowledge about deceased organ and tissue donation, had more positive attitudes toward deceased organ and tissue donation. CONCLUSION For more potential deceased organ and tissue donors to be referred for donation, there should be continuous education for emergency physicians on brain-dead organ and tissue donation-related knowledge and procedures. In addition, institutional or systematic improvements that can lead to organ donation when deciding on the withdrawal of life-sustaining treatment should be considered.
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Affiliation(s)
- Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Kwi Hwa Park
- Department of Medical Education, Gachon University College of Medicine, Incheon, Korea
| | - Song Yi Park
- Department of Emergency Medicine, College of Medicine, Dong-A University, Busan, Korea
- Department of Medical Education, College of Medicine, Dong-A University, Busan, Korea
| | - Seung Min Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Hun Jung
- Department of Emergency Medicine, Chonnam National University, Gwangju, Korea
| | - Wonjoon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hye Park
- Department of Medical Education, Yonsei University, Wonju College of Medicine, Wonju, Korea
- Department of Emergency Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
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5
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Silva E Silva V, Hornby L, Lotherington K, Rochon A, Regina Silva A, Pearson H, MacNutt L, Robertson A, Werestiuk K, Kuhl D, John P, Dhanani S, Sarti A. Burnout, compassion fatigue and work-related stressors among organ donation and transplantation coordinators: A qualitative study. Intensive Crit Care Nurs 2021; 68:103125. [PMID: 34454831 DOI: 10.1016/j.iccn.2021.103125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 07/07/2021] [Accepted: 07/17/2021] [Indexed: 11/05/2022]
Abstract
AIM Organ and Tissue Donation Coordinators (OTDCs) are healthcare professionals who manage deceased organ donation cases. This study investigated the experiences and perceptions of OTDCs, pertaining to compassion fatigue, burnout, and resilience as it relates to their daily work. METHODOLOGY A qualitative descriptive study was undertaken using semi-structured interviews conducted with a convenience sample of OTDCs. SETTING A Canadian Organ Donation Organization. FINDINGS Seven out of the ten OTDCs contacted participated in this study. Coordinators all agreed that they work in a high-pressure and demanding environment and the constant exposure to work-related stress and grief has resulted in the majority of them experiencing signs and symptoms of burnout and compassion fatigue occurring throughout their career. Participants described that the emotional toll of work-related stressors and difficult cases led them to use a variety of defence strategies to protect and support their well-being. They also recognised that more strategies to help mitigate work-related stressors and to prevent burnout and compassion fatigue are needed and that management and institutions should lead the development of such interventions. CONCLUSION Our results describe how coordinators' mental health is affected by their daily work. Further research is needed to comprehensively examine these work-related stressors and to generate additional data to support the development of interventions to mitigate burnout and compassion fatigue among OTDCs.
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Affiliation(s)
- Vanessa Silva E Silva
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada.
| | - Laura Hornby
- University of Ottawa,75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Ken Lotherington
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
| | - Andrea Rochon
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
| | - Amina Regina Silva
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
| | - Hilary Pearson
- HDL Consulting, 120 S. State College Blvd, CA 92821, Canada
| | - Linda MacNutt
- HDL Consulting, 120 S. State College Blvd, CA 92821, Canada
| | - Adrian Robertson
- Manitoba Transplant Program, 820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada
| | - Kim Werestiuk
- Manitoba Transplant Program, 820 Sherbrook St, Winnipeg, MB R3A 1R9, Canada
| | - David Kuhl
- HDL Consulting, 120 S. State College Blvd, CA 92821, Canada; University of British Columbia, Department of Family Practice, 3rd Floor David Strangway Building, 5950 University Boulevard, Vancouver, British Columbia V6T 1Z3, Canada
| | - Peggy John
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
| | - Sonny Dhanani
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada; University of Ottawa,75 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada
| | - Aimee Sarti
- Canadian Blood Services, 1800 Alta Vista Drive, Ottawa, Ontario K1G 4J5, Canada; Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario K1H 5B2, Canada
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6
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Huang C, Chen Z, Wang T, He X, Chen M, Ju W. A marginal liver graft with hyperbilirubinemia transplanted successfully by ischemia-free liver transplantation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:425. [PMID: 33842646 PMCID: PMC8033382 DOI: 10.21037/atm-20-6296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The shortage of transplant organs remains a serious issue worldwide, and using liver grafts from extended criteria donors could expand the donor pool. Extended criteria donor liver allografts have a high chance of complications such as primary nonfunction, early allograft dysfunction, and ischemic-type biliary lesions. How to employ these extended criteria donors safely and effectively warrants further investigation. Herein, we report the successful use of a marginal donor liver with hyperbilirubinemia to save the life of an acute-on-chronic liver failure recipient using a new surgical technique: ischemia-free liver transplantation (IFLT). The graft was retrieved for transplantation due to the following reasons: (I) the recipient was in a life-threatening situation and no living donor donation candidate was available; (II) the graft was considered transplantable except for cholestasis; and (III) IFLT could reduce ischemia/reperfusion injury (IRI), resuscitate the allograft ex situ, and maintain organ viability before transplantation. The graft was transplanted successfully using the IFLT procedure. Although anatomic biliary stricture occurred after surgery, no IRI-related complications were found during the follow-up. The use of liver grafts from extended criteria donors is safe and effective under IFLT. Additional IFLT clinical studies need to be performed, particularly concerning donor management, graft selection, and ex situ resuscitation.
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Affiliation(s)
- Changjun Huang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Zhitao Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Tielong Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Maogen Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Weiqiang Ju
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.,Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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7
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Kotsopoulos AM, Jansen NE, Vos P, Witjes M, Volbeda M, Epker JL, Sonneveld HPC, Simons KS, Bronkhorst EM, van der Hoeven HG, Abdo WF. Determining the impact of timing and of clinical factors during end-of-life decision-making in potential controlled donation after circulatory death donors. Am J Transplant 2020; 20:3574-3581. [PMID: 32506559 PMCID: PMC7754148 DOI: 10.1111/ajt.16104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/05/2020] [Accepted: 05/23/2020] [Indexed: 01/25/2023]
Abstract
Controlled donation after circulatory death (cDCD) occurs after a decision to withdraw life-sustaining treatment and subsequent family approach and approval for donation. We currently lack data on factors that impact the decision-making process on withdraw life-sustaining treatment and whether time from admission to family approach, influences family consent rates. Such insights could be important in improving the clinical practice of potential cDCD donors. In a prospective multicenter observational study, we evaluated the impact of timing and of the clinical factors during the end-of-life decision-making process in potential cDCD donors. Characteristics and medication use of 409 potential cDCD donors admitted to the intensive care units (ICUs) were assessed. End-of-life decision-making was made after a mean time of 97 hours after ICU admission and mostly during the day. Intracranial hemorrhage or ischemic stroke and a high APACHE IV score were associated with a short decision-making process. Preserved brainstem reflexes, high Glasgow Coma Scale scores, or cerebral infections were associated with longer time to decision-making. Our data also suggest that the organ donation request could be made shortly after the decision to stop active treatment and consent rates were not influenced by daytime or nighttime or by the duration of the ICU stay.
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Affiliation(s)
- Angela M. Kotsopoulos
- Department of Intensive Care MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Piet Vos
- Department of Intensive CareElisabeth TweeSteden HospitalTilburgThe Netherlands
| | - Marloes Witjes
- Department of Intensive Care MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Meint Volbeda
- Department of Intensive Care MedicineUMCG University Medical CenterGroningenThe Netherlands
| | - Jelle L. Epker
- Department of Intensive Care MedicineErasmus University Medical CenterRotterdamThe Netherlands
| | | | - Koen S. Simons
- Department of Intensive Care MedicineJeroen Bosch HospitalDen BoschThe Netherlands
| | - Ewald M. Bronkhorst
- Department of Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Hans G. van der Hoeven
- Department of Intensive Care MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Wilson F. Abdo
- Department of Intensive Care MedicineRadboud University Medical CenterNijmegenThe Netherlands
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8
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The Implementation of a Multidisciplinary Approach for Potential Organ Donors in the Emergency Department: Erratum. Transplantation 2020; 104:e87. [DOI: 10.1097/tp.0000000000003105] [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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9
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Dicks SG, Burkolter N, Jackson LC, Northam HL, Boer DP, van Haren FM. Grief, Stress, Trauma, and Support During the Organ Donation Process. Transplant Direct 2020; 6:e512. [PMID: 32047840 PMCID: PMC6964929 DOI: 10.1097/txd.0000000000000957] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022] Open
Abstract
The organ donation process is complex and stressful for the family of the potential donor and members of the multidisciplinary team who may experience grief, ethical dilemmas, vicarious trauma, or compassion fatigue. Several studies each explore the role of a specific healthcare group and the impact of inhospital processes on group members. We conducted a systematic literature search to identify such studies and a qualitative synthesis to consolidate findings and highlight features of the interaction and relationships between role players. Our results suggest that, while healthcare professionals have different roles, attitudes, and views, the experience of stressors and interdisciplinary tension is common. Nevertheless, staff are united by the goal of caring for the patient and family. We therefore propose that, while focusing on bereavement care and other aspects of the family's experience, staff can find other shared goals and develop understanding, trust, empathy, and respect for each other's positions, thereby improving functioning in the complex adaptive system that forms at this time. Education and training can equip staff to facilitate anticipatory mourning, family-led activities, and a meaningful parting from their relative, assisting families with their grief and increasing staff members' efficacy, confidence, and interdisciplinary teamwork. Knowledge of systems thinking and opportunities to share ideas and experiences will enable staff to appreciate each other's roles, while supportive mentors, self-care strategies, and meaningful feedback between role players will foster healthy adjustment and shared learning. A focus on psychosocial outcomes such as family satisfaction with the process, collaboration within the multidisciplinary team, and reduction in the role stress of healthcare professionals will contribute to family well-being as well as personal and professional growth for staff.
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Affiliation(s)
- Sean G. Dicks
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
| | | | | | - Holly L. Northam
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Douglas P. Boer
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Frank M.P. van Haren
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
- Canberra Health Services, Canberra, ACT, Australia
- School of Medicine, Australian National University, Canberra, ACT, Australia
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10
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Cascales-Campos PA, Ferreras D, Alconchel F, Febrero B, Royo-Villanova M, Martínez M, Rodríguez JM, Fernández-Hernández JÁ, Ríos A, Pons JA, Sánchez-Bueno F, Robles R, Martínez-Barba E, Martínez-Alarcón L, Parrilla P, Ramírez P. Controlled donation after circulatory death up to 80 years for liver transplantation: Pushing the limit again. Am J Transplant 2020; 20:204-212. [PMID: 31329359 DOI: 10.1111/ajt.15537] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/20/2019] [Accepted: 07/09/2019] [Indexed: 01/25/2023]
Abstract
Our main objective was to compare liver transplant (LT) results between donation after circulatory death (DCD) and donation after brainstem death (DBD) in our hospital and to analyze, within the DCD group, the influence of age on the results obtained with DCD donors aged >70 years and up to 80 years. All DCD-LTs performed were analyzed prospectively. The results of the DCD group were compared with those of a control group who received a DBD-LT immediately after each DCD-LT. Later, the results obtained within the DCD group were analyzed according to the age of the donors, considering 2 subgroups with a cut-off point at 70 years. Survival results for LT with DCD and super rapid recovery were not inferior to those obtained in a similar group of patients transplanted with DBD livers. However, the cost of DCD was a higher rate of biliary complications, including ischemic cholangiopathy. Donor age was not a negative factor.
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Affiliation(s)
- Pedro A Cascales-Campos
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - David Ferreras
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Felipe Alconchel
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Beatriz Febrero
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Mario Royo-Villanova
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Intensive Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - María Martínez
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Intensive Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - José M Rodríguez
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Juan Á Fernández-Hernández
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Antonio Ríos
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - José A Pons
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Department of Hepatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Sánchez-Bueno
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Ricardo Robles
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Enrique Martínez-Barba
- Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Department of Patholoy, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Laura Martínez-Alarcón
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Pascual Parrilla
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Pablo Ramírez
- Department of Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.,Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
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Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, Malhotra R. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020; 24:804-808. [PMID: 33132564 PMCID: PMC7584817 DOI: 10.5005/jp-journals-10071-23578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Transplantation of Human Organ Act was passed in India in 1994 to streamline organ donation and transplantation activities. It is time to retrospect ourselves and analyze the method to increase organ donation. Type of study Retrospective observational analysis. Objectives To evaluate the change in organ donation rate and reasons for changes in rates. Subjects Brainstem dead declared patients whose family consented for organ donations in the last 23 years (1997–2019) at Ruby Hall Clinic, Pune, India. Materials and methods Retrospectively demographic data of the brainstem dead declared donors, the primary diagnoses, comorbidities, and the complete data of their management till organ retrieval was assessed. Results One hundred cases in the age group 15–75 years (mean 41.6 ± 15.3 years) of brainstem death consented for organ donation were retrospectively studied. The period was divided into two groups, group I and group II included study duration from 1997 to 2013 and from 2013 to 2019 respectively. During the entire period, though the major cause of donor death remained road traffic accidents (RTA) in both the groups (84.21% till 2013 vs 48.15% after 2013), the proportion of donors declared brain dead due to RTA dipped significantly after 2013 (p = 0.004) and the non-RTA causes of brain dead contributed more than RTA causes (51.85% non-RTA vs 48.15% RTA). The major contributor among non-RTA causes was intracranial bleeds (5.26% before 2013 vs 33.33% after 2013, p = 0.014). Compared to the previous 17 years (from 1997) there were more than fourfold rise in the rate of transplantation in the last 6 years (2014–2019) at our institute. Kidneys were retrieved from 90% donors followed by cornea 84%, liver 65%, heart 22%, skin 7%, lungs 6%, and pancreas 5%. Conclusion We have observed that the cadaveric organ donation rate significantly improved after 2013. Reasons might be widening of the donor pool by the selection of more of non-RTA brain death donors over RTA, acceptability of elderly population donor (>60 years) by our transplant teams, early identification of potential organ donor, and better protocol-based management of the cadaver organ donor. How to cite this article Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, et al. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital: 23 Years of Experience. Indian J Crit Care Med 2020;24(9):804–808.
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Affiliation(s)
- Kapil G Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Sushma Gurav
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Abhijeet Deshmukh
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Prajakta Pote
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Amit Tungenwar
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Ria Malhotra
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
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Witjes M, Jansen NE, van der Hoeven JG, Abdo WF. Interventions aimed at healthcare professionals to increase the number of organ donors: a systematic review. Crit Care 2019; 23:227. [PMID: 31221214 PMCID: PMC6587298 DOI: 10.1186/s13054-019-2509-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background The last decade, there have been many initiatives worldwide to increase the number of organ donors. However, it is not clear which initiatives are most effective. The aim of this study is to provide an overview of interventions aimed at healthcare professionals in order to increase the number of organ donors. Methods We systematically searched PubMed, EMBASE, CINAHL, PsycINFO, and the Cochrane Library for English language studies published until April 24, 2019. We included studies describing interventions in hospitals aimed at healthcare professionals who are involved in the identification, referral, and care of a family of potential organ donors. After the title abstract and full-text selection, two reviewers independently assessed each study’s quality and extracted data. Results From the 18,854 records initially extracted from five databases, we included 22 studies in our review. Of these 22 studies, 14 showed statistically significant effects on identification rate, family consent rate, and/or donation rate. Interventions that positively influenced one or more of these outcomes were training of emergency personnel in organ donation, an electronic support system to identify and/or refer potential donors, a collaborative care pathway, donation request by a trained professional, and additional family support in the ICU by a trained nurse. The methodological quality of the studies was relatively low, mainly because of the study designs. Conclusions Although there is paucity of data, collaborative care pathways, training of healthcare professionals and additional support for relatives of potential donors seem to be promising interventions to increase the number of organ donors. Trial registration PROSPERO, CRD42018068185 Electronic supplementary material The online version of this article (10.1186/s13054-019-2509-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marloes Witjes
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands.,Dutch Transplant Foundation, Leiden, The Netherlands
| | | | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands
| | - Wilson F Abdo
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands.
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