1
|
Mahdi S, Marzieh L, Habib R, Elahe P, Sanaz D. The role of healthcare professionals to improve organ donation and transplantation outcome: a national study. Cell Tissue Bank 2024; 25:159-165. [PMID: 36707455 PMCID: PMC9883121 DOI: 10.1007/s10561-023-10071-7] [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: 09/04/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Improve the quality of donor coordination activities caused by an increased organ donation rate. The aim of this study was to assess the influence of organ donation coordinators' characteristics on rate of donation and family consent rate in Recognition Centers (RCs) and Organ Procurement Units (OPUs) in Iran by analyzing the organ procurement and transplantation data. MATERIALS AND METHODS Based on a questionnaire, this retrospective study evaluated the number of confirmed brain deaths, family consent rate, organ recoveries, rate of expired brain death cases before and after family consent in Iran. RESULTS According to results, the overall family consent rate in the entire country is equal to 60.63%. The work experience had a significant effect on the number of procured organs (P < 0.004), death rate after family consent (P < 0.04), and eligible donor death before family consent (P < 0.03). The type of unit (RCs or OPUs) had significant difference on death after family consent (P < 0.023), the death before family consent (P < 0.014), the sum of procured organ (P < 0.04). CONCLUSION The consent rate and donor management in the cases of brain death are unacceptable. The coordinators need training to increase their efficiency in terms of family approach and maintenance of brain death. Only by improving the level of family consent and increasing the coordinators' maintenance skills for brain death cases can the amount of organ donation in Iran be doubled to the current amount.
Collapse
Affiliation(s)
- Shadnoush Mahdi
- Nutrition & Food Technology, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Latifi Marzieh
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahban Habib
- Cardiovascular Research Foundation of Southern California, Beverly Hills, CA USA
- Southern California Medical Education Consortium, Universal Health System, Temecula, CA USA
| | - Pourhosein Elahe
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Dehghani Sanaz
- Organ Procurement Unit, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Tissue Bank & Research Center, Tehran University of Medical Sciences, Sina University Hospital, Hassan-abad Sq. Emam Khomeini St, Tehran, Iran
| |
Collapse
|
2
|
Spardy J, Concepcion J, Yeager M, Andrade R, Braun H, Elkbuli A. National Analysis of Recent Trends in Organ Donation and Transplantation in the United States: Toward Optimizing Care Delivery and Patient Outcomes. Am Surg 2023; 89:5201-5209. [PMID: 36423909 DOI: 10.1177/00031348221135776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION In 2021, over 100 000 people were awaiting solid organ transplantation, yet only 44 634 transplants were performed. The aim of this study is to evaluate trends in donor availability, waitlist additions, and transplants performed in the United States from 2001 to 2021. METHODS This was a retrospective analysis to evaluate trends in donor availability, waitlist additions, and solid organ transplants for the 4 most common organs requiring transplants (kidney, liver, heart, and lung) between 2001 and 2021 according to OPTN data. RESULTS Between 2001 and 2021, the overall number of transplants performed, donors available, and waitlist additions increased by 71%, 61%, and 54%, respectively. The number of kidney transplant waitlist additions significantly increased compared to other organs (P < .001). For each kidney transplant performed, there was a 2.25 increase in waitlist additions throughout the study period (P < .001). For each liver and heart transplant performed, there was a .92 and .80 increase in waitlist additions, respectively (P < .001). Lung transplants increased the most by 138% and there was an increase in waitlist additions for every transplant by 1.0 (P < .001). CONCLUSION There was an absolute increase in the annual number of transplants, donor recruitment, and patients added to the waitlist between 2001 and 2021. Kidney transplant waitlist additions are increasing at a rate outpacing the rates of donor recruitment and transplantation.
Collapse
Affiliation(s)
- Jeffrey Spardy
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | | | - Matthew Yeager
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ryan Andrade
- A.T. Still University School of Osteopathic Medicine, Mesa, AZ, USA
| | - Hillary Braun
- Department of Surgery, Zuckerberg General Hospital and Trauma Center, San Francisco, CA, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
| |
Collapse
|
3
|
Flynn F, Dobrescu MA, Richard G, Hassan C, Pigeon M, Chagnon M, Charbonney E, Serri K, D'Aragon F, Weiss MJ, Williamson D, Frenette AJ. Self-perceived role and knowledge of community pharmacists in organ donation. Int J Clin Pharm 2023:10.1007/s11096-023-01570-4. [PMID: 36977857 DOI: 10.1007/s11096-023-01570-4] [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: 07/22/2022] [Accepted: 03/03/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Although a majority of North Americans is in favor of organ donation, registration remains challenging. Community pharmacists are highly accessible frontline health care professionals that could contribute to a new common registration donation consent system. AIM The objective of the study was to assess self-perceived professional role and organ donation knowledge of community pharmacists in Quebec. METHOD We designed a telephone interview survey using a three round modified Delphi process. Following questionnaires testing, we randomly sampled 329 community pharmacists in Quebec. Following administration, we validated the questionnaire by conducting an exploratory factorial analysis using principal component followed by a varimax rotation and rearranging domains and items accordingly. RESULTS A total of 443 pharmacists were contacted, 329 provided answers to the self-perception role and 216 of them completed the knowledge questionnaire. Overall, community pharmacists of Quebec had a positive view on organ donation and demonstrated interest in acquiring knowledge. Respondents have identified lack of time and high pharmacy attendance as non-limiting barriers to implementing the intervention. The average score on the knowledge questionnaire was 61.2%. CONCLUSION With the implementation of an appropriate education program to address this knowledge gap, we believe that community pharmacists could be key players in registered organ donation consent.
Collapse
Affiliation(s)
- Francis Flynn
- Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin O, Local J-3240, Montreal, QC, H4J 1C5, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada
| | - Marc-Alexandru Dobrescu
- Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin O, Local J-3240, Montreal, QC, H4J 1C5, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada
| | - Guillaume Richard
- Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin O, Local J-3240, Montreal, QC, H4J 1C5, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada
| | - Chadi Hassan
- Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin O, Local J-3240, Montreal, QC, H4J 1C5, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada
| | - Marjorie Pigeon
- Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin O, Local J-3240, Montreal, QC, H4J 1C5, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada
| | - Miguel Chagnon
- Statistics Consultation Service, Université de Montréal, Montréal, Canada
| | - Emmanuel Charbonney
- Critical Care Department, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
- Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Karim Serri
- Faculté de Médecine, Université de Montréal, Montréal, Canada
- Critical Care and Cardiology Divisions, Hôpital du Sacré-Coeur de Montréal, Montreal, Canada
- Centre de Recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
| | | | - Matthew-John Weiss
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec, Université Laval Research Center, Quebec, QC, Canada
- Pediatrics Department, Intensive Care Division, Faculté de Médecine, Université Laval, Quebec, QC, Canada
- Transplant Québec, Montreal, QC, Canada
| | - David Williamson
- Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin O, Local J-3240, Montreal, QC, H4J 1C5, Canada.
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada.
- Centre de Recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada.
| | - Anne Julie Frenette
- Pharmacy Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul. Gouin O, Local J-3240, Montreal, QC, H4J 1C5, Canada
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada
- Centre de Recherche CIUSSSS du Nord de L'Ile, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada
| |
Collapse
|
4
|
Murakami M, Yamazaki H, Suzuki T, Soejima Y, Ishizuka O, Kamijo Y. Newspaper Campaign to Promote Deceased Organ Donation: Who Can Appeal to the General Japanese Population? Transplant Proc 2023; 55:268-273. [PMID: 36822886 DOI: 10.1016/j.transproceed.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/05/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Various interventions are reportedly effective in promoting organ donor registration. However, the identity of those who best serve as presenters to appeal to the general public is not known. METHODS A campaign for organ donor registration was conducted through a local newspaper advertisement in Japan. The advertisement appeared in 439,733 copies of the newspaper on January 9, 2021. In addition to the main message, 6 different presenters with photos of their faces and quick response codes were listed in the advertisement, namely a urologist, transplant physician, nephrologist, dialysis physician, ophthalmologist, and kidney transplant recipient who was a nephrologist himself (ie, a recipient and nephrologist). Newspaper readers watched each video about deceased organ donation via the quick response codes, and the number of video views acquired 30 days after the appearance was the main outcome, which was assessed using YouTube analytics. The proportions (95% CI) of people who watched each video among 439,733 newspaper readers were compared among the 6 presenters. RESULTS The analyzed videos were viewed 262 times. The video produced by the recipient and nephrologist had the highest number of views among the 6 presenters (proportion: 0.019% [95% CI, 0.015-0.023]), followed by the one produced by the dialysis physician (0.011% [95% CI, 0.008-0.014]), the nephrologist (0.010% [95% CI, 0.007-0.014]), the urologist (0.008% [95% CI, 0.006-0.012]), the transplant physician (0.006% [95% CI, 0.004-0.009]), and the ophthalmologist (0.005% [95% CI, 0.004-0.008]). CONCLUSIONS The appeal by the recipient and the nephrologist reached the highest proportion of people who watched the video about deceased organ donation in Japan.
Collapse
Affiliation(s)
- Minoru Murakami
- Department of Nephrology, Saku Central Hospital, Nagano, Japan; Patient Driven Academic League (PeDAL), Tokyo, Japan.
| | - Hajime Yamazaki
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Nagano, Japan
| | - Osamu Ishizuka
- Department of Urology, Shinshu University School of Medicine, Nagano, Japan
| | - Yuji Kamijo
- Department of Nephrology, Shinshu University School of Medicine, Nagano, Japan
| |
Collapse
|
5
|
Bobier C, Rodger D, Hurst DJ, Omelianchuk A. In defense of xenotransplantation research: Because of, not in spite of, animal welfare concerns. Xenotransplantation 2023; 30:e12791. [PMID: 36573621 DOI: 10.1111/xen.12791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/11/2022] [Accepted: 12/12/2022] [Indexed: 12/28/2022]
Abstract
It is envisioned that one day xenotransplantation will bring about a future where transplantable organs can be safely and efficiently grown in transgenic pigs to help meet the global organ shortage. While recent advances have brought this future closer, worries remain about whether it will be beneficial overall. The unique challenges and risks posed to humans that arise from transplanting across the species barrier, in addition to the costs borne by non-human animals, has led some to question the value of xenotransplantation altogether. In response, we defend the value of xenotransplantation research, because it can satisfy stringent welfare conditions on the permissibility of animal research and use. Along the way, we respond to the alleged concerns, and conclude that they do not currently warrant a cessation or a curtailing of xenotransplantation research.
Collapse
Affiliation(s)
- Christopher Bobier
- Department of Theology and Philosophy, Hendrickson Institute for Ethical Leadership, St. Mary's University of Minnesota, Winona, Minnesota, USA
| | - Daniel Rodger
- Operating Department Practice, Institute of Health and Social Care, School of Allied and Community Health, London South Bank University, London, UK.,Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Daniel J Hurst
- Department of Family Medicine Rowan University School of Osteopathic Medicine Stratford, New Jersey, USA
| | - Adam Omelianchuk
- The Center for Medical Ethics and Health Policy at Baylor College of Medicine, Houston, Texas, USA
| |
Collapse
|
6
|
Meyer CH, Grant AA, Enofe N, Matey A, Frankinburger E, Sola R, Nguyen J, Andrade IFP, Veselsky SL, Sciarretta J, Williams KN, Kim S, Smith RN. Organ donation after self-inflicted injury: A single institution analysis. Clin Transplant 2022; 36:e14679. [PMID: 35533053 DOI: 10.1111/ctr.14679] [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: 11/14/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study sought to determine the contribution of self-inflicted injury-related deaths to local organ donation rates and analyze contributing factors. METHODS A retrospective review of adult patients with traumatic self-inflicted injuries was performed at a Level I trauma center from 2013 to 2017. Data were obtained from the institutional trauma registry and cross-referenced with the local organ procurement organization (OPO). Referral rates were analyzed and outcomes, demographics and injury characteristics were compared between patients who underwent donation versus those who did not. RESULTS 142 adult patients presented with traumatic self-inflicted injury, and 100 (70.4%) had referral calls made to the local OPO. These patients were predominantly male (83%), and gunshot injuries accounted for 75% of all mechanisms. Sixty-four percent had organ referrals versus tissue referrals (34%), and 17 (26.6%) of those patients went on to donate. The median number of organs procured was 4 [IQR 0-5]. In multivariate analysis, for each year increase in age, patients were less likely to have an organ referral (OR = .96 [95% CI .93-.99]; p = .0134) and less likely to undergo donation (OR = .95 [95% CI .90-.99]; p = .0308). CONCLUSIONS Self-inflicted injury, though tragic, may provide a significant contribution to the limited organ donor registry.
Collapse
Affiliation(s)
- Courtney H Meyer
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA.,Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - April A Grant
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Nosayaba Enofe
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | | | - Emil Frankinburger
- Grady Health System, Atlanta, Georgia, USA.,Lifelink Foundation, Atlanta, Georgia, USA
| | - Richard Sola
- Grady Health System, Atlanta, Georgia, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Jonathan Nguyen
- Grady Health System, Atlanta, Georgia, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | | | - Steven L Veselsky
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA.,West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, USA
| | - Jason Sciarretta
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Keneeshia N Williams
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA
| | - Steven Kim
- Emory University School of Medicine, Atlanta, Georgia, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Randi N Smith
- Emory University School of Medicine, Atlanta, Georgia, USA.,Grady Health System, Atlanta, Georgia, USA.,Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Schildmann J, Nadolny S, Führer A, Frese T, Mau W, Meyer G, Richter M, Steckelberg A, Mikolajczyk R. [Reasons and Influencing Factors for the Willingness to Document Preferences Regarding Organ Donation: Results of an Online Survey]. Psychother Psychosom Med Psychol 2022; 72:354-361. [PMID: 35213903 DOI: 10.1055/a-1718-3896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Different options to regulate decisions about organ transplantation were subjected to discussions prior to parliamentary decision on 16.01.2020. The goal of this study was the description of citizens' attitudes towards organ donation and investigation of predictors of (documentation of) willingness to donate. METHODS Cross sectional online survey in Berlin and Saxony-Anhalt between 25.11.2019 till 16.01.2020. Descriptive, statistical analysis. We report absolute and relative frequencies. We conducted logistic regression analysis for the influence of age, income and gender on knowledge, willingness to donate and possession of an organ donor card. RESULTS Of 20 020 invited citizens, 676 (3.4%) participated in the online survey; 54.9% were in favour of an opt-out regulation, 49.4% supported an opt-in regulation, 63.3% of respondents were willing or rather willing to donate an organ and 43.2% possessed an organ donor card. Willingness to donate and possession of an organ donor card decreased with increasing age. A Higher educational level was associated with having an organ donor card. Gender, income, education and knowledge about organ donation were not associated with the willingness to donate an organ. Of those who were willing to donate but who had not a donor card, 45.7% had communicated their will to relatives. Reasons indicated for lack of documentation included practical reasons as also fears related to medical care in case of critical health state. DISCUSSION None of the discussed legislative regulations on organ donation has been supported by a clear majority of respondents. Distinct population-based surveys can serve as starting point for developing targeted initiatives to increase the documentation of citizens' will regarding organ donation following brain death.
Collapse
Affiliation(s)
- Jan Schildmann
- Institut für Geschichte und Ethik der Medizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Stephan Nadolny
- Institut für Geschichte und Ethik der Medizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.,Stabsstelle Pflegewissenschaft, Franziskus-Hospital Harderberg, Niels-Stensen-Klinken, Georgsmarienhütte, Germany
| | - Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Thomas Frese
- Institut für Allgemeinmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Wilfried Mau
- Institut für Rehabilitationsmedizin, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Matthias Richter
- Institut für Medizinische Soziologie, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Anke Steckelberg
- Institut für Gesundheits- und Pflegewissenschaft, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| |
Collapse
|
8
|
Ewald J, Rivieccio F, Radosa L, Schuster S, Brakhage AA, Kaleta C. Dynamic optimization reveals alveolar epithelial cells as key mediators of host defense in invasive aspergillosis. PLoS Comput Biol 2021; 17:e1009645. [PMID: 34898608 PMCID: PMC8699926 DOI: 10.1371/journal.pcbi.1009645] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/23/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
Aspergillus fumigatus is an important human fungal pathogen and its conidia are constantly inhaled by humans. In immunocompromised individuals, conidia can grow out as hyphae that damage lung epithelium. The resulting invasive aspergillosis is associated with devastating mortality rates. Since infection is a race between the innate immune system and the outgrowth of A. fumigatus conidia, we use dynamic optimization to obtain insight into the recruitment and depletion of alveolar macrophages and neutrophils. Using this model, we obtain key insights into major determinants of infection outcome on host and pathogen side. On the pathogen side, we predict in silico and confirm in vitro that germination speed is an important virulence trait of fungal pathogens due to the vulnerability of conidia against host defense. On the host side, we found that epithelial cells, which have been underappreciated, play a role in fungal clearance and are potent mediators of cytokine release. Both predictions were confirmed by in vitro experiments on established cell lines as well as primary lung cells. Further, our model affirms the importance of neutrophils in invasive aspergillosis and underlines that the role of macrophages remains elusive. We expect that our model will contribute to improvement of treatment protocols by focusing on the critical components of immune response to fungi but also fungal virulence traits.
Collapse
Affiliation(s)
- Jan Ewald
- Department of Bioinformatics, Friedrich Schiller University Jena, Jena, Germany.,Center for Scalable Data Analytics and Artificial Intelligence (ScaDS.AI), University of Leipzig, Leipzig, Germany
| | - Flora Rivieccio
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute (HKI), Jena, Germany.,Department of Microbiology and Molecular Biology, Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany
| | - Lukáš Radosa
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute (HKI), Jena, Germany
| | - Stefan Schuster
- Department of Bioinformatics, Friedrich Schiller University Jena, Jena, Germany
| | - Axel A Brakhage
- Department of Molecular and Applied Microbiology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute (HKI), Jena, Germany.,Department of Microbiology and Molecular Biology, Institute of Microbiology, Friedrich Schiller University Jena, Jena, Germany
| | - Christoph Kaleta
- Research Group Medical Systems Biology, Institute of Experimental Medicine, Kiel University, Kiel, Germany
| |
Collapse
|
9
|
Timar J, Bleil M, Daly T, Koomar S, Hasz R, Nathan H. Successful strategies to increase organ donation: the Gift of Life Donor Program Philadelphia model. Indian J Thorac Cardiovasc Surg 2021; 37:380-394. [PMID: 34629767 PMCID: PMC8464643 DOI: 10.1007/s12055-021-01219-9] [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: 03/16/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 10/20/2022] Open
Abstract
Organ donation connects the ending of one life with the renewal of another. Acute care hospitals care for the organ donor and transplant organizations complete life-saving surgeries. Between them is a vital component: a less-known medical team dedicated to ensuring that organ donation and transplantation are possible. Organ procurement organizations (OPOs) support grieving families during a painful time of loss, providing a rare and precious opportunity in donation. The OPO is simultaneously poised to ensure that organs successfully begin their journey to renewing life and restoring hope for recipients and their loved ones. Every OPO faces a myriad of challenges in meeting its responsibilities. A recognized leader in the field, Gift of Life Donor Program (GLDP) in Philadelphia, Pennsylvania has been committed to meeting these challenges for nearly fifty years. The successes of this OPO reflect the legacies of organ donors, recipients, and their cherished loved ones.
Collapse
Affiliation(s)
- Jennifer Timar
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Maria Bleil
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Theresa Daly
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Susan Koomar
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Richard Hasz
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| | - Howard Nathan
- Gift of Life Donor Program, 401 N. 3rd St, Philadelphia, PA 19123 USA
| |
Collapse
|
10
|
Ma J, Zeng L, Li T, Tian X, Wang L. Experiences of Families Following Organ Donation Consent: A Qualitative Systematic Review. Transplant Proc 2021; 53:501-512. [PMID: 33483168 DOI: 10.1016/j.transproceed.2020.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This systematic review synthesizes qualitative evidence on the experiences of donor families after consent to organ donation. METHODS This robust, qualitative systematic review included an exhaustive search of electronic databases, including PubMed, Scopus, EBSCO PsycINFO, and CINAHL Complete. Manual searches of reference lists and gray literature were conducted to achieve a comprehensive identification of all relevant research. A qualitative study design served to capture the experiences of donor families after organ donation consent. RESULTS A total of 6 articles that met the eligibility criteria were identified and included in this review. Three key themes emerged from the primary research: 1. family members were ambivalent about consent due to the ambiguity of brain death; 2. conversations about donation requirements proved uncomfortable; and 3. support is needed after donation. CONCLUSIONS Family members demonstrated ongoing ambivalence and distress that lasted for weeks after organ donation due to the ambiguity of brain death. Some family members were unhappy with having been approached for a conversation about organ donation. Donor families were not always able to deal with the difficulties they faced after their decision about organ donation. Health care professionals should provide ongoing care and updated information to family members. This review helped to identify family members' needs for both psychological and financial assistance.
Collapse
Affiliation(s)
- Juanjuan Ma
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China
| | - Li Zeng
- Nursing Department, Shenzhen Shekou People's Hospital, Shenzhen, China.
| | - Tingjun Li
- The Second People's Hospital of Futian District, Shenzhen, China
| | - Xiaofei Tian
- The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lili Wang
- Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
| |
Collapse
|
11
|
Organ donation in the US and Europe: The supply vs demand imbalance. Transplant Rev (Orlando) 2020; 35:100585. [PMID: 33071161 DOI: 10.1016/j.trre.2020.100585] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
Organ donation and transplantation remain the best and most cost-effective clinical solution for end-stage organ failure. Several agencies across the US and Europe provide legislative, regulatory, and humanitarian services to generate smoother applications in all transplantation processes and donor-recipient relationships. US and European statistics present nine types of grafts, with kidneys being the most transplanted organ worldwide. However, organ shortage, religion, underrepresented minority groups, difficulties in obtaining consent, lack of understanding, and general ethical concerns present challenging barriers to organ donation, reflecting the complexity of graft procurement and allocation. Breaking down these barriers to reduce the organ-supply imbalance requires an appropriate multifaceted approach. Some of the key areas include increasing the potential donor pool and consent rates, apt organ allocation, and improving organ health. Additionally, suitable policies and standardized guidelines for both donors and recipients, alongside educational initiatives, are needed to ensure patient safety and global awareness. Looking forward, novel and effective research plans and initiatives are needed if we are to avoid a colossal supply-demand gap.
Collapse
|
12
|
Siminoff LA, Gardiner HM, Alolod GP, Wilson-Genderson M. Using Online Communication Skills Training to Increase Organ Donation Authorization. Prog Transplant 2020; 30:212-219. [DOI: 10.1177/1526924820933846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Family denial of organ donation from deceased donor-eligible patients is a major contributor to the deficit of transplantable organs in the United States. Research Question: Does an evidence-based communication intervention improve deceased organ donor authorization rates from family decision-makers? Design: This implementation and dissemination study used Communicating Effectively about Donation on Organ Procurement Organization professionals responsible for discussing donation and obtaining authorization from family decision-makers. A 14-month, nationwide social marketing campaign generated a sample of 682 requesters, yielding a final analyzable sample of 253 participants. Serving as their own controls, participants spent the first 3 months in a preintervention period, completed the web-based intervention, and progressed to a 3-month postintervention period. Participants completed brief online weekly surveys to assess the intervention’s impact on their communication skills. Results: Authorization rates did not improve overall between the pre- and postintervention periods. A differential effect of the intervention on 3 distinct groups of requesters was found: one group exhibited high and stable authorization rates pre–post (78%-74%); a second group had low initial authorization rates that increased after exposure to the intervention (46%-73%); the third had low and variable rates of authorization that failed to improve after the intervention (45%-36%). Conclusion: This study underscores the value of evidence-based communication training. Training targeted to requesters’ skill levels is needed to realize overall improvements in individual performance, the quality of donation discussions, and rates of family decision-maker authorization to solid organ donation.
Collapse
Affiliation(s)
- Laura A. Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, PA, USA
| | - Heather M. Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, PA, USA
| | - Gerard P. Alolod
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, PA, USA
| | - Maureen Wilson-Genderson
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, PA, USA
| |
Collapse
|
13
|
Zhang T, Dunson J, Kanwal F, Galvan NTN, Vierling JM, O’Mahony C, Goss JA, Rana A. Trends in Outcomes for Marginal Allografts in Liver Transplant. JAMA Surg 2020; 155:2769119. [PMID: 32777009 PMCID: PMC7407315 DOI: 10.1001/jamasurg.2020.2484] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/12/2020] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Investigating outcomes after marginal allograft transplant is essential in determining appropriate and more aggressive use of these allografts. OBJECTIVE To determine the time trends in the outcomes of marginal liver allografts as defined by 6 different sets of criteria. DESIGN, SETTING, AND PARTICIPANTS In this case-control, multicenter study, 75 050 patients who received a liver transplant between March 1, 2002, and September 30, 2016, were retrospectively analyzed to last known follow-up (n = 55 395) or death (n = 19 655) using the United Network for Organ Sharing Database. The study period was divided into three 5-year eras: 2002-2006, 2007-2011, and 2012-2016. Kaplan-Meier survival analysis with log-rank test and Cox proportional hazards regression analysis were used to examine the allograft after transplant with marginal allografts, which were defined as 90th percentile Donor Risk Index allografts (calculated over the entire study period), donor after circulatory death allografts, national share allografts, old age (donors >70 years) allografts, fatty liver allografts, and 90th percentile Discard Risk Index allografts. Statistical analysis was performed from August to December 2019. MAIN OUTCOMES AND MEASURES Allograft failure after transplant as defined by the Organ Procurement and Transplantation Network database. RESULTS Among the 75 050 patients (44 394 men; mean [SD] age, 54.3 [9.9] years) in the study, Donor Risk Index, patient Model for End-stage Liver Disease scores, and balance of risk scores significantly increased over time. Multivariate Cox proportional hazards regression analysis indicated that 90th percentile Donor Risk Index allograft survival increased across the study period (2002-2006: hazard ratio, 1.41 [95% CI, 1.34-1.49]; 2007-2011: hazard ratio, 1.25 [95% CI, 1.17-1.34]; 2012-2016: hazard ratio, 1.10 [95% CI, 0.98-1.24]). Secondary definitions of marginal allografts (donor after circulatory death, national share, old age donors, fatty liver, and 90th percentile Discard Risk Index) showed similar improvements in allograft survival. CONCLUSIONS AND RELEVANCE The study's findings encourage the aggressive use of liver allografts and may indicate a need for a redefinition of allograft marginality in liver transplantation.
Collapse
Affiliation(s)
- Theodore Zhang
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas
| | - Jordan Dunson
- Department of Student Affairs, Baylor College of Medicine, Houston, Texas
| | - Fasiha Kanwal
- Michael E. DeBakey Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Nhu Thao Nguyen Galvan
- Division of Abdominal Transplantation, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas
| | - John M. Vierling
- Division of Gastroenterology, Nutrition, and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Christine O’Mahony
- Liver Center, Division of Abdominal Transplantation, Department of General Surgery, Baylor College of Medicine, Houston, Texas
| | - John A. Goss
- Liver Center, Division of Abdominal Transplantation, Department of General Surgery, Baylor College of Medicine, Houston, Texas
| | - Abbas Rana
- Division of Abdominal Transplantation, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
14
|
Bogaert S, Peeters P, Suchonos N, Decruyenaere A, Decruyenaere P, Vermassen F, Hoste EA. WITHDRAWN: Impact on Delayed Graft Function of the Renal Resistive Index in the Immediate Postoperative Period After Kidney Transplantation: A Cohort Analysis. Transplant Proc 2020:S0041-1345(19)31053-X. [PMID: 32703673 DOI: 10.1016/j.transproceed.2019.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
Collapse
Affiliation(s)
- Stijn Bogaert
- Intensive Care Unit, Ghent University Hospital, Ghent, Belgium; Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
| | | | - Nicole Suchonos
- Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany
| | | | | | - Frank Vermassen
- Department of Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Eric Aj Hoste
- Intensive Care Unit, Ghent University Hospital, Ghent, Belgium; Research-Foundation (FWO), Brussels, Belgium
| |
Collapse
|
15
|
Melvinsdottir I, Foley DP, Hess T, Gunnarsson SI, Kohmoto T, Hermsen J, Johnson MR, Murray D, Dhingra R. Heart and kidney transplant: should they be combined or subsequent? ESC Heart Fail 2020; 7:2734-2743. [PMID: 32608197 PMCID: PMC7524231 DOI: 10.1002/ehf2.12864] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/25/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023] Open
Abstract
AIMS End-stage heart failure patients often present with severe kidney failure and have limited treatment options. We compared the clinical characteristics and outcomes among end-stage heart and kidney failure patients who underwent combined heart and kidney transplant (HKTx) with those who underwent kidney transplant after heart transplant (KAH). METHODS AND RESULTS All patients from 2007-2016 who underwent combined HKTx (n = 715) and those who underwent KAH (n = 130) using the United Network for Organ Sharing database were included. Kaplan-Meier curves and Cox models compared survivals and identified predictors of death. Number of combined HKTx performed annually in United States increased from 59 in 2007 to 146 in 2016 whereas KAH decreased from 34 in 2007 to 6 in 2016. Among KAH patients, average wait time for kidney transplant was 3.0 years, time to dialysis or to kidney transplant after heart transplant did not differ with varying severity of kidney disease at baseline (P for both >0.05). Upon follow-up (mean 3.5 ± 2.7 years), 151 patients died. In multivariable models, patients who underwent combined HKTx had 4.7-fold greater risk of death [95% confidence interval (CI) 2.4-9.4) than KAH patients upon follow up. A secondary analysis using calculation of survival only after kidney transplant for KAH patients still conferred higher risk for combined HKTx patients [hazard ratio (HR) 2.6 95% CI 1.33-5.15]. In subgroup analyses after excluding patients on dialysis (HR 3.99 95% CI 1.98-8.04) and analysis after propensity matching for age, gender, and glomerular filtration rate (HR 3.01 95% CI 1.40-6.43) showed similar and significantly higher risk for combined HKTx patients compared with KAH patients. Lastly, these results also remained unchanged after excluding transplant centres who performed only one type of procedure preferentially, i.e. HKTx or KAH (HR 4.70 95% CI 2.35-9.42). CONCLUSIONS National registry data show continual increase in combined HKTx performed annually in the United States but inferior survival compared with KAH patients. Differences in patient characteristics or level of kidney dysfunction at baseline do not explain these poor outcomes among HKTx patients compared with KAH patients. Consensus guidelines are greatly needed to identify patients who may benefit more from dual organ transplants.
Collapse
Affiliation(s)
- Inga Melvinsdottir
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - David P Foley
- Division of Transplantation, Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Timothy Hess
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Sverrir I Gunnarsson
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Takushi Kohmoto
- Division of Cardiac Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.,Division of Cardiac Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Joshua Hermsen
- Division of Cardiac Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Maryl R Johnson
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - David Murray
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Ravi Dhingra
- Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.,Advanced Heart Disease and Transplant, Cardiovascular Division, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| |
Collapse
|
16
|
Survey on attitudes toward brain-dead and living donor transplantation in medical students: a cross-sectional study in Japan. Clin Exp Nephrol 2020; 24:638-645. [PMID: 32236783 DOI: 10.1007/s10157-020-01878-9] [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: 08/14/2019] [Accepted: 03/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although a shortage in organ donation is a critical problem in Japan, understanding of and attitude toward organ transplantation in medical students have not been sufficiently reported. METHODS Between 2013 and 2018, we surveyed 702 medical students in the fifth-year clinical training in our urology department. The survey concerned (1) knowledge of Japanese transplantation law, which was amended in 2010, and (2) whether the respondents had an organ donor card and had agreed to be a brain-dead donor or a living donor in kidney transplantation with specific reasons for their choices. RESULTS All 702 students answered the survey. Of 657 students who provided valid answers to the first section, 402 (61%) recognized the amendment to the Japanese transplantation law, and only 11 (1.7%) fully understood its contents. Of 702 students, 194 (28%) had a donor card, 384 (55%) agreed to be a brain-dead donor, and 529 (75%) agreed to be a living donor in kidney transplantation. As the specific reasons for their choices, only a few medical students wrote reasons based on their medical standpoint, and more students wrote emotional reasons. CONCLUSIONS The understanding of and attitude toward organ transplantation were not remarkably high in the fifth-year medical students in Japan. To solve the donor shortage problem, education about organ transplantation may need to be more effective.
Collapse
|
17
|
Iglesias-González E, Torras-Ambros J. Impacto de la perfusión hipotérmica pulsativa en el injerto renal de donante subóptimo: nuestra experiencia inicial. ENFERMERÍA NEFROLÓGICA 2020. [DOI: 10.37551/s2254-28842020007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: Estudios recientes han demostrado que el mantenimiento de la viabilidad de riñones con criterios expandidos durante su preservación sea un reto. La máquina de perfusión hipotérmica pretende mitigar el efecto del almacenamiento en frío sobre la calidad del órgano cuando el tiempo de isquemia fría es prolongada o el donante subóptimo.Objetivo: Evaluar las complicaciones que presentan los pacientes trasplantados renales con preservación está-tica fría o perfusión hipotérmica pulsátil.Material y Método: Estudio observacional retrospec-tivo durante 2010-2012 donde se incluyeron todos los trasplantes renales realizados en un hospital de tercer nivel. Las variables de estudio: estancia hospitalaria, horas de isquemia, necesidad de diálisis y número de sesiones post trasplante y el dispositivo de almacena-miento, edad y patologías asociadas al donante.Resultados: Se realizaron 175 trasplantes donde 70 procedieron de donantes ≥65 años. Se perfundieron en máquina 30 riñones y en 40 se utilizó la preservación estática. Nuestros hallazgos respecto al uso de la má-quina de perfusión conllevan un descenso en la estancia media hospitalaria y una menor necesidad de hemodiá-lisis postrasplante.Conclusiones: Debido al alto porcentaje de órganos procedentes de donantes de edad avanzada y difíciles de preservar, resulta fundamental buscar técnicas de perfusión intravascular continua para una preservación más efectiva del órgano.
Collapse
Affiliation(s)
- Estefanía Iglesias-González
- Departamento Extracción Multiorgánica y Trasplante Renal. Hospital Universitario de Bellvitge. Hospitalet de Llobregat. Barcelona. España
| | - Joan Torras-Ambros
- Departamento de Nefrología. Hospital Universitario de Bellvitge. Hospitalet de Llobregat. Barcelona. España
| |
Collapse
|
18
|
Rana A, Joshi M, Price MB, Ganni S, Bakhtiyar SS, Vierling JM, Galvan NT, Cotton RT, O'Mahony CA, Kanwal F, Goss JA. A learning curve in using orphan liver allografts for transplantation. Clin Transplant 2020; 34:e13821. [PMID: 32034946 DOI: 10.1111/ctr.13821] [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: 08/05/2019] [Revised: 01/24/2020] [Accepted: 02/05/2020] [Indexed: 11/28/2022]
Abstract
Given the critical shortage of donor livers, marginal liver allografts have potential to increase donor supply. We investigate trends and long-term outcomes of liver transplant using national share allografts transplanted after rejection at the local and regional levels. We studied a cohort of 75 050 candidates listed in the Organ Procurement and Transplantation Network for liver transplantation between 2002 and 2016. We compared patients receiving national share and regional/local share allografts from 2002-2006, 2007-2011, and 2012-2016, performing multivariate Cox regression for graft survival. Recipient and center-level covariates that were not significant (P < .05) were removed. Graft survival of national share allografts improved over time. National share allografts had a 26% increased risk for graft failure in 2002-2006 but no impact on graft survival in 2007-2011 and 2012-2016. The cold ischemia time (CIT) of national share allografts decreased from 10.4 to 8.0 hours. We demonstrate that CIT had significant impact on graft survival using national share allografts (CIT <6 hours: hazard ratio 0.75 and CIT >12 hours: hazard ratio 1.25). Despite a trend toward sicker recipients and poorer quality allografts, graft survival outcomes using national share allografts have improved to benchmark levels. Reduction in cold ischemia time is a possible explanation.
Collapse
Affiliation(s)
- Abbas Rana
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Manasi Joshi
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew Brent Price
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Saif Ganni
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Syed S Bakhtiyar
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - John M Vierling
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Nhu Thao Galvan
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Ronald T Cotton
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Christine A O'Mahony
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Fasiha Kanwal
- Division of Medicine-Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - John A Goss
- Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
19
|
Murakami M, Fukuma S, Ikezoe M, Izawa S, Watanabe H, Yamaguchi H, Kitazawa A, Takahashi K, Natsukawa S, Fukuhara S. Knowledge Does Not Correlate with Behavior toward Deceased Organ Donation: A Cross-Sectional Study in Japan. Ann Transplant 2020; 25:e918936. [PMID: 31896742 PMCID: PMC6977621 DOI: 10.12659/aot.918936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Although knowledge is an important factor that influences decisions regarding deceased organ donation, the associations of knowledge with attitude and behavior regarding organ donation remain uncertain in countries with low organ donation rates like Japan. Material/Methods We conducted a cross-sectional survey of hospital medical and non-medical staff in 15 Japanese medical facilities. The questionnaire included items on knowledge, attitude, and behavior toward deceased organ donation and transplantation. Participants were divided into 3 groups according to the tertile of knowledge score. Modified Poisson regression models were used for associations of knowledge score with organ donor registration and willingness to become an organ donor after death. Results Of the 1967 staff, 1275 returned the questionnaires (response rate, 64.8%). There were 1190 study subjects with complete data for analysis. For the lowest (n=512), middle (n=428), and highest (n=250) tertile knowledge groups, the proportions of participants who registered and expressed willingness to donate organs were 20.1%, 23.4%, and 28.4% and 31.1%, 38.3%, and 44.0%, respectively. The adjusted proportion ratios for organ donor registration were 0.90 (95% CI, 0.73–1.10) for the middle and 1.00 (0.80–1.26) for the highest tertile of knowledge, compared with the lowest tertile. However, participants with the highest tertile of knowledge score expressed higher willingness for organ donation than the lowest tertile (adjusted proportion ratio, 1.37; 95% CI, 1.13–1.66). Conclusions For hospital staff in Japanese medical facilities, high knowledge about organ donation and transplantation was not associated with donor registration, but was associated with willingness to become an organ donor.
Collapse
Affiliation(s)
- Minoru Murakami
- Department of Healthcare Epidemiology, School of Public Health in The Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Nephrology, Saku Central Hospital, Nagano, Japan
| | - Shingo Fukuma
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaya Ikezoe
- Department of Nephrology, Saku Central Hospital, Nagano, Japan
| | | | | | | | | | - Katsusada Takahashi
- Saku Central Hospital Health Services Facility for The Elderly, Nagano, Japan
| | | | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in The Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
20
|
Abstract
OBJECTIVES To systematically review the global published literature defining a potential deceased organ donor and identifying clinical triggers for deceased organ donation identification and referral. DATA SOURCES Medline and Embase databases from January 2006 to September 2017. STUDY SELECTION All published studies containing a definition of a potential deceased organ donor and/or clinical triggers for referring a potential deceased organ donor were eligible for inclusion. Dual, independent screening was conducted of 3,857 citations. DATA EXTRACTION Data extraction was completed by one team member and verified by a second team member. Thematic content analysis was used to identify clinical criteria for potential deceased organ donation identification from the published definitions and clinical triggers. DATA SYNTHESIS One hundred twenty-four articles were included in the review. Criteria fell into four categories: Neurological, Medical Decision, Cardiorespiratory, and Administrative. Distinct and globally consistent sets of clinical criteria by type of deceased organ donation (neurologic death determination, controlled donation after circulatory determination of death, and uncontrolled donation after circulatory determination of death) are reported. CONCLUSIONS Use of the clinical criteria sets reported will reduce ambiguity associated with the deceased organ donor identification and the subsequent referral process, potentially reducing the number of missed donors and saving lives globally through increased transplantation.
Collapse
|
21
|
Damar HT, Ordin YS, Top FÜ. Factors Affecting Attitudes Toward Organ Donation in Health Care Professionals. Transplant Proc 2019; 51:2167-2170. [DOI: 10.1016/j.transproceed.2019.01.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/28/2019] [Indexed: 10/26/2022]
|
22
|
de Tantillo L, González JM, Ortega J. Organ Donation After Circulatory Death and Before Death: Ethical Questions and Nursing Implications. Policy Polit Nurs Pract 2019; 20:163-173. [PMID: 31407946 DOI: 10.1177/1527154419864717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Scientific advances have enabled thousands of individuals to extend their lives through organ donation. Yet, shortfalls of available organs persist, and individuals in the United States die daily before they receive what might have been lifesaving organs. For years, the legal foundation of organ donation in the United States has been known as the Dead Donor Rule, requiring death to be defined for organ donation purposes by either a cardiac standard (termination of the heartbeat) or a neurological one (cessation of all brain function). In this context, one solution used by an increasing number of health care facilities since 2006 is donation after circulatory death, generally defined as when care is withdrawn from individuals who have known residual brain function. Despite its increased use, donation after circulatory death remains ethically controversial. In addition, some ethicists have advocated forgoing the Dead Donor Rule altogether and allowing donation before or near death in certain circumstances. However, nurses and other health professionals must carefully consider the practical and ethical implications of broadening the Dead Donor Rule-as may be already occurring-or removing it entirely. Such changes could harm both the integrity of the health care system as well as efforts to secure organ donation commitments from the public and are outweighed by the moral and pragmatic cost. Nurses should be prepared to confront the challenge posed by the ongoing scarcity of organs and advocate for ethical alternatives including research on effective care pathways and education regarding organ donation.
Collapse
Affiliation(s)
- Lila de Tantillo
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Juan M González
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| | - Johis Ortega
- University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
| |
Collapse
|
23
|
Sandal S, Bae S, McAdams-DeMarco M, Massie AB, Lentine KL, Cantarovich M, Segev DL. Induction immunosuppression agents as risk factors for incident cardiovascular events and mortality after kidney transplantation. Am J Transplant 2019; 19:1150-1159. [PMID: 30372596 PMCID: PMC6433494 DOI: 10.1111/ajt.15148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/30/2018] [Accepted: 10/19/2018] [Indexed: 01/25/2023]
Abstract
Low T cell counts and acute rejection are associated with increased cardiovascular events (CVEs); T cell-depleting agents decrease both. Thus, we aimed to characterize the risk of CVEs by using an induction agent used in kidney transplant recipients. We conducted a secondary data analysis of patients who received a kidney transplant and used Medicare as their primary insurance from 1999 to 2010. Outcomes of interest were incident CVE, all-cause mortality, CVE-related mortality, and a composite outcome of mortality and CVE. Of 47 258 recipients, 29.3% received IL-2 receptor antagonist (IL-2RA), 33.3% received anti-thymocyte globulin (ATG), 7.3% received alemtuzumab, and 30.0% received no induction. Compared with IL-2RA, there was no difference in the risk of CVE in the ATG (adjusted hazard ratio [aHR] 0.98, 95% confidence interval [CI] 0.92-1.05) and alemtuzumab group (aHR 1.01, 95% CI 0.89-1.16), but slightly higher in the no induction group (aHR 1.06, 95% CI 1.00-1.14). Acute rejection did not modify this association in the latter group but did increase CVE by 46% in the alemtuzumab group. There was no difference in the hazard of all-cause or CVE-related mortality. Only in the ATG group, a 7% lower hazard of the composite outcome of mortality and CVE was noted. Induction agents are not associated with incident CVE, although prospective trials are needed to determine a personalized approach to prevention.
Collapse
Affiliation(s)
- Shaifali Sandal
- Department of Medicine, Divisions of Nephrology and Multi-Organ Transplant Program, McGill University Health Centre, Montreal, QC
| | - Sunjae Bae
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mara McAdams-DeMarco
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B. Massie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Marcelo Cantarovich
- Department of Medicine, Divisions of Nephrology and Multi-Organ Transplant Program, McGill University Health Centre, Montreal, QC
| | - Dorry L. Segev
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
24
|
Effects of phased education on attitudes toward organ donation and willingness to donate after brain death in an Asian country. Asian J Surg 2019; 42:256-266. [DOI: 10.1016/j.asjsur.2018.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/15/2018] [Accepted: 04/20/2018] [Indexed: 11/21/2022] Open
|
25
|
Beaudry A, Ferguson TW, Rigatto C, Tangri N, Dumanski S, Komenda P. Cost of Dialysis Therapy by Modality in Manitoba. Clin J Am Soc Nephrol 2018; 13:1197-1203. [PMID: 30021819 PMCID: PMC6086697 DOI: 10.2215/cjn.10180917] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/14/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The prevalence of ESKD is increasing worldwide. Treating ESKD is disproportionately costly in comparison with its prevalence, mostly due to the direct cost of dialysis therapy. Here, we aim to provide a contemporary cost description of dialysis modalities, including facility-based hemodialysis, peritoneal dialysis, and home hemodialysis, provided with conventional dialysis machines and the NxStage System One. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We constructed a cost-minimization model from the perspective of the Canadian single-payer health care system including all costs related to dialysis care. The labor component of costs consisted of a breakdown of activity-based per patient direct labor requirements. Other costs were taken from statements of operations for the kidney program at Seven Oaks General Hospital (Winnipeg, Canada). All costs are reported in Canadian dollars. RESULTS Annual maintenance expenses were estimated as $64,214 for in-center facility hemodialysis, $43,816 for home hemodialysis with the NxStage System One, $39,236 for home hemodialysis with conventional dialysis machines, and $38,658 for peritoneal dialysis. Training costs for in-center facility hemodialysis, home hemodialysis with the NxStage System One, home hemodialysis with conventional dialysis machines, and peritoneal dialysis are estimated as $0, $16,143, $24,379, and $7157, respectively. The threshold point to achieve cost neutrality was determined to be 9.7 months from in-center hemodialysis to home hemodialysis with the NxStage System One, 12.6 months from in-center hemodialysis to home hemodialysis with conventional dialysis machines, and 3.2 months from in-center hemodialysis to peritoneal dialysis. CONCLUSIONS Home modalities have lower maintenance costs, and beyond a short time horizon, they are most cost efficient when considering their incremental training expenses. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_07_18_CJASNPodcast_18_8_F.mp3.
Collapse
Affiliation(s)
- Alain Beaudry
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| | - Thomas W. Ferguson
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| | - Claudio Rigatto
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| | - Navdeep Tangri
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| | - Sandi Dumanski
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Paul Komenda
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Seven Oaks Hospital Chronic Disease Innovation Centre, Winnipeg, Manitoba, Canada; and
| |
Collapse
|
26
|
Gritane K, Jusinskis J, Malcevs A, Suhorukovs V, Amerika D, Puide I, Ziedina I. Influence of Pretransplant Dialysis Vintage on Repeated Kidney Transplantation Outcomes. Transplant Proc 2018; 50:1249-1257. [PMID: 29880343 DOI: 10.1016/j.transproceed.2018.01.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/20/2017] [Accepted: 01/23/2018] [Indexed: 01/17/2023]
Abstract
Dialysis has a dose-dependent effect on first kidney transplantation outcomes, and a shorter waiting time on dialysis is associated with superior graft function. There are not enough data to support this statement in the case of a repeated transplantation. As such, we aimed to evaluate the influence of the dialysis vintage before the last transplantation on graft function as well as patient and graft survival in repeated transplantation situations. Patients who underwent repeated kidney transplantations were included in the retrospective study. Specifically, 79 patients were included who were divided into 4 groups according to the dialysis vintage before the last transplantation. We assessed graft function and patient and graft survival rates after 1- and 3-year follow-up. One-year graft function was worse for patients with a dialysis vintage of more than 31 months (P = .005), but there was no difference after 3 years. One- and 3-year graft survival was better for patients with a dialysis vintage of less than 12 months (P = .017). We concluded that a longer waiting time on dialysis was associated with worse graft function and diminished long-term graft survival after repeated kidney transplantation.
Collapse
Affiliation(s)
- K Gritane
- Riga Stradins University, Transplant Research Laboratory, Riga, Latvia
| | - J Jusinskis
- Riga Stradins University, Transplant Research Laboratory, Riga, Latvia; Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - A Malcevs
- Riga Stradins University, Transplant Research Laboratory, Riga, Latvia; Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - V Suhorukovs
- Riga Stradins University, Transplant Research Laboratory, Riga, Latvia; Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - D Amerika
- Riga Stradins University, Transplant Research Laboratory, Riga, Latvia; Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - I Puide
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - I Ziedina
- Riga Stradins University, Transplant Research Laboratory, Riga, Latvia; Pauls Stradins Clinical University Hospital, Riga, Latvia.
| |
Collapse
|
27
|
Ordin YS, Söylemez BA. Effects of Peer Education on Attitudes Toward Organ Donation in Nursing Students. Transplant Proc 2018; 50:2971-2975. [PMID: 29706233 DOI: 10.1016/j.transproceed.2018.02.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/17/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Nurses play an effective role in the identification of donors and in the families' decision-making processes related to organ donation. It is recommended that nursing students be offered specific education regarding organ donation and transplantation. The aim of this study was to examine the effects of peer education on attitudes toward organ donation and the rate of attaining a donor card in undergraduate nursing students. METHODS This study was a quasi-experimental trial in a single group conducted between February 2016 and October 2016. Data were collected in 3 stages (pretest, posttest 1, and posttest 2) by using the Organ Donation Attitudes Scale. Data analysis was made with descriptive statistics, repeated measures analysis of variance, and the McNemar test. RESULTS The mean age of the participants was 21.63 ± 1.19 years. There was no statistically significant difference in students' attitudes toward organ donation after peer education (P > .05). The difference in the number of students having a donor card after peer education was highly significant (P < .05). CONCLUSIONS These study results showed that peer training did not positively change nursing students' attitudes toward organ donation but encouraged them to acquire a donor card and increased their knowledge of the organ donation system.
Collapse
Affiliation(s)
- Y S Ordin
- Department of Surgical Nursing, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
| | - B A Söylemez
- Department of Internal Medicine Nursing, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
| |
Collapse
|
28
|
Lan C, Song JL, Yan LN, Yang JY, Wen TF, Li B, Xu MQ. Pediatric Donor to Adult Recipients in Donation After Cardiac Death Liver Transplantation: A Single-Center Experience. Transplant Proc 2018; 49:1383-1387. [PMID: 28736011 DOI: 10.1016/j.transproceed.2017.01.088] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/11/2017] [Accepted: 01/24/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND The impact of using liver allografts from donors who are younger than 14 years at the time of donation after cardiac death (DCD) liver transplantation in terms of early allograft dysfunction (EAD) and graft survival is undefined. To determine if adults undergoing DCD liver transplantation who receive a graft from a donor age younger than or equal to 13 years have similar outcomes to recipients of organs from older than 18-year-old donors. METHODS Records from adult patients undergoing DCD liver transplantation between March 2012 and December 2015 who received whole grafts from donors after cardiac death were reviewed. Patients with donors younger than or equal to 13 years (group 1) and older than 18 years (group 2) were compared for EAD rates, hepatic artery thrombosis (HAT), and graft survival. RESULTS Records of 60 DCD liver transplantation patients were analyzed. The 90-day and 1-year graft survival rate of both groups was 90% versus 96% (P = .427) and 80% versus 84% (P = .668), respectively. The EAD rates of groups 1 and 2 were 30% versus 34% (P = .806). The incidence of HAT was 20% in group 1 compared with 12% in group 2 (P = .610). Also, 0.7% < graft to recipient weight ratio (GRWR) <0.8% was also usable for pediatric donor to adult recipients. CONCLUSIONS Whole liver grafts from donors younger than or equal to 13 years can potentially be used in selected size-matched (GRWR >0.7%) DCD adult recipients.
Collapse
Affiliation(s)
- C Lan
- Institute of Hepatobiliary, Pancreatic and Intestinal Diseases, North Sichuan Medical College, Nanchong, Sichuan, China; Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - J L Song
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - L N Yan
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - J Y Yang
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - T F Wen
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - B Li
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - M Q Xu
- Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
| |
Collapse
|
29
|
Chancellor WZ, Charles EJ, Mehaffey JH, Hawkins RB, Foster CA, Sharma AK, Laubach VE, Kron IL, Tribble CG. Expanding the donor lung pool: how many donations after circulatory death organs are we missing? J Surg Res 2018; 223:58-63. [PMID: 29433886 PMCID: PMC6475907 DOI: 10.1016/j.jss.2017.09.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 08/15/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The number of patients with end-stage pulmonary disease awaiting lung transplantation is at an all-time high, while the supply of available organs remains stagnant. Utilizing donation after circulatory death (DCD) donors may help to address the supply-demand mismatch. The objective of this study is to determine the potential donor pool expansion with increased procurement of DCD organs from patients who die at hospitals. MATERIAL AND METHODS The charts of all patients who died at a single, rural, quaternary-care institution between August 2014 and June 2015 were reviewed for lung transplant candidacy. Inclusion criteria were age <65 y, absence of cancer and lung pathology, and cause of death other than respiratory or sepsis. RESULTS A total of 857 patients died within a 1-year period and were stratified by age: pediatric <15 y (n = 32, 4%), young 15-64 y (n = 328, 38%), and old >65 y (n = 497, 58%). Those without cancer totaled 778 (90.8%) and 512 (59%) did not have lung pathology. This leaves 85 patients qualifying for DCD lung donation (pediatric n = 10, young n = 75, and old n = 0). Potential donors were significantly more likely to have clear chest X-rays (24.3% versus 10.0%, P < 0.0001) and higher mean PaO2/FiO2 (342.1 versus 197.9, P < 0.0001) compared with ineligible patients. CONCLUSIONS A significant number of DCD lungs are available every year from patients who die within hospitals. We estimate the use of suitable DCD lungs could potentially result in a significant increase in the number of lungs available for transplantation.
Collapse
Affiliation(s)
- William Zachary Chancellor
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
| | - Eric J Charles
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - James Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Carrie A Foster
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Ashish K Sharma
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Victor E Laubach
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Irving L Kron
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Curtis G Tribble
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
| |
Collapse
|
30
|
A perspective on the physical, mechanical and biological specifications of bioinks and the development of functional tissues in 3D bioprinting. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.bprint.2018.02.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
31
|
Hematopoietic Stem Cell Transplantation: A Bioethical Lens. Stem Cells Int 2017; 2017:1286246. [PMID: 28740510 PMCID: PMC5504964 DOI: 10.1155/2017/1286246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 03/22/2017] [Accepted: 05/15/2017] [Indexed: 01/03/2023] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is one of a range of therapeutic options available to patients suffering from various diseases. HSCT procedure involves important ethical and legal aspects that can occur at every phase of the procedure: the clinical choice of whether to perform the procedure, pretransplantation preparation regimens, donor selection, stem cell harvest procedure, transplantation phase, and short-term and long-term follow-up care. In this discussion paper, we outline the ethical issue-facing physicians involved in HSCT. Currently, HSCT is a widely accepted treatment for many life-threatening diseases. It thus represents a real therapeutic hope for many patients. It does, however, carry a burden of possible morbidity and mortality. Consequently, there are substantial information and communication issues involved in the consent process for HSCT. In the final decision, the judgements of different parties, such as patients, family members, and healthcare professionals, intersect and overlap and this is particularly true when the patient is a minor. Finally, HSCT is a very expensive procedure. The social and economic concerns of HSCT are discussed within the actual contextual framework of the dramatic increase in healthcare costs and inequalities in healthcare in relation to socioeconomic status, educational status, and ethnicity.
Collapse
|
32
|
Shen F, Yan R. Design and Implementation of a Hypothermic Machine Perfusion Device for Clinical Preservation of Isolated Organs. SENSORS (BASEL, SWITZERLAND) 2017; 17:E1256. [PMID: 28587173 PMCID: PMC5492428 DOI: 10.3390/s17061256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/17/2022]
Abstract
The imbalance between limited organ supply and huge potential need has hindered the development of organ-graft techniques. In this paper a low-cost hypothermic machine perfusion (HMP) device is designed and implemented to maintain suitable preservation surroundings and extend the survival life of isolated organs. Four necessary elements (the machine perfusion, the physiological parameter monitoring, the thermostatic control and the oxygenation apparatus) involved in this HMP device are introduced. Especially during the thermostatic control process, a modified Bayes estimation, which introduces the concept of improvement factor, is realized to recognize and reduce the possible measurement errors resulting from sensor faults and noise interference. Also, a fuzzy-PID controller contributes to improve the accuracy and reduces the computational load using the DSP. Our experiments indicate that the reliability of the instrument meets the design requirements, thus being appealing for potential clinical preservation applications.
Collapse
Affiliation(s)
- Fei Shen
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China.
| | - Ruqiang Yan
- School of Instrument Science and Engineering, Southeast University, Nanjing 210096, China.
| |
Collapse
|
33
|
Yang SS, Yang J, Ahn C, Min SI, Ha J, Kim SJ, Park JB. The Need for New Donor Stratification to Predict Graft Survival in Deceased Donor Kidney Transplantation. Yonsei Med J 2017; 58:626-630. [PMID: 28332370 PMCID: PMC5368150 DOI: 10.3349/ymj.2017.58.3.626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/06/2016] [Accepted: 12/16/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to determine whether stratification of deceased donors by the United Network for Organ Sharing (UNOS) criteria negatively impacts graft survival. MATERIALS AND METHODS We retrospectively reviewed deceased donor and recipient pretransplant variables of kidney transplantations that occurred between February 1995 and December 2009. We compared clinical outcomes between standard criteria donors (SCDs) and expanded criteria donors (ECDs). RESULTS The deceased donors consisted of 369 patients. A total of 494 transplant recipients were enrolled in this study. Mean age was 41.7±11.4 year (range 18-69) and 273 patients (55.4%) were male. Mean duration of follow-up was 8.8±4.9 years. The recipients from ECD kidneys were 63 patients (12.8%). The overall mean cold ischemia time was 5.7±3.2 hours. Estimated glomerular filtration rate at 1, 2, and 3 years after transplantation were significantly lower in ECD transplants (1 year, 62.2±17.6 vs. 51.0±16.4, p<0.001; 2 year, 62.2±17.6 vs. 51.0±16.4, p=0.001; 3 year, 60.9±23.5 vs. 54.1±18.7, p=0.047). In multivariate analysis, donor age (≥40 years) was an independent risk factor for graft failure. In Kaplan-Meier analyses, there was no significant difference in death-censored graft survival (Log rank test, p>0.05), although patient survival was lower in ECDs than SCDs (Log rank test, p=0.011). CONCLUSION Our data demonstrate that stratification by the UNOS criteria does not predict graft survival. In order to expand the donor pool, new criteria for standard/expanded donors need to be modified by regional differences.
Collapse
Affiliation(s)
- Shin Seok Yang
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Jaeseok Yang
- Transplantation Center, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Transplantation Center, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Il Min
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jongwon Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Joo Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Berm Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
34
|
Murakami M, Fukuma S, Ikezoe M, Iizuka C, Izawa S, Yamamoto Y, Yamazaki S, Fukuhara S. Effects of structured education program on organ donor designation of nursing students and their families: A randomized controlled trial. Clin Transplant 2016; 30:1513-1519. [DOI: 10.1111/ctr.12845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Minoru Murakami
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
- Department of Nephrology Saku Central Hospital Nagano Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
- Institute for Advancement of Clinical and Translational Science (iACT) Kyoto University Hospital Kyoto Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE) Fukushima Medical University Fukushima Japan
| | - Masaya Ikezoe
- Department of Nephrology Saku Central Hospital Nagano Japan
| | | | | | - Yosuke Yamamoto
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
- Institute for Advancement of Clinical and Translational Science (iACT) Kyoto University Hospital Kyoto Japan
| | - Shin Yamazaki
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology School of Public Health in the Graduate School of Medicine Kyoto University Kyoto Japan
- Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE) Fukushima Medical University Fukushima Japan
| |
Collapse
|
35
|
Hoste P, Ferdinande P, Hoste E, Vanhaecht K, Rogiers X, Eeckloo K, Van Deynse D, Ledoux D, Vandewoude K, Vogelaers D. Recommendations for further improvement of the deceased organ donation process in Belgium. Acta Clin Belg 2016; 71:303-12. [PMID: 27594299 DOI: 10.1080/17843286.2016.1216259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Belgium has achieved high deceased organ donation rates but according to the medical record data in the Donor Action database, deceased potential donors are still missed along the pathway. Between 2010 and 2014, 12.9 ± 3.3% of the potential donors after brain death (DBD) and 24.6 ± 1.8% of the potential donors after circulatory (DCD) death were not identified. Conversion rates of 41.7 ± 2.1% for DBD and 7.9 ± 0.9% for DCD indicate room for further improvement. We identify and discuss different issues in the monitoring of donation activities, practices and outcomes; donor pool; legislation on deceased organ donation; registration; financial reimbursement; educational and training programs; donor detection and practice clinical guidance. The overall aim of this position paper, elaborated by a Belgian expert panel, is to provide recommendations for further improvement of the deceased organ donation process up to organ procurement in Belgium.
Collapse
|
36
|
Callison K, Levin A. Donor registries, first-person consent legislation, and the supply of deceased organ donors. JOURNAL OF HEALTH ECONOMICS 2016; 49:70-75. [PMID: 27388535 DOI: 10.1016/j.jhealeco.2016.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
In this paper, we exploit the varied timing in state adoption of organ donor registries and first-person consent (FPC) legislation to examine corresponding changes in the supply of deceased organ donors. Results indicate that the establishment of a state organ donor registry leads to an increase in donation rates of approximately 8%, while the adoption of FPC legislation has no effect on the supply of organ donors. These results reinforce the need to encourage individuals to communicate their donation preferences, either explicitly via a registry or by discussing them with family.
Collapse
Affiliation(s)
- Kevin Callison
- Grand Valley State University, 50 Front Ave SW, Grand Rapids, MI 49504, United States.
| | - Adelin Levin
- Grand Valley State University, 50 Front Ave SW, Grand Rapids, MI 49504, United States
| |
Collapse
|
37
|
Hvidt NC, Mayr B, Paal P, Frick E, Forsberg A, Büssing A. For and against Organ Donation and Transplantation: Intricate Facilitators and Barriers in Organ Donation Perceived by German Nurses and Doctors. J Transplant 2016; 2016:3454601. [PMID: 27597891 PMCID: PMC5002484 DOI: 10.1155/2016/3454601] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/25/2016] [Indexed: 11/25/2022] Open
Abstract
Background. Significant facilitators and barriers to organ donation and transplantation remain in the general public and even in health professionals. Negative attitudes of HPs have been identified as the most significant barrier to actual ODT. The purpose of this paper was hence to investigate to what extent HPs (physicians and nurses) experience such facilitators and barriers in ODT and to what extent they are intercorrelated. We thus combined single causes to circumscribed factors of respective barriers and facilitators and analyzed them for differences regarding profession, gender, spiritual/religious self-categorization, and self-estimated knowledge of ODT and their mutual interaction. Methods. By the use of questionnaires we investigated intricate facilitators and barriers to organ donation experienced by HPs (n = 175; 73% nurses, 27% physicians) in around ten wards at the University Hospital of Munich. Results. Our study confirms a general high agreement with the importance of ODT. Nevertheless, we identified both facilitators and barriers in the following fields: (1) knowledge of ODT and willingness to donate own organs, (2) ethical delicacies in ODT, (3) stressors to handle ODT in the hospital, and (4) individual beliefs and self-estimated religion/spirituality. Conclusion. Attention to the intricacy of stressors and barriers in HPs continues to be a high priority focus for the availability of donor organs.
Collapse
Affiliation(s)
- Niels Christian Hvidt
- Research Unit of General Practice, Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, J. B. Winsløwsvej 9A, 5000 Odense C, Denmark
| | - Beate Mayr
- Forschungsstelle Spiritual Care, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Munich School of Philosophy, Kaulbachstraße 31, 80539 Munich, Germany
- Research Centre Spiritual Care, Department of Psychosomatic Medicine and Psychotherapy, The University Hospital Klinikum rechts der Isar, Langerstraße 3, 81675 Munich, Germany
| | - Piret Paal
- Hospice Care DaSein, Karlstraße 55, 80333 Munich, Germany
| | - Eckhard Frick
- Forschungsstelle Spiritual Care, Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Munich School of Philosophy, Kaulbachstraße 31, 80539 Munich, Germany
- Research Centre Spiritual Care, Department of Psychosomatic Medicine and Psychotherapy, The University Hospital Klinikum rechts der Isar, Langerstraße 3, 81675 Munich, Germany
| | - Anna Forsberg
- Department of Transplantation and Cardiology, Skåne University Hospital, 221 85 Lund, Sweden
- Department of Health Sciences, Lund University, P.O. Box 157, 221 00 Lund, Sweden
| | - Arndt Büssing
- Institute of Integrative Medicine, Faculty of Medicine, Witten/Herdecke University, Herdecke, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
| |
Collapse
|
38
|
Klassen DK, Edwards LB, Stewart DE, Glazier AK, Orlowski JP, Berg CL. The OPTN Deceased Donor Potential Study: Implications for Policy and Practice. Am J Transplant 2016; 16:1707-14. [PMID: 26813036 DOI: 10.1111/ajt.13731] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/06/2016] [Accepted: 01/17/2016] [Indexed: 01/25/2023]
Abstract
The Organ Procurement and Transplantation Network (OPTN) Deceased Donor Potential Study, funded by the Health Resources and Services Administration, characterized the current pool of potential deceased donors and estimated changes through 2020. The goal was to inform policy development and suggest practice changes designed to increase the number of donors and organ transplants. Donor estimates used filtering methodologies applied to datasets from the OPTN, the National Center for Health Statistics, and the Agency for Healthcare Research and Quality and used these estimates with the number of actual donors to estimate the potential donor pool through 2020. Projected growth of the donor pool was 0.5% per year through 2020. Potential donor estimates suggested unrealized donor potential across all demographic groups, with the most significant unrealized potential (70%) in the 50-75-year-old age group and potential Donation after Circulatory Death (DCD) donors. Actual transplants that may be realized from potential donors in these categories are constrained by confounding medical comorbidities not identified in administrative databases and by limiting utilization practices for organs from DCD donors. Policy, regulatory, and practice changes encouraging organ procurement and transplantation of a broader population of potential donors may be required to increase transplant numbers in the United States.
Collapse
Affiliation(s)
- D K Klassen
- United Network for Organ Sharing, Richmond, VA
| | - L B Edwards
- Research Department, United Network for Organ Sharing, Richmond, VA
| | - D E Stewart
- Research Department, United Network for Organ Sharing, Richmond, VA
| | | | - J P Orlowski
- LifeShare Transplant Donor Services of Oklahoma, Oklahoma City, OK
| | - C L Berg
- Department of Medicine, Duke University School of Medicine, Durham, NC
| |
Collapse
|
39
|
Ralph AF, Alyami A, Allen RDM, Howard K, Craig JC, Chadban SJ, Irving M, Tong A. Attitudes and beliefs about deceased organ donation in the Arabic-speaking community in Australia: a focus group study. BMJ Open 2016; 6:e010138. [PMID: 26787253 PMCID: PMC4735320 DOI: 10.1136/bmjopen-2015-010138] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To describe the beliefs and attitudes to organ donation in the Arabic-speaking community. DESIGN Arabic-speaking participants were purposively recruited to participate in 6 focus groups. Transcripts were analysed thematically. PARTICIPANTS 53 participants, aged 19-77 years, and originating from 8 countries, participated in 1 of 6 focus groups. Participants identified as Christian (73%), Islam (26%), Buddhist (2%) or did not identify with any religion (2%). RESULTS 6 themes (with subthemes) were identified; religious conviction; invisibility of organ donation; medical suspicion; owning the decision; and reciprocal benefit. CONCLUSIONS Although organ donation is considered a generous life-saving 'gift', representative members of the Arabic-speaking community in Australia were unfamiliar with, unnerved by and sceptical about the donation process. Making positive decisions about organ donation would likely require resolving tensions between respecting family, community and religious values versus their individual autonomy. Providing targeted education about the process and benefits of organ donation within the Arabic community may clarify ambiguities surrounding cultural and religious-based views on organ donation, reduce taboos and suspicion towards donation, and in turn, lead to increased organ donation rates.
Collapse
Affiliation(s)
- Angelique F Ralph
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ali Alyami
- Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia Transplantation Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Richard D M Allen
- Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia Transplantation Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kirsten Howard
- The Institute for Choice, University of South Australia, North Sydney, New South Wales, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Steve J Chadban
- Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia Transplantation Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michelle Irving
- Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| |
Collapse
|
40
|
Ríos A, López-Navas A, Martínez-Alarcón L, Ramírez P, Parrilla P. Latin Americans in Spain and their attitude toward living kidney donation. Clin Transplant 2015; 29:1054-62. [DOI: 10.1111/ctr.12626] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 01/08/2023]
Affiliation(s)
- A. Ríos
- International Collaborative Donor Project (“Proyecto Colaborativo Internacional Donante”); Murcia Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology; University of Murcia; Murcia Spain
- Transplant Unit; Surgery Service; IMIB - Virgen de la Arrixaca University Hospital; Murcia Spain
- Regional Transplant Center; Consejería de Sanidad y Consumo de la Región de Murcia; Murcia Spain
| | - A. López-Navas
- International Collaborative Donor Project (“Proyecto Colaborativo Internacional Donante”); Murcia Spain
- Regional Transplant Center; Consejería de Sanidad y Consumo de la Región de Murcia; Murcia Spain
- Department of Psychology; UCAM; San Antonio Catholic University; Murcia Spain
| | - L. Martínez-Alarcón
- International Collaborative Donor Project (“Proyecto Colaborativo Internacional Donante”); Murcia Spain
- Transplant Unit; Surgery Service; IMIB - Virgen de la Arrixaca University Hospital; Murcia Spain
- Regional Transplant Center; Consejería de Sanidad y Consumo de la Región de Murcia; Murcia Spain
| | - P. Ramírez
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology; University of Murcia; Murcia Spain
- Transplant Unit; Surgery Service; IMIB - Virgen de la Arrixaca University Hospital; Murcia Spain
- Regional Transplant Center; Consejería de Sanidad y Consumo de la Región de Murcia; Murcia Spain
| | - P. Parrilla
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology; University of Murcia; Murcia Spain
- Transplant Unit; Surgery Service; IMIB - Virgen de la Arrixaca University Hospital; Murcia Spain
| |
Collapse
|
41
|
Williams AM, Allingham RR, Stamer WD, Muir KW. Eye Care Professionals' Perspectives on Eye Donation and an Eye Donation Registry for Research: A Single-Institution, Cross-Sectional Study. Curr Eye Res 2015; 41:867-71. [PMID: 26287578 DOI: 10.3109/02713683.2015.1056376] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE A centralized eye donation registry for research could help to bridge the gap between patients interested in donating their eyes to science and scientists who conduct research on human eye tissue. Previous research has demonstrated patient and family support for such a registry. In this study, we assessed the views that eye care professionals have toward an eye donation registry for research. MATERIALS AND METHODS Surveys were distributed to all 46 clinical faculty members of the Duke University Eye Center. In addition to collecting demographic information, the surveys assessed clinicians' experience with discussing eye donation with patients, described the proposed eye donation registry for research and asked how the registry would affect the clinicians' practice. RESULTS A total of 21 eye care professionals returned the survey. Thirty-three percent reported discussing eye donation with patients, and 43% reported that a patient has asked about donating their eyes for research on their disease. Eighty-six percent of eye care professionals reported that a centralized registry would improve the way they work with patients who express a desire to donate their eyes for research. CONCLUSIONS The majority of eye care professionals at our academic institution indicated that an eye donation registry for research would improve how they work with patients who are interested in donating their eyes for research on their disease. Future research should examine how best to communicate this registry to ophthalmic patients.
Collapse
Affiliation(s)
- Andrew M Williams
- a Michigan State University College of Human Medicine , Grand Rapids , MI , USA
| | - R Rand Allingham
- b Department of Ophthalmology , Duke University Medical Center , Durham , NC , USA , and
| | - W Daniel Stamer
- b Department of Ophthalmology , Duke University Medical Center , Durham , NC , USA , and
| | - Kelly W Muir
- b Department of Ophthalmology , Duke University Medical Center , Durham , NC , USA , and.,c Durham VA Medical Center, Health Services Research and Development , Durham , NC , USA
| |
Collapse
|
42
|
Kidney transplantation: Hemodialysis and surrounding are they informed enough? INDIAN JOURNAL OF TRANSPLANTATION 2015. [DOI: 10.1016/j.ijt.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
43
|
Radunz S, Benkö T, Stern S, Saner FH, Paul A, Kaiser GM. Medical students' education on organ donation and its evaluation during six consecutive years: results of a voluntary, anonymous educational intervention study. Eur J Med Res 2015; 20:23. [PMID: 25880285 PMCID: PMC4359403 DOI: 10.1186/s40001-015-0116-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/24/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND One of the main reasons for organ shortage is insufficient education on organ donation. Knowledgeable medical students could share the information with friends and families resulting in a positive attitude to organ donation of the general public. METHODS During six consecutive years (2009 to 2014), we conducted a voluntary, anonymous educational intervention study on organ donation among fourth year medical students in the course of the main surgery lecture at the University of Essen, Germany. RESULTS Questionnaires of 383 students were analyzed. Prior to the specific lecture on organ donation, 64% of the students carried a signed organ donor card with the intention to donate. Further information regarding organ donation was required by 37% of the students. The request for further information was statistically significantly higher among students without a donor card compared to organ donor card carriers (P < 0.0001). After the lecture, the number of students requiring further information decreased statistically significantly to 19% (P < 0.0001). CONCLUSIONS Already a 45-minute lecture for fourth year medical students significantly decreases their request for further information on organ donation and improves their attitude to organ donation. Continued training on organ donation will help medical students to become disseminators for this important topic in our society.
Collapse
Affiliation(s)
- Sonia Radunz
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Tamás Benkö
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Sabrina Stern
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Fuat H Saner
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Andreas Paul
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - Gernot M Kaiser
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| |
Collapse
|
44
|
Weiss J, Coslovsky M, Keel I, Immer FF, Jüni P. Organ donation in Switzerland--an analysis of factors associated with consent rate. PLoS One 2014; 9:e106845. [PMID: 25208215 PMCID: PMC4160222 DOI: 10.1371/journal.pone.0106845] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Aim Switzerland has a low post mortem organ donation rate. Here we examine variables that are associated with the consent of the deceased’s next of kin (NOK) for organ donation, which is a prerequisite for donation in Switzerland. Methods and Analysis During one year, we registered information from NOK of all deceased patients in Swiss intensive care units, who were approached for consent to organ donation. We collected data on patient demographics, characteristics of NOK, factors related to the request process and to the clinical setting. We analyzed the association of collected predictors with consent rate using univariable logistic regression models; predictors with p-values <0.2 were selected for a multivariable logistic regression. Results Of 266 NOK approached for consent, consent was given in 137 (51.5%) cases. In multivariable analysis, we found associations of consent rates with Swiss nationality (OR 3.09, 95% CI: 1.46–6.54) and German language area (OR 0.31, 95% CI: 0.14–0.73). Consent rates tended to be higher if a parent was present during the request (OR 1.76, 95% CI: 0.93–3.33) and if the request was done before brain death was formally declared (OR 1.87, 95% CI: 0.90–3.87). Conclusion Establishing an atmosphere of trust between the medical staff putting forward a request and the NOK, allowing sufficient time for the NOK to consider donation, and respecting personal values and cultural differences, could be of importance for increasing donation rates. Additional measures are needed to address the pronounced differences in consent rates between language regions.
Collapse
Affiliation(s)
- Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Michael Coslovsky
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Isabelle Keel
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Franz F. Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
- * E-mail:
| | - Peter Jüni
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | |
Collapse
|
45
|
Regalia K, Zheng P, Sillau S, Aggarwal A, Bellevue O, Fix OK, Prinz J, Dunn S, Biggins SW. Demographic factors affect willingness to register as an organ donor more than a personal relationship with a transplant candidate. Dig Dis Sci 2014; 59:1386-91. [PMID: 24519521 PMCID: PMC4071122 DOI: 10.1007/s10620-014-3053-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 01/27/2014] [Indexed: 12/09/2022]
Abstract
BACKGROUND Transplant candidate caregivers (TCCs) are an under-utilized but potentially devoted pool of advocates who themselves may be recruited to register for deceased organ donation. AIM The purpose of this study was to assess and compare recruitment barriers to deceased donor registration efforts in TCCs and health fair attendees (HFAs). METHODS A 42-item questionnaire assessing willingness to register as an organ donor and perceptions and knowledge about organ donation was administered to 452 participants (174 in Denver, 278 in San Francisco). Logistic regression, stratified by study site, was used to assess associations between explanatory variables and willingness to register as an organ donor. RESULTS In Denver, 83 % of TCCs versus 68 % of HFAs indicated a willingness to register (p = 0.03). Controlling for study group (TCC vs HFA), predictors of willingness to register were female gender [odds ratio (OR) 2.4], Caucasian race (OR 2.3), college graduate (OR 11.1), married (OR 2.4) and higher positive perception of organ donation (OR 1.2), each p < 0.05. In San Francisco, 58 % of TCCs versus 70 % of HFAs indicated a willingness to register (p = 0.03). Controlling for study group (TCC vs HFA), predictors of willingness to register were Caucasian race (OR 3.5), college graduate (OR 2.2), married (OR 1.9), higher knowledge (OR 1.6) and higher positive perception of organ donation (OR 1.2), each p < 0.05. In both locales, Caucasians were more likely to have positive perceptions about organ donation and were more willing to register. CONCLUSIONS Demographic characteristics, not personal connection to a transplant candidate, explain willingness to register as an organ donor.
Collapse
Affiliation(s)
- Kirsten Regalia
- University of Colorado Denver Division of Gastroenterology and Hepatology, Denver CO
| | - Patricia Zheng
- University of California San Francisco Division of Gastroenterology, Denver CO
| | - Stefan Sillau
- University of Colorado Denver Department of Biostatistics, Denver CO
| | - Anuj Aggarwal
- University of California San Francisco Division of Gastroenterology, Denver CO
| | - Oliver Bellevue
- University of California San Francisco Division of Gastroenterology, Denver CO
| | - Oren K. Fix
- University of California San Francisco Division of Gastroenterology, Denver CO
| | | | | | - Scott W. Biggins
- University of Colorado Denver Division of Gastroenterology and Hepatology, Denver CO
| |
Collapse
|
46
|
White SL, Zinsser DM, Paul M, Levine GN, Shearon T, Ashby VB, Magee JC, Li Y, Leichtman AB. Patient selection and volume in the era surrounding implementation of Medicare conditions of participation for transplant programs. Health Serv Res 2014; 50:330-50. [PMID: 24838079 DOI: 10.1111/1475-6773.12188] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate evidence of practice changes affecting kidney transplant program volumes, and donor, recipient and candidate selection in the era surrounding the introduction of Centers for Medicare and Medicaid Services (CMS) conditions of participation (CoPs) for organ transplant programs. DATA Scientific Registry of Transplant Recipients; CMS ESRD and Medicare claims databases. DESIGN Retrospective analysis of national registry data. METHODS A Cox proportional hazards model of 1-year graft survival was used to derive risks associated with deceased-donor kidney transplants performed from 2001 to 2010. FINDINGS Among programs with ongoing noncompliance with the CoPs, kidney transplant volumes declined by 38 percent (n = 766) from 2006 to 2011, including a 55 percent drop in expanded criteria donor transplants. Volume increased by 6 percent (n = 638) among programs remaining in compliance. Aggregate risk of 1-year graft failure increased over time due to increasing recipient age and obesity, and longer ESRD duration. CONCLUSIONS Although trends in aggregate risk of 1-year kidney graft loss do not indicate that the introduction of the CoPs has systematically reduced opportunities for marginal candidates or that there has been a systematic shift away from utilization of higher risk deceased donor kidneys, total volume and expanded criteria donor utilization decreased overall among programs with ongoing noncompliance.
Collapse
Affiliation(s)
- Sarah L White
- Department of Internal Medicine, Division of Nephrology, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI; The George Institute for International Health, University of Sydney, Camperdown, NSW
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Ghahramani N, Karparvar Z, Ghahramani M, Shadrou S. International survey of nephrologists' perceptions and attitudes about rewards and compensations for kidney donation. Nephrol Dial Transplant 2014; 28:1610-21. [PMID: 23780679 DOI: 10.1093/ndt/gft079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Payment for organ donation, whether in the form of incentives, rewards or compensation is highly debated and has been denounced by many professional and legislative bodies. Despite the passionate discussion in the literature, there is very limited data on attitudes and perceptions of physicians about providing rewards or compensation to organ donors. We investigated the relationship between demographic and practice characteristics of nephrologists and their perceptions and attitudes about rewards and compensations for organ donation. METHODS Using a web-based survey, we explored the views of nephrologists around the world about rewards and compensations for kidney donation. The relationship between attitudes and demographic characteristics of 1280 nephrologists from 74 countries was examined by univariate and multivariable analyses. RESULTS Seventy-five percent agreed with donor health insurance, 26% favored direct financial compensation and 31% agreed with financial rewards for unrelated donors. Sixty-six percent believed that rewards will lead to increased donation. Seventy-three percent indicated that rewards will lead to exploitation of the poor and 78% agreed with legislation prohibiting organ sales. Thirty-seven percent believed that rewards will negatively impact deceased-donor transplantation. Nephrologists from India/Pakistan and the Middle East had more favorable views about rewards, while respondents from Latin America and Europe, older than 50, female nephrologists and those practicing in rural areas had less favorable views. CONCLUSIONS We conclude that a minority of nephrologists favor rewards for donation, many agree with some compensation and a considerable majority favor donor health insurance. Perceptions of nephrologists about rewards and compensation are influenced by age, sex, urban versus rural location and geographic region of practice.
Collapse
Affiliation(s)
- Nasrollah Ghahramani
- Pennsylvania State University College of Medicine, Division of Nephrology, Hershey, PA, USA.
| | | | | | | |
Collapse
|
48
|
Noto-Kadou-Kaza B, Sabi KA, Imangue G, Al-Torayhi MH, Amekoudi EYM, Tsevi CM, Zamd M, Medkouri G, Benghanem MG, Ramdani B. [Kidney transplantation in Morocco: are hemodialysis caretakers well informed?]. Pan Afr Med J 2014; 19:365. [PMID: 25932078 PMCID: PMC4407941 DOI: 10.11604/pamj.2014.19.365.5257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 11/18/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction La transplantation rénale constitue le traitement idéal de l'insuffisance rénale chronique. Cependant il existe une insuffisance de donneurs contrairement aux receveurs dont le nombre ne cesse de s'accroitre. La méconnaissance de la transplantation par les hémodialysés et leur entourage pourrait être l'une des causes. Notre but était d’évaluer les connaissances et opinions de l'hémodialysé et de son entourage sur la transplantation rénale. Méthodes L'enquête menée en Aout 2013 avait inclus 83 hémodialysés de notre centre et 70 membres de leur entourage. Ils ont été soumis à un questionnaire qui portait sur les thèmes suivants: statut socio-économique, volonté d’être transplanté ou d’être donneur, avantages de la transplantation rénale, point de vue de la religion sur la transplantation. Aucun des individus interrogés n'avait jamais fait l'objet d'une transplantation ou d'un don d'organe. Résultats Parmi 83 hémodialysés on notait 49,4% de femmes avec une moyenne d’âge de 41,4±12 ans. Le niveau socio-économique bas représentait 66,7%. Le manque d'information chez était estimé à 62,7%. Seuls 41% se disaient être candidat à la transplantation rénale mais 12% seulement était inscrit sur la liste d'attente de greffe. La transplantation était estimée plus couteuse que l'hémodialyse par 50,6% des patients et seuls 71,1% estimaient qu'elle offrait une meilleure vie. Pour 20,5%, l'Islam s'opposerait au don cadavérique et pour 10,9% au don vivant. Parmi les 70 membres de l'entourage interrogé il y avait 56,8% de femmes; la moyenne d’âge était de 44,4±10,5 ans. Le niveau économique bas représentait 52,3%. Le manque d'information était estimé à 61,4%. Pour 56,8% la vie serait impossible avec un seul rein. Seuls 13,6% étaient inscrit sur le registre de don. Pour 45,5% l'Islam s'opposerait au don cadavérique. Conclusion Il importe d'intensifier la sensibilisation des hémodialysées et leur famille sur la transplantation rénale.
Collapse
Affiliation(s)
- Béfa Noto-Kadou-Kaza
- Service de Néphrologie, de Dialyse et de Transplantation Rénale du CHU Ibn Rochd de Casablanca-Maroc
| | - Kossi Akomola Sabi
- Service de Néphrologie et d'Hémodialyse du CHU Sylvanus Olympio de Lomé-Togo
| | - Ghislain Imangue
- Service de Néphrologie, de Dialyse et de Transplantation Rénale du CHU Ibn Rochd de Casablanca-Maroc
| | - Mays Hadi Al-Torayhi
- Service de Néphrologie, de Dialyse et de Transplantation Rénale du CHU Ibn Rochd de Casablanca-Maroc
| | | | | | - Mohamed Zamd
- Service de Néphrologie, de Dialyse et de Transplantation Rénale du CHU Ibn Rochd de Casablanca-Maroc
| | - Ghislaine Medkouri
- Service de Néphrologie, de Dialyse et de Transplantation Rénale du CHU Ibn Rochd de Casablanca-Maroc
| | - Mohamed Gharbi Benghanem
- Service de Néphrologie, de Dialyse et de Transplantation Rénale du CHU Ibn Rochd de Casablanca-Maroc
| | - Benyounes Ramdani
- Service de Néphrologie, de Dialyse et de Transplantation Rénale du CHU Ibn Rochd de Casablanca-Maroc
| |
Collapse
|
49
|
Donor and procurement related issues in vascularized composite allograft transplantation. Curr Opin Organ Transplant 2013; 18:665-71. [DOI: 10.1097/mot.0000000000000027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Clinical and Histopathologic Comparative Analysis Between Kidney Transplant Recipients From Expanded-Criteria Donors and Standard-Criteria Donors. Transplant Proc 2013; 45:3234-8. [DOI: 10.1016/j.transproceed.2013.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/09/2013] [Indexed: 11/21/2022]
|