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Tejedor M, Neria F, De La Rosa G, Almohalla Álvarez C, Padilla M, Boscà Robledo A, Fundora Suárez Y, Sánchez-Bueno F, Gómez-Bravo MA, Berenguer M. Women Are Also Disadvantaged in Accessing Transplant Outside the United States: Analysis of the Spanish Liver Transplantation Registry. Transpl Int 2024; 37:12732. [PMID: 38773987 PMCID: PMC11106452 DOI: 10.3389/ti.2024.12732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/16/2024] [Indexed: 05/24/2024]
Abstract
Sex inequities in liver transplantation (LT) have been documented in several, mostly US-based, studies. Our aim was to describe sex-related differences in access to LT in a system with short waiting times. All adult patients registered in the RETH-Spanish Liver Transplant Registry (2000-2022) for LT were included. Baseline demographics, presence of hepatocellular carcinoma, cause and severity of liver disease, time on the waiting list (WL), access to transplantation, and reasons for removal from the WL were assessed. 14,385 patients were analysed (77% men, 56.2 ± 8.7 years). Model for end-stage liver disease (MELD) score was reported for 5,475 patients (mean value: 16.6 ± 5.7). Women were less likely to receive a transplant than men (OR 0.78, 95% CI 0.63, 0.97) with a trend to a higher risk of exclusion for deterioration (HR 1.17, 95% CI 0.99, 1.38), despite similar disease severity. Women waited longer on the WL (198.6 ± 338.9 vs. 173.3 ± 285.5 days, p < 0.001). Recently, women's risk of dropout has reduced, concomitantly with shorter WL times. Even in countries with short waiting times, women are disadvantaged in LT. Policies directed at optimizing the whole LT network should be encouraged to guarantee a fair and equal access of all patients to this life saving resource.
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Affiliation(s)
| | - Fernando Neria
- Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
| | | | | | | | | | | | | | | | - Marina Berenguer
- Hepatology—Liver Transplantation Unit, IIS La Fe and CIBER-EHD, Hospital Universitari i Politècnic La Fe, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
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2
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Alvarez-Marquez AJ, Huet J, Pérez-Villares JM, Daga-Ruiz D, Diaz-Aunión C, Castro de la Nuez P, Cuende N. Meeting the Shortage of Human Cells and Tissues: The Andalusian Quality Assurance Programme for Tissue Donation. Transpl Int 2024; 37:12627. [PMID: 38751769 PMCID: PMC11094268 DOI: 10.3389/ti.2024.12627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/08/2024] [Indexed: 05/18/2024]
Abstract
Background A quality assurance programme for the tissue donation process was launched in Andalusia in 2020 to facilitate the integration of tissue donation into end-of-life care, and to respond to the growing need for human tissue for therapeutic purposes. The results of this programme are presented here. Methods After identifying the hospital departments in which to intensify the detection of tissue donors, expanding training activities and designing a specific data collection system for possible tissue donors who do not donate their tissues, the results of the donation activity were quantified and the causes of non-donation were analysed by applying the critical pathway for deceased tissue donation methodology. Results After an initial drop in activity, which coincided with the coronavirus pandemic, the number of tissue donors increased by 48.4% in 2022 compared to 2019. From the eligible donors, 83% were actual tissue donors and 71% were utilised donors. The modifiable causes of tissue donation loss, in order of frequency, were family refusal, followed by organisational or logistical issues, failure to notify or failure to identify possible donors, and failure to complete donor evaluation. Conclusion As a result of the collaboration of the various professionals involved in the programme, tissue donation activity has increased remarkably, the potential and effectiveness of the donation process have been evaluated, and areas for improvement have been identified, which we hope will lead to continuous improvement of the process.
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Affiliation(s)
| | - Jesus Huet
- Andalusian Transplant Coordination, Andalusian Health Service, Seville, Spain
| | - José Miguel Pérez-Villares
- Andalusian Transplant Coordination, Andalusian Health Service, Seville, Spain
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Domingo Daga-Ruiz
- Andalusian Transplant Coordination, Andalusian Health Service, Seville, Spain
- Servicio de Medicina Intensiva, Hospital Virgen de la Victoria, Málaga, Spain
| | | | | | - Natividad Cuende
- Andalusian Transplant Coordination, Andalusian Health Service, Seville, Spain
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van Merweland R, Busschbach J, van de Wetering J, Ismail S. Strategies to address perceived barriers to timely kidney transplantation in the Netherlands: A qualitative study from a stakeholders' perspective. PEC INNOVATION 2023; 3:100236. [PMID: 38161684 PMCID: PMC10757244 DOI: 10.1016/j.pecinn.2023.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/15/2023] [Accepted: 11/25/2023] [Indexed: 01/03/2024]
Abstract
Objective We present strategies to perceived barriers to access to kidney transplantation (KT) in the Netherlands. Methods This qualitative study (N = 70) includes nephrologists, social workers, surgeons, nurses, patients, former living kidney donors, policy employees, and insurance representatives. Interviews were conducted both in focus groups and individually and coded with NVivo. Results Participants proposed strategies within five domains. 1.Policy: Making KT guideline more visible. 2.Medical: Increase access and transparency to KT medical eligibility criteria (e.g., age, BMI) for patients and healthcare providers. 3.Psychological: Support patients who continue to use dialysis because of social interaction opportunities associated with dialysis settings to find such interaction elsewhere. Link kidney patients with fears for KT to experienced experts or trained professionals. 4.Social: Support patients with language barriers with interpreters and visual explanations. Support patients using social media, e.g. Facebook, to identify potential donors. Better expectation management to reduce reports of inadequate aftercare for living donors. 5.Economical: Solving negative economic incentives for KT by changing incentives. Conclusion Stakeholders see strategies for barriers in the entire care pathway. Innovation This large qualitative study gives an important overview which strategies stakeholders see improving access to KT. Some strategies offer opportunities to solve barriers in the short-term.
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Affiliation(s)
- Ruben van Merweland
- Erasmus MC, Department of Psychiatry, Section Medical Psychology and Psychotherapy, Rotterdam, the Netherlands
| | - Jan Busschbach
- Erasmus MC, Department of Psychiatry, Section Medical Psychology and Psychotherapy, Rotterdam, the Netherlands
| | - Jacqueline van de Wetering
- Erasmus MC, Department of Internal Medicine, Nephrology, and Transplantation, Erasmus MC Transplant Institute, Rotterdam, the Netherlands
| | - Sohal Ismail
- Erasmus MC, Department of Psychiatry, Section Medical Psychology and Psychotherapy, Rotterdam, the Netherlands
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Westphal GA, Besen BAMP, de Andrade J, Sardinha LA, Franke CA. Brazilian Contributions on Standardized Education for Brain Death Determination. Neurocrit Care 2023; 39:740-741. [PMID: 37752296 DOI: 10.1007/s12028-023-01850-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Glauco Adrieno Westphal
- Organ Procurement Organization of Santa Catarina, Rua Esteves Júnior, 390, Florianópolis, SC, 88015-130, Brazil.
| | | | - Joel de Andrade
- Organ Procurement Organization of Santa Catarina, Rua Esteves Júnior, 390, Florianópolis, SC, 88015-130, Brazil
| | - Luiz Antônio Sardinha
- Medical ICU, Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Cowie S, Choy SH, Shah DM, Gomez MP, Yoong BK, Koong JK. Healthcare System Impact on Deceased Organ Donation and Transplantation: A Comparison Between the Top 10 Organ Donor Countries With 4 Countries in Southeast Asia. Transpl Int 2023; 36:11233. [PMID: 37711402 PMCID: PMC10498995 DOI: 10.3389/ti.2023.11233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/11/2023] [Indexed: 09/16/2023]
Abstract
The need for organ donation is constantly increasing. Some countries have made improvements, while others, such as countries in Southeast Asia (SEA), have some of the lowest rates of deceased donors (pmp). This review aims to compare 14 countries with regards to many variables related to healthcare systems. Countries leading in deceased organ donation spend more on health and education, which is associated with increased potential for deceased organ donation. Out-of-pocket expenditure, is also associated with a decrease in deceased organ donation. Countries in SEA are lacking in healthcare resources such as workforce and materials, which are both necessary for a successful transplant program. Most countries in SEA have an excellent foundation for successful organ donation systems, including proper legislation, government support, and brain death laws along with an overall acceptance of brain death diagnosis. Priorities should include improving coordination, donor identification, and healthcare worker education. Countries in SEA have a lot of potential to increase deceased organ donation, especially by investing in healthcare and education. There is no one size fits all for organ donation programs and countries in SEA should focus on their strengths and take cultural differences into consideration when planning interventions.
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Affiliation(s)
- Sandra Cowie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Seow-Huey Choy
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Boon-Koon Yoong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jun-Kit Koong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Kazzaz YM, Maghrabi F, Alkhathaami RA, Alghannam RF, Alonazi NM, Alrubaiaan AA, Alkadeeb NA, Antar M, Babakr R. Paediatric organ donation following neurological determinants of death in intensive care units in Saudi Arabia: a retrospective cross-sectional study. BMJ Open 2023; 13:e072073. [PMID: 37586859 PMCID: PMC10432649 DOI: 10.1136/bmjopen-2023-072073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES The aim of this retrospective cross-sectional study was to assess the performance of paediatric organ donation in intensive care units following neurological determinants of death in Saudi Arabia. DESIGN Retrospective cross-sectional study. SETTING Paediatric intensive care units at three tertiary centres over 5 years. PARTICIPANTS 423 paediatric deaths (<14 years) from January 2017 to December 2021. PRIMARY OUTCOME Patients were identified as either possible, potential, eligible, approached, consented or actual donors based on organ donation definitions from the WHO, Transplantation Society and UK potential donor audit. SECONDARY OUTCOME Secondary outcome was causative mechanisms of brain injury in possible donors. Demographics of the study cohort (age, sex, hospital length of stay (LOS), paediatric intensive care unit LOS, pre-existing comorbidities, admission type and diagnosis category) were compared between possible and non-possible donors. Demographics were also compared between patients who underwent neurological determination of death and patients who did not. RESULTS Among the 423 paediatric deaths, 125 (29.6%) were identified as possible donors by neurological criteria (devastating brain insult with likelihood of brain death, Glasgow Coma Score of 3 and ≥2 absent brainstem reflexes). Of them, 41 (32.8%) patients were identified as potential donors (neurological determination of death examinations initiated by the treating team), while only two became actual donors. The eligible death conversion rate was 6.9%. The reporting rate to organ procurement organisation was 70.7% with a consent rate of 8.3%. The most common causes of brain insult causing death were cardiac arrest (44 of 125 patients, 35.2%), followed by traumatic brain injury and drowning (31 of 125 patients, 24.8%), and intracranial bleeding (13 of 125 patients, 11.4%). CONCLUSION Major contributors to low actual donation rate were consent, donor identification and donor referral.
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Affiliation(s)
- Yasser Mohammed Kazzaz
- Department of Pediatrics, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fidaa Maghrabi
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Raghad Ali Alkhathaami
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rahaf Fahad Alghannam
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nora Mohammad Alonazi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Nayla Anwar Alkadeeb
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohannad Antar
- Department of Pediatrics, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Razan Babakr
- Department of Pediatrics, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Quick BL, Kriss LA, Morrow E, Hartman D, Koester B. A Test of Autonomy Restoration Postscripts to Mitigate Psychological Reactance to an Opt-Out Organ Donor Registry in the United States. HEALTH COMMUNICATION 2023:1-13. [PMID: 37482679 DOI: 10.1080/10410236.2023.2232607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
The organ shortage continues to present problems around the world including the United States. In response, some countries have switched from an opt-in organ donor registry to an opt-out registry. The United States currently utilizes an opt-in registry where an individual is not considered an organ donor until they register their intentions. In the current study, U.S. adults were randomly assigned to a 2 (message valence: promotional, refutational) x 2 (autonomy restoration postscript: present, not present) x 2 (social proof: high likes, low likes) posttest only control group design evaluating social media message regarding an opt-out organ donor registry for implementation in the U.S. Results revealed an interaction between message valence and autonomy on freedom threat perceptions toward the message. Consistent with psychological reactance theory, freedom threat perceptions were positively associated with reactance, which in turn was positively associated with an intention to sign a petition and call a representative to voice disapproval of the opt-out organ donor registry. The discussion is focused on pragmatic recommendations for organ donor practitioners and advocates as well as the theoretical contributions to reactance theory.
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Affiliation(s)
- Brian L Quick
- Department of Communication and the Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign
| | - Lauren A Kriss
- School of Journalism and Mass Communication, University of Wisconsin-Madison
| | - Ethan Morrow
- Department of Communication, University of Illinois at Urbana-Champaign
| | - Dan Hartman
- Department of Communication, University of Illinois at Urbana-Champaign
| | - Brenda Koester
- Department of Communication, University of Illinois at Urbana-Champaign
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Streit S, Johnston-Webber C, Mah J, Prionas A, Wharton G, Casanova D, Mossialos E, Papalois V. Ten Lessons From the Spanish Model of Organ Donation and Transplantation. Transpl Int 2023; 36:11009. [PMID: 37305337 PMCID: PMC10249502 DOI: 10.3389/ti.2023.11009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/14/2023] [Indexed: 06/13/2023]
Abstract
The organ donation and transplantation program in Spain has long been considered the gold standard worldwide. An in-depth understanding of the Spanish program may promote the development and reform of transplant programs in other countries. Here, we present a narrative literature review of the Spanish organ donation and transplantation program supplemented by expert feedback and presented according to a conceptual framework of best practices in the field. Core features of the Spanish program include its three-tiered governing structure, close and collaborative relationships with the media, dedicated professional roles, a comprehensive reimbursement strategy, and intensive tailored training programs for all personnel. Several more sophisticated measures have also been implemented, including those focused on advanced donation after circulatory death (DCD) and expanded criteria for organ donation. The overall program is driven by a culture of research, innovation, and continuous commitment and complemented by successful strategies in prevention of end-stage liver and renal disease. Countries seeking ways to reform their current transplant systems might adopt core features and may ultimately aspire to include the aforementioned sophisticated measures. Countries intent on reforming their transplant system should also introduce programs that support living donation, an area of the Spanish program with potential for further improvement.
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Affiliation(s)
- Simon Streit
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Charlotte Johnston-Webber
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Jasmine Mah
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Apostolos Prionas
- Department of Surgery, Imperial College, London, United Kingdom
- Department of General Surgery, Whipps Cross Hospital, Barts Health NHS Trust, London, United Kingdom
| | - George Wharton
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Daniel Casanova
- University Hospital Valdecilla, University of Cantabria, Santander, Spain
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College, London, United Kingdom
| | - Vassilios Papalois
- Department of Surgery, Imperial College, London, United Kingdom
- Renal and Transplant Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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Gardiner D, McGee A, Simpson C, Ahn C, Goldberg A, Kinsella A, Nagral S, Weiss MJ. Baseline Ethical Principles and a Framework for Evaluation of Policies: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1471. [PMID: 37138553 PMCID: PMC10150897 DOI: 10.1097/txd.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/26/2022] [Accepted: 12/15/2022] [Indexed: 05/05/2023] Open
Abstract
To maintain public trust and integrity in organ and tissue donation and transplantation (OTDT), policymakers, governments, clinical leaders, and decision-makers must ensure that policies proposed to increase donation and transplant activity satisfy baseline ethical principles established by international agreement, declaration, and resolution. This article describes the output of the Baseline Ethical Domain group of an international forum designed to guide stakeholders in considering these aspects of their system. Methods This Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. The domain working group members included administrative, clinical, and academic experts in deceased and living donation ethics and 2 Patient, Family, and Donor partners. Identification of internationally accepted baseline ethical principles was done after literature reviews performed by working group members, and a framework for consideration of existing or novel policies was completed over a series of virtual meetings from March to September 2021. Consensus on the framework was achieved by applying the nominal group technique. Recommendations We used the 30 baseline ethical principles described in World Health Organization Guiding Principles, Declaration of Istanbul, and Barcelona Principles to generate an ethical framework-presented graphically as a spiral series of considerations-designed to assist decision makers in incorporating these ethical principles into practice and policy. We did not seek to determine what is ethical but instead described a method of evaluation for policy decisions. Conclusions The proposed framework could be applied to new or existing OTDT policy decisions to facilitate the transformation of widely accepted ethical principles into practical evaluations. The framework includes adaptation for local contexts and could be applied broadly internationally.
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Affiliation(s)
- Dale Gardiner
- Medical Directorate, NHS Blood and Transplant, Nottingham, United Kingdom
| | - Andrew McGee
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Faculty of Business and Law, QUT, Brisbane, Australia
| | - Christy Simpson
- Australian Centre for Health Law Research, QUT, Brisbane, Australia
- Department of Bioethics, Dalhousie University, Halifax, Canada
- Canadian Blood Services, Ottawa, Canada
| | - Curie Ahn
- Division of Nephrology, National Medical Center, Seoul, South Korea
| | - Aviva Goldberg
- Department of Pediatric Nephrology, University of Manitoba, Winnipeg, Canada
| | - Austin Kinsella
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Sanjay Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, Mumbai, India
- Co-chair: Declaration of Istanbul Custodian Group
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Transplant Québec, Montréal, Québec, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Québec, Québec, Canada
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Urquhart R, Kendell C, Weiss M, Kureshi N, Dirk J, Cordoba W, Beed S. Views of leaders in under-represented and equity-denied communities on organ and tissue donation in Nova Scotia, Canada, in light of the Human Organ and Tissue Donation Act: a qualitative descriptive study. BMJ Open 2023; 13:e068726. [PMID: 37072355 PMCID: PMC10124243 DOI: 10.1136/bmjopen-2022-068726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE To explore the views of underserved and equity-denied communities in Nova Scotia, Canada, regarding organ and tissue donation and deemed consent legislation. DESIGN A qualitative descriptive study was undertaken, employing both interviews and focus groups. SETTING The province of Nova Scotia, Canada-the first jurisdiction in North America to implement deemed consent legislation for organ and tissue donation. PARTICIPANTS Leaders of African Nova Scotian, Lesbian, Gay, Bisexual, Trans, Queer, Two Spirit (LGBTQ2S+) and Faith-based communities (Islam and Judaism) were invited to participate (n=11). Leaders were defined as persons responsible for community organisations or in other leadership roles, and were purposively recruited by the research team. RESULTS Through thematic analysis, four main themes were identified: (1) alignment with personal values as well as religious beliefs and perspectives; (2) trust and relationships, which need to be acknowledged and addressed in the context of deemed consent legislation; (3) cultural competence, which is essential to the roll-out of the new legislation and (4) communication and information to combat misconceptions and misinformation, facilitate informed decision-making, and mitigate conflict within families. CONCLUSIONS Leaders of African Nova Scotian, LGBTQ2S+ and Faith-based communities in Nova Scotia are highly supportive of deemed consent legislation. Despite this, many issues exemplify the need for cultural competence at all levels. These findings should inform ongoing implementation of the legislation and other jurisdictions considering a deemed consent approach to organ and tissue donation.
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Affiliation(s)
- Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Cynthia Kendell
- Department of Surgery, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Matthew Weiss
- Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Quebec, Quebec, Canada
| | - Nelofar Kureshi
- Department of Surgery, Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jade Dirk
- Research, Discovery, and Innovation, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Wendy Cordoba
- Faculty of Science, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Stephen Beed
- Department of Critical Care, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
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11
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Xie X, Wu Q. Factors influencing organ donation in Fujian's Organ Procurement Organization: A retrospective study. Clin Transplant 2023; 37:e14902. [PMID: 36587295 DOI: 10.1111/ctr.14902] [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: 10/31/2022] [Revised: 12/14/2022] [Accepted: 12/29/2022] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The Organ Procurement Organization (OPO) was established in August 2018. The organization's workload, work efficiency, and quality control of organ donation and procurement have continuously improved, making it one of the most successful OPOs in Fujian Province. This study explores the factors that influence the success and failure of organ donation in Fujian Province, China. METHODS Data from 236 potential organ donors registered at an OPO in Fujian Province between January 2020 and May 2022 were retrospectively analyzed. RESULTS Among the 236 potential organ donors, 71 cases of organ donation were successful (30.08% conversion rate). Univariate analysis showed that demographic factors, such as differences in sex, age, marital status, and domicile location, were significantly associated with successful organ donation (p < .05). Among hospital-related factors, differences in hospital departments were significant (p < .05). Considering disease-related factors, spontaneous respiration was significant (p < .05). For factors related to organ donation, differences in coordinators were significant (p < .05). Multivariate analysis showed that age, domicile location, spontaneous respiration, and coordinators influenced organ donation success (p < .05). Multifactor analysis revealed that factors, such as age ≤50 years, domicile location in other provinces, no spontaneous respiration, and highly skilled coordinators, could promote successful organ donation. CONCLUSIONS Programs should clarify the screening criteria for key potential organ donors, enhance the promotion and popularization of organ donation, and boost the number and professional skills of organ donation coordinators to improve the organ donation conversion rate.
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Affiliation(s)
- Xianyu Xie
- Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
| | - Qinde Wu
- Fujian Medical University Union Hospital, Fuzhou City, Fujian Province, China
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12
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Piana A, Breda A, Pecoraro A, Prudhomme T, Territo A. Comment on: "Surgeon preimplantation macroscopic graft appraisal improves risk stratification of deceased kidney donors: a prospective study". Minerva Urol Nephrol 2022; 74:805-806. [PMID: 36629811 DOI: 10.23736/s2724-6051.22.05178-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy - .,Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain -
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Thomas Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain
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Frutos MÁ, Crespo M, Valentín MDLO, Alonso-Melgar Á, Alonso J, Fernández C, García-Erauzkin G, González E, González-Rinne AM, Guirado L, Gutiérrez-Dalmau A, Huguet J, Moral JLLD, Musquera M, Paredes D, Redondo D, Revuelta I, Hofstadt CJVD, Alcaraz A, Alonso-Hernández Á, Alonso M, Bernabeu P, Bernal G, Breda A, Cabello M, Caro-Oleas JL, Cid J, Diekmann F, Espinosa L, Facundo C, García M, Gil-Vernet S, Lozano M, Mahillo B, Martínez MJ, Miranda B, Oppenheimer F, Palou E, Pérez-Saez MJ, Peri L, Rodríguez O, Santiago C, Tabernero G, Hernández D, Domínguez-Gil B, Pascual J. Recommendations for living donor kidney transplantation. Nefrologia 2022; 42 Suppl 2:5-132. [PMID: 36503720 DOI: 10.1016/j.nefroe.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023] Open
Abstract
This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes. Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor. Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations. This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors' health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors. Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.
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Affiliation(s)
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Juana Alonso
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Esther González
- Nephrology Department, Hospital Universitario 12 Octubre, Spain
| | | | - Lluis Guirado
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | - Jorge Huguet
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | | | - Mireia Musquera
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | - David Paredes
- Donation and Transplantation Coordination Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Ignacio Revuelta
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Antonio Alcaraz
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Manuel Alonso
- Regional Transplantation Coordination, Seville, Spain
| | | | - Gabriel Bernal
- Nephrology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alberto Breda
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | - Mercedes Cabello
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Joan Cid
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Laura Espinosa
- Paediatric Nephrology Department, Hospital La Paz, Madrid, Spain
| | - Carme Facundo
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | | | - Miquel Lozano
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | | | - Eduard Palou
- Immunology Department, Hospital Clinic i Universitari, Barcelona, Spain
| | | | - Lluis Peri
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | - Domingo Hernández
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain.
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14
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Thaweerat W, Dangprapai Y. Differences in Perspective Toward Organ Donation Between Second-Year and Final-Year Medical Students in a Thai Medical School. MEDICAL SCIENCE EDUCATOR 2022; 32:1343-1349. [PMID: 36532383 PMCID: PMC9755390 DOI: 10.1007/s40670-022-01640-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 06/17/2023]
Abstract
Medical students, as prospective physicians, should develop a good attitude toward organ donation since physicians can positively affect the decision to donate organs. This study compared perspectives toward organ donation between Thai second-year and final-year (sixth-year) medical students, and explored changes that might occur during medical school training. Second-year and final-year medical students at the Faculty of Medicine Siriraj Hospital, Mahidol University, were invited to participate in the survey. The demographic data of the participants were collected and the attitudes toward organ donation were measured from the questionnaire. In total, 89 second-year and 60 final-year medical students voluntarily enrolled in the study. Nearly all the participating medical students supported organ donation and were willing to donate their organs after death. The majority of participants had a positive attitude toward organ donation in many perspectives, e.g., their beliefs, family issues, and donation procedure. There was a statistical difference between the proportion of second-year and final-year students who supported that a brain death condition is a true death (59.6% and 93.3%, respectively, p < 0.001) and who did not feel uncomfortable mentioning organ donation (82.0% and 96.7%, respectively, p = 0.007). In conclusion, there were significant differences in perspective between second-year and final-year students regarding brain death and discomfort perceived during organ donation-related situations. Experience gained during medical school could generate a more positive attitude toward organ donation. Therefore, medical schools play an essential role in nurturing a positive perspective toward organ donation in future physicians.
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Affiliation(s)
- Wajana Thaweerat
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700 Thailand
| | - Yodying Dangprapai
- Department of Physiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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15
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Iserson KV, Schears RM, Padela AI, Baker EF, Moskop JC. Increasing Solid Organ Donation: A Role for Emergency Physicians. J Emerg Med 2022; 63:702-708. [PMID: 36372592 DOI: 10.1016/j.jemermed.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/15/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND More than 100,000 Americans with failing organs await transplantation, mostly from dead donors. Yet only a fraction of patients declared dead by neurological criteria (DNC) become organ donors. DISCUSSION Emergency physicians (EPs) can improve solid organ donation in the following ways: providing perimortem critical care support to potential organ donors, promptly notifying organ procurement organizations (OPOs), asking neurocritical care specialists to evaluate selected emergency department patients for death based on established neurologic criteria, participating in research to advance these developments, implementing automatic OPO notification technologies, and educating the professional and lay communities about organ donation and transplantation, including exploration of opt-out (presumed consent) organ recovery policies. CONCLUSION With future improvements in organ preservation and DNC assessment, EPs may become even more involved in the donation process. EPs should support and engage in efforts to promote organ donation and transplantation.
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Affiliation(s)
- Kenneth V Iserson
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Raquel M Schears
- Department of Emergency Medicine, University of Central Florida College of Medicine, Orlando, Florida
| | - Aasim I Padela
- Department of Emergency Medicine and Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Medical College of Wisconsin Hub for Collaborative Medicine, Milwaukee, Wisconsin
| | | | - John C Moskop
- Biomedical Ethics, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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16
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Xie Q, Lei L, Duan F, Luo Y, Luo C. Construction of an Index System for Assessing Competences of Transplant Coordinators in China: A Delphi Survey. Transplant Proc 2022; 54:2103-2108. [PMID: 36195499 DOI: 10.1016/j.transproceed.2022.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Transplant coordinators (TCs) play a pivotal role in the entire donation process. Their professional competences have a direct impact on donation rates. However, few specific indicators are available for assessing TCs' professional competence. Therefore, it is imperative to develop an assessment index system to measure their competence. Our objective was to construct an index system for assessing TCs' professional competences. METHODS Based on a literature review and semistructured interviews, a focus group and 12 TCs were enrolled to design the questionnaires. Then, a modified Delphi method was used. Two rounds of questionnaires were distributed to 21 experts from 7 provinces across multiple research areas between October 2020 and March 2021. The data were sorted and analyzed by a focus group. RESULTS A combined assessment index system, namely, APT, including 3 constructs, the admittance assessment model (henceforth A), practical operation assessment model (P), and thousand-point performance assessment model (T), was constructed. This APT index system consisted of 3 first-level items, 8 second-level items, and 34 third-level items. CONCLUSIONS The APT assessment system has been unanimously recognized by experts. This index system, as a precursor form, will further lay the foundation for formation of an assessment instrument and provide references for other countries.
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Affiliation(s)
- Qin Xie
- Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China; Southwest Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Lei Lei
- School of Nursing, Army Medical University, Third Military Medical University, Chongqing, China
| | - Fangjian Duan
- Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Yu Luo
- School of Nursing, Army Medical University, Third Military Medical University, Chongqing, China
| | - Chunmei Luo
- Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China.
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17
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Silva E Silva V, Schirmer J, de Aguiar Roza B, Sarti A, Hickey M, Dhanani S, Almost J, Schafer M, Tranmer J. Understanding organ donation processes and structures in ontario: A social network analysis approach. Soc Sci Med 2022; 310:115243. [PMID: 36027760 DOI: 10.1016/j.socscimed.2022.115243] [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: 01/23/2022] [Revised: 06/17/2022] [Accepted: 07/23/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transplant rates in Ontario rose steeply in the decade prior to the COVID-19 pandemic. Reasons for that increase remain unclear, but the inter-organizational arrangement of organ donation programs may have contributed. However, there is a paucity of literature investigating these inter-organizational arrangements, with a limited understanding of how communication facilitates organ donation. Understanding these arrangements may help to re-establish rising organ donation rates post-pandemic. OBJECTIVE To describe interprofessional interactions of Organ and Tissue Donation Coordinators (OTDCs) during organ donation cases, within organ donation programs in Ontario, from an organizational perspective (describing structure, context, process). METHODS Mixed-method social network analysis (SNA) approach analyzing 14 organ donation cases just before the COVID-19 pandemic. RESULTS Structure: Social network graphs depict the joint work performed by hospital staff and OTDCs, with a great part of the communication being processed through the OTDC. CONTEXT Network density ranged from 0.05 to 0.24 across cases, and health care professionals perceived an atmosphere of shared vision and trust among team members. PROCESS Most networks had a degree centralization <0.50 suggesting a decentralized information flow, and participants perceived decisions being jointly made. The characteristic path length of cases ranged from 1.6 to 3.2, suggesting potential for rapid information diffusion. Overall, data reinforced the OTDC role of intermediator within the communication process, and hospital staff perceived OTDCs as central players. Hospital staff and OTDCs reported frustration with some aspects of the flow of information during the organ allocation processes. CONCLUSION Findings from this study provide a network map of communications within organ donation cases and reinforce the importance of the OTDC role. Opportunities for quality improvement within these processes are identified.
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Affiliation(s)
- Vanessa Silva E Silva
- Brock University, Department of Nursing, 1812 ir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada; Queen's Univeristy, School of Nursing, 92 Barrie Street Kingston, Ontario, K7L 3N6, Canada.
| | | | | | - Aimee Sarti
- University of Ottawa, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Michael Hickey
- University of Ottawa, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Sonny Dhanani
- University of Ottawa, Faculty of Medicine, Roger Guindon Hall, 451 Smyth Rd #2044, Ottawa, ON, K1H 8M5, Canada
| | - Joan Almost
- Queen's Univeristy, School of Nursing, 92 Barrie Street Kingston, Ontario, K7L 3N6, Canada
| | - Markus Schafer
- Department of Sociology, Baylor University, Waco, TX, United States
| | - Joan Tranmer
- Queen's Univeristy, School of Nursing, 92 Barrie Street Kingston, Ontario, K7L 3N6, Canada
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18
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Symons X, Poulden B. An Ethical Defense of a Mandated Choice Consent Procedure for Deceased Organ Donation. Asian Bioeth Rev 2022; 14:259-270. [PMID: 35791333 PMCID: PMC9250577 DOI: 10.1007/s41649-022-00206-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/20/2022] [Accepted: 03/27/2022] [Indexed: 01/10/2023] Open
Abstract
Organ transplant shortages are ubiquitous in healthcare systems around the world. In response, several commentators have argued for the adoption of an opt-out policy for organ transplantation, whereby individuals would by default be registered as organ donors unless they informed authorities of their desire to opt-out. This may potentially lead to an increase in donation rates. An opt-out system, however, presumes consent even when it is evident that a significant minority are resistant to organ donation. In this article, we defend a mandated choice framework for consent to deceased organ donation. A mandated choice framework, coupled with good public education, would likely increase donation rates. More importantly, however, a mandated choice framework would respect the autonomous preferences of people who do not wish to donate. We focus in particular on the Australian healthcare context, and consider how a mandated choice system could function as an ethical means to increase the organ donation rate in Australia. We make the novel proposal that all individuals who vote at an Australian federal election be required to state their organ donation preferences when voting.
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Affiliation(s)
- Xavier Symons
- Plunkett Centre for Ethics, Australian Catholic University, Sydney, NSW Australia
| | - Billy Poulden
- The University of Notre Dame Australia, Fremantle, Australia
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19
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Recomendaciones para el trasplante renal de donante vivo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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20
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Marsolais P, Larouche G, Lagacé AM, Williams V, Serri K, Bernard F, Rico P, Frenette AJ, Williamson D, Albert M, Charbonney E. The Suitability of Potential Organ Donors Using Real Case-Scenarios; Do we Need to Create a "Donor Board" Process for Donors Perceived as Unlikely Suitable? Transpl Int 2022; 35:10107. [PMID: 35340845 PMCID: PMC8944411 DOI: 10.3389/ti.2022.10107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/11/2022] [Indexed: 12/01/2022]
Abstract
Introduction: Despite availability of selection criteria, different interpretations can lead to variability in the appreciation of donor eligibility with possible viable organs missed. Our primary objective was to test the perception of feasibility of potential organ donors through the survey of a small sample of external evaluators. Methods: Clinical scenarios summarizing 66 potential donors managed in the first year of our Organ Recovery Center were sent to four critical care physicians to evaluate the feasibility of the potential donors and the probability of organ procurement. Results: Potential donors procuring at least one organ were identified in 55 of the 66 cases (83%). Unanimity was reached in 38 cases, encompassing 35 out of the 55 converted and 3 of the non-converted donors. The overall agreement was moderate (kappa = 0.60, 95% CI: 0.37–0.82). For the organs finally procured for transplantation, organ donation was predicted for the majority of the cases, but high discrepancy was present with the final outcome of organs not procured (particularly liver and kidney). Conclusion: The assessment of a potential donor is a complex dynamic process. In order to increase organ availability, standardized electronically clinical data, as well a “donor board” structure of decision might inform future systems.
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Affiliation(s)
- Pierre Marsolais
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | | | - Anne-Marie Lagacé
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada
| | - Virginie Williams
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada
| | - Karim Serri
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Francis Bernard
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Philippe Rico
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Anne Julie Frenette
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada.,Facutly of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - David Williamson
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada.,Facutly of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - Martin Albert
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Emmanuel Charbonney
- Hôpital du Sacré-Coeur de Montréal (CIUSSS-NIM), Montréal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.,Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
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21
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Díaz-Cobacho G, Cruz-Piqueras M, Delgado J, Hortal-Carmona J, Martínez-López MV, Molina-Pérez A, Padilla-Pozo Á, Ranchal-Romero J, Rodríguez-Arias D. Public Perception of Organ Donation and Transplantation Policies in Southern Spain. Transplant Proc 2022; 54:567-574. [PMID: 35303996 DOI: 10.1016/j.transproceed.2022.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND This research explores how public awareness and attitudes toward donation and transplantation policies may contribute to Spain's success in cadaveric organ donation. MATERIALS AND METHODS A representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018. RESULTS Most participants trust Spain's donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), and few nondonors have expressed their refusal (14%). Only a minority are aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased's preferences and be consulted when the deceased's wishes are unknown, as is the case in Spain. CONCLUSION Public trust in the transplant system may contribute to Spain's high performance in organ donation. High levels of societal support toward organ donation and transplantation do not correspond with similar levels of public awareness of donation and transplantation policies in Spain.
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Affiliation(s)
- Gonzalo Díaz-Cobacho
- Department of Philosophy 1, University of Granada, Granada, Spain; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain
| | | | - Janet Delgado
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain
| | - Joaquín Hortal-Carmona
- Department of Philosophy 1, University of Granada, Granada, Spain; Centro de salud Albayzín, Servicio Andaluz de Salud, Granada, Spain
| | - M Victoria Martínez-López
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain
| | - Alberto Molina-Pérez
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain; Institute for Advanced Social Studies, Spanish National Research Council (IESA-CSIC), Córdoba, Spain
| | - Álvaro Padilla-Pozo
- Department of Political and Social Sciences, University Pompeu Fabra, Barcelona, Spain
| | - Julia Ranchal-Romero
- Institute for Advanced Social Studies, Spanish National Research Council (IESA-CSIC), Córdoba, Spain
| | - David Rodríguez-Arias
- Department of Philosophy 1, University of Granada, Granada, Spain; ELPAT-ESOT Public Issues Working Group, European Society of Organ Transplantation, Padova, Italy; FiloLab-UGR Scientific Unit of Excellence, University of Granada, Spain.
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22
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Parsons JA, Venter B. Deemed consent for organ donation in Northern Ireland. Lancet Reg Health Eur 2022; 12:100254. [PMID: 34950919 PMCID: PMC8672031 DOI: 10.1016/j.lanepe.2021.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Shortages of organs for transplantation have led many countries to introduce systems of deemed consent for organ donation, whereby donation is the default upon death and an individual must provide express opposition to donation to prevent it. Despite a lack of clear supporting evidence, it is often suggested that deemed consent will contribute significantly to addressing the organ shortage. Northern Ireland appears set to be one of the next countries to pursue this route, with the Organ and Tissue Donation (Deemed Consent) Bill currently making its way through the Northern Ireland Assembly. If passed, this Bill will see Northern Ireland follow in the footsteps of the rest of the UK. In this viewpoint, we provide an overview of Northern Ireland's progress towards introducing deemed consent and argue two related points. First, that public awareness of the policy (if introduced) is vital to both its defensibility and longevity, and that this must be recognised through the imposition of a ministerial duty to focus on such awareness. Second, that policymakers in Northern Ireland ought to support the policy to ensure consistency across the UK in organ procurement, thereby preventing Northern Ireland from disproportionately benefitting from the UK-wide organ allocation system.
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23
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Bailey PK, Lyons H, Caskey FJ, Ben-Shlomo Y, Al-Talib M, Babu A, Selman LE. Expectations of a new opt-out system of consent for deceased organ donation in England: A qualitative interview study. Health Expect 2021; 25:607-616. [PMID: 34951093 PMCID: PMC8957744 DOI: 10.1111/hex.13394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction In 2020 England moved to an opt‐out deceased donation law. We aimed to investigate the views of a mixed stakeholder group comprising people with kidney disease, family members and healthcare practitioners towards the change in legislation. We investigated the expected impacts of the new legislation on deceased‐donor and living‐donor transplantation, and views on media campaigns regarding the law change. Methods We undertook in‐depth qualitative interviews with people with kidney disease (n = 13), their family members (n = 4) and healthcare practitioners (n = 15). Purposive sampling was used to ensure diversity for patients and healthcare practitioners. Family members were recruited through snowball sampling and posters. Interviews were audio‐recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. Results Three themes with six subthemes were identified: (i) Expectations of impact (Hopeful patients; Cautious healthcare professionals), (ii) Living‐donor transplantation (Divergent views; Unchanged clinical recommendations), (iii) Media campaigns (Single message; Highlighting recipient benefits). Patients expected the law change would result in more deceased‐donor transplant opportunities. Conclusions Clinicians should ensure patients and families are aware of the current evidence regarding the impact of opt‐out consent: expectations of an increased likelihood of receiving a deceased‐donor transplant are not currently supported by the evidence. This may help to prevent a decline in living‐donor transplantation seen in other countries with similar legislation. Media campaigns should include a focus on the impact of organ receipt. Patient or Public Contribution Two patient representatives from the Kidney Disease Health Integration Team, Primrose Granville and Soumeya Bouacida, contributed to the content and design of the study documents.
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Affiliation(s)
- Pippa K Bailey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Hannah Lyons
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Leeds School of Medicine, University of Leeds, Leeds, UK
| | - Fergus J Caskey
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Yoav Ben-Shlomo
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mohammed Al-Talib
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Renal Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Adarsh Babu
- Department of Renal Medicine, Gloucestershire Royal Hospital, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Lucy E Selman
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Potter JE, Elliott RM, Kelly MA, Perry L. Education and training methods for healthcare professionals to lead conversations concerning deceased organ donation: An integrative review. PATIENT EDUCATION AND COUNSELING 2021; 104:2650-2660. [PMID: 33775500 DOI: 10.1016/j.pec.2021.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To determine which training methods positively influenced healthcare professionals' communication skills and families' deceased organ donation decision-making. METHODS An integrative review using systematic methods and narrative synthesis for data analysis. Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (EBSCO), Embase (OVID) and ProQuest Dissertations & Theses Global, were searched between August 1997 and March 2020, retrieving 1019 papers. Included papers (n = 14) were appraised using the Medical Education Research Study Quality Instrument. RESULTS Training programmes offered theory, experiential learning, feedback and debriefing including self-reflection, the opportunity to role-play and interact with simulated participants within realistic case scenarios. Programmes reported observed and self-rated improvements in communication learning and confidence. The methodological quality score averaged 13, (72% of maximum); few studies used an experimental design, examined behavioural change or families' perspectives. Weak evidence suggested training could increase organ donation authorisation/consent rates. CONCLUSIONS Multiple training strategies are effective in improving interprofessional healthcare professionals' confidence and learning of specialised communication. Methodological limitations restricted the ability to present definitive recommendations and further research is warranted, inclusive of family decision-making experiences. PRACTICE IMPLICATIONS Learning of specialised communication skills is enhanced by using multiple training strategies, including role-play and debriefing.
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Affiliation(s)
- Julie E Potter
- University of Technology Sydney, Faculty of Health, Ultimo, Australia; Royal North Shore Hospital, Department of Medical Oncology, St Leonards, Australia.
| | - Rosalind M Elliott
- University of Technology Sydney, Faculty of Health, Ultimo, Australia; Royal North Shore Hospital, Department of Intensive Care, St Leonards, Australia; Northern Sydney Local Health District, Nursing and Midwifery Directorate, St Leonards, Australia.
| | - Michelle A Kelly
- University of Technology Sydney, Faculty of Health, Ultimo, Australia; Curtin University, Curtin School of Nursing, Bentley, Australia.
| | - Lin Perry
- University of Technology Sydney, Faculty of Health, Ultimo, Australia; Prince of Wales Hospital, Department of Endocrinology, Randwick, Australia.
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Crespo M, Mazuecos A, Domínguez-Gil B. Global Perspective on Kidney Transplantation: Spain. KIDNEY360 2021; 2:1840-1843. [PMID: 35373004 PMCID: PMC8785836 DOI: 10.34067/kid.0002502021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Marta Crespo
- Department of Nephrology, Hospital del Mar, Barcelona, Spain,Nephrology Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
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Beraldo S, Karpus J. Nudging to donate organs: do what you like or like what we do? MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:329-340. [PMID: 33733389 PMCID: PMC8349348 DOI: 10.1007/s11019-021-10007-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
An effective method to increase the number of potential cadaveric organ donors is to make people donors by default with the option to opt out. This non-coercive public policy tool to influence people's choices is often justified on the basis of the as-judged-by-themselves principle: people are nudged into choosing what they themselves truly want. We review three often hypothesized reasons for why defaults work and argue that the as-judged-by-themselves principle may hold only in two of these cases. We specify further conditions for when the principle can hold in these cases and show that whether those conditions are met is often unclear. We recommend ways to expand nationwide surveys to identify the actual reasons for why defaults work and discuss mandated choice policy as a viable solution to many arising conundrums.
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Affiliation(s)
- Sergio Beraldo
- Department of Economics and Statistics, University of Napoli, Naples, Italy
| | - Jurgis Karpus
- Faculty of Philosophy, Philosophy of Science and the Study of Religion, LMU Munich, Munich, Germany.
- Faculty of Psychology and Educational Sciences, General and Experimental Psychology, LMU Munich, Munich, Germany.
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Ballesté C, Valero R, Istrate M, Peralta P, Mosharafa AA, Morsy AA, Bakr MA, Kamal Abdelkader AI, Sheashaa H, Juvelekian GS, Khachab M, Ahdab R, Faour W, Tahiri Jouti N, Benghanem Gharbi M, Bayahia R, Dakka T, Desatnik P, Jambou P, Pisarski P, Samson-Himmelstjerna P, Lücking KM, Manyalich M. Design and implementation of the European-Mediterranean Postgraduate Programme on Organ Donation and Transplantation (EMPODaT) for Middle East/North Africa countries. Transpl Int 2021; 34:1553-1565. [PMID: 33993570 DOI: 10.1111/tri.13918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre- and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries.
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Affiliation(s)
- Chloe Ballesté
- Surgery and Surgical Specializations Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Transplant Counseling Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Donation and Transplantation Institute (DTI), Barcelona, Spain
| | - Ricard Valero
- Surgery and Surgical Specializations Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Department of Anesthesiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Melania Istrate
- Surgery and Surgical Specializations Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Donation and Transplantation Institute (DTI), Barcelona, Spain
| | - Particia Peralta
- CETT-UB Department, SE-elearning, University of Barcelona, Barcelona, Spain
| | | | | | - Mohamed Adel Bakr
- Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Hussein Sheashaa
- Mansoura Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Georges S Juvelekian
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
- Saint George Hospital UMC, Beirut, Lebanon
| | - Maha Khachab
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Reshdi Ahdab
- American University Medical Center Rizk Hospital, Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
| | - Wissam Faour
- Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
| | - Nadia Tahiri Jouti
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco
| | - Mohammed Benghanem Gharbi
- Faculty of Medicine and Pharmacy of Casablanca, Hassan II University of Casablanca, Casablanca, Morocco
- Ibn Rochd Hospital, Casablanca, Morocco
| | - Rabia Bayahia
- Nephrology Department, University Hospital Ibn Sina, Rabat, Morocco
- Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | - Taoufik Dakka
- Faculty of Medicine, Mohammed V University, Rabat, Morocco
| | | | - Patrick Jambou
- Faculty of Medicine, University Côte d'Azur, Nice, France
| | | | | | | | - Martí Manyalich
- Surgery and Surgical Specializations Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Transplant Counseling Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Donation and Transplantation Institute (DTI), Barcelona, Spain
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Singh R, Varughese B, El-Menyar A, Shahbal S, Al Maslamani Y, Salam AM, Al Thani H. Opt-Out Consent at Different Levels of Attitude to Organ Donation: A Household Survey in Qatar. J Multidiscip Healthc 2021; 14:401-410. [PMID: 33633451 PMCID: PMC7901440 DOI: 10.2147/jmdh.s285011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Demand for an organ transplant is surpassing the number of organ donors and hence increasing waiting lists worldwide, compelling many countries to adopt an opt-out consent system for organ donation. Opt-out is used in several European countries and has increased organ registration rate. No study on this subject has been published from the gulf region to associate sociodemographic characteristics, knowledge, attitude, beliefs, and intention domains regarding an opt-out consent for organ donation. Materials and Methods A household survey was conducted between October and November 2016 using a validated questionnaire. Integer codes were assigned for qualitative data to interpret results at par with quantitative data for each domain to allow data for advanced statistical analysis. Results Of 1044 surveyed participants, 724 (69.34%) those aged 37.7±10.4 agreed to adopting an opt-out consent system of which 231 (29.4%) were Qatari citizens and 353 (48.8%) were males. Mean levels of indices such as attitude, behavioral beliefs, and intention domains to organ donation were found higher in opt out participants. After adjusting statistical significant variables, multivariate analysis showed that attitude index was associated to opt out system (OR: 16.7, 95% C.I.:10.6-26.3, p=0.001) whereas; knowledge index (OR: 0.25, 95% C.I.: 0.07-0.83, p=0.03), behavioral beliefs (OR: 0.55, 95% C.I.: 0.35-0.86, p=0.009) and intention indices (OR: 0.42, 95% C.I.: 0.20-0.87, p=0.02) were associated with opt-in system for organ donation in Qatar. Regression model was able to discriminate (AUC: 84%, 95% C.I.:81% to 87%) for opt-out consent. Future probabilities for opt-out consent were 0.80, 0.88, 0.92,0.95,0.96,0.97,0.99 and 0.993 for 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80 and 0.90 attitude levels after using 200 re-samples to make traditional multivariate regression model to realistic model for the population. Conclusion The majority of the survey participants showed a good attitude but less knowledge, behavioral beliefs, and intention towards adopting an opt-out system for organ donation in Qatar.
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Affiliation(s)
- Rajvir Singh
- Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
| | | | | | - Saad Shahbal
- Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
| | | | - Amar M Salam
- Department of Cardiology & Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
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Abstract
Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of transplantation activity (for example, in the number of transplantations, the number of people with a functioning graft, in rates of living versus deceased donation, and in the use of expanded criteria donors) suggest that there is ample room for improvement. Herein we review the policy and clinical measures that should be considered to increase access to transplantation and improve post-transplantation outcomes. This Roadmap, generated by a group of major European stakeholders collaborating within a Thematic Network, presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation. This framework can be adopted by countries and institutions that are interested in advancing transplantation, both within and outside the European Union. Within this framework, a priority ranking of initiatives is suggested that could serve as the basis for a new European Union Action Plan on Organ Donation and Transplantation.
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Silva E Silva V, Hornby L, Almost J, Lotherington K, Appleby A, Silva AR, Rochon A, Dhanani S. Burnout and compassion fatigue among organ and tissue donation coordinators: a scoping review. BMJ Open 2020; 10:e040783. [PMID: 33323439 PMCID: PMC7745321 DOI: 10.1136/bmjopen-2020-040783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To collate and synthesise available literature on burnout and compassion fatigue (CF) among organ and tissue donation coordinators (OTDCs) and to respond to the research question: what is known about burnout and CF among OTDCs worldwide? DESIGN Scoping review using Joanna Briggs Institute methodology for scoping reviews. DATA SOURCES Medline, EMBASE, PsycINFO, CINAHL, LILACS, PTSpubs and grey literature (ResearchGate, OpenGrey, Organ Donation Organization (ODO) websites, open access theses and dissertations) up to April 2020. STUDY SELECTION Studies reporting aspects of burnout and CF among OTDCs, including risk and protective factors. DATA EXTRACTION Two reviewers independently screened the studies for eligibility and extracted data from chosen sources using a data extraction tool developed for this study; NVIVO was used to perform a qualitative directed content analysis. RESULTS The searches yielded 741 potentially relevant records, of which 29 met the inclusion criteria. The majority of articles were from the USA (n=7, 24%), Canada (n=6, 21%) and Brazil (n=6, 21%), published between 2013 and 2020 (n=13, 45%) in transplant journals (n=11, 38%) and used a qualitative design approach (n=12, 41%). In the thematic analysis, we classified the articles into five categories: (1) burnout characteristics, (2) CF characteristics, (3) coping strategies, (4) protective factors and (5) ambivalence. CONCLUSION We identified aspects of burnout and CF among OTDCs, including defining characteristics, demographic predispositions, protective factors, coping strategies, precursors, consequences and personal ambivalences. Researchers described burnout and CF characteristics but did not use consistent terms when referring to CF and burnout, which may have hindered the identification of all relevant sources. This gap should be addressed by the application of consistent terminology, systematic approaches and appropriate research methods that combine quantitative and qualitative investigation to examine the underlying reasons for the development of burnout and CF among OTDCs.
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Affiliation(s)
- Vanessa Silva E Silva
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Laura Hornby
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Joan Almost
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Ken Lotherington
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Amber Appleby
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Amina Regina Silva
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Andrea Rochon
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Organ Donation and Transplantation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sonny Dhanani
- Critical Care, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Li X, Miao J, Gao R, Hu D, Qian G, Wei D, Zhou J, Zhang L, Xu W, Chen J, Hu C. The general public new views on deceased organ donation in China. Medicine (Baltimore) 2020; 99:e23438. [PMID: 33327273 PMCID: PMC7738062 DOI: 10.1097/md.0000000000023438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The organ donation in China has developed rapidly since fully launched donations after citizens death in 2015. This study was conducted to evaluate how the Chinese general public views changed on deceased organ donation, and to improve the donation process. METHODS A total of 110 eligible studies, including 103, 410 individuals, were selected to analyze through searching PubMed, CBMdisc, CQVIP, CNKI, and Wanfang Data from Jan 1, 1990 to May 31, 2019. The pooled proportions (and 95% CIs) of cognition, attitudes and willingness related to organ donation were calculated using the Freeman-Tukey double arcsine transformation. RESULTS The pooled proportions of knowing about organ donation and willing to donate increased from 84.6% (73.0-93.4) and 32.4% (23.9-41.6) before 2015, to 86.4% (74.5-95.1) and 39.9% (32.8-47.2) after 2015, respectively. The willingness to posthumous organ donation for cornea, heart, kidney, and liver had a significant improvement. Especially, the proportion of willingness to donate cornea increased to 56.0% (43.3-68.3) after 2015, from 39.2% (31.2-47.4) before 2015. However, although 69.7% (62.7-76.4) of participants approved the deceased organ donation, only 35.6% (29.7-41.8) and 43.9% (37.2-50.8) were willing to donate their own and relatives organs postmortem, respectively. The leading reasons for refraining from donating organs postmortem were distrusting the medical professionals (49.8%, 35.2-64.4) and traditional Chinese values (40.6%, 32.4-49.0). Popularizing knowledge about organ donation (61.5%, 45.7-76.1), humanitarian aid (57.1%, 48.8-65.3), and priority of using donated organs for relatives (53.1%, 30.8-74.7) were the applauded strategies to improve the willingness to posthumous organ donation. CONCLUSIONS The willingness toward posthumous organ donation has a significant improvement among Chinese general public since 2015, however, several important measures still need to be taken to promote the favorable attitudes and willingness toward organ donation.
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Affiliation(s)
- Xiaoshan Li
- Department of Lung Transplant Center, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi
| | - Junyan Miao
- School of Public Health, Nantong University, Nantong
| | - Rong Gao
- Department of Clinical Laboratory, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Di Hu
- School of Public Health, Nantong University, Nantong
| | - Gongtao Qian
- Department of Lung Transplant Center, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi
| | - Dong Wei
- Department of Lung Transplant Center, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi
| | - Jianmei Zhou
- Department of Lung Transplant Center, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi
| | - Lihua Zhang
- Department of Lung Transplant Center, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi
| | - Weiwei Xu
- Department of Lung Transplant Center, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi
| | - Jingyu Chen
- Department of Lung Transplant Center, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi
| | - Chunxiao Hu
- Department of Lung Transplant Center, the Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi
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Opt-out policy and the organ shortage problem: Critical insights and practical considerations. Transplant Rev (Orlando) 2020; 35:100589. [PMID: 33232867 DOI: 10.1016/j.trre.2020.100589] [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: 08/20/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 10/22/2022]
Abstract
The legal shift to an opt-out system of consent for deceased organ donation is now official in England, Wales and Scotland. While it is commendable that national governments across the United Kingdom have publicly signalled their serious engagement with organ donation, it remains questionable that opt-out policy can in and of itself solve the public health issue of organ shortage. Opt-out policy risks becoming a futile solution if it fails to attend to key factors in clinical practice. Thus, this article provides critical insights and practical considerations in order to work towards increasing the availability of organs for transplantation: 1) organ donation specialists on their own are not enough, a collaborative hospital culture of donation is also needed; 2) investment in innovative perfusion technologies is fundamental to increase both the quantity and quality of organs utilised for transplants; and 3) opt-out does not solve the enduring problem of consent or authorization for donation, rather than hoping that opt-out will shift the societal culture of donation and make donation the default choice, it is necessary to acknowledge that families' authorization remains essential and their emotional experience can neither be minimized nor excluded altogether. Importantly, consent rates are not the only factor to account for overall deceased donation rates. The organ shortage cannot be solely attributed to a matter of negative public attitudes reversible by law. Doing that does a disservice to the public and diverts strategic attention and resources from fostering the organizational and technological enablers of organ donation in clinical practice.
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Tonelli M, Vanholder R, Himmelfarb J. Health Policy for Dialysis Care in Canada and the United States. Clin J Am Soc Nephrol 2020; 15:1669-1677. [PMID: 32586926 PMCID: PMC7646249 DOI: 10.2215/cjn.14961219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Contemporary dialysis treatment for chronic kidney failure is complex, is associated with poor clinical outcomes, and leads to high health costs, all of which pose substantial policy challenges. Despite similar policy goals and universal access for their kidney failure programs, the United States and Canada have taken very different approaches to dealing with these challenges. While US dialysis care is primarily government funded and delivered predominantly by private for-profit providers, Canadian dialysis care is also government funded but delivered almost exclusively in public facilities. Differences also exist for regulatory mechanisms and the policy incentives that may influence the behavior of providers and facilities. These differences in health policy are associated with significant variation in clinical outcomes: mortality among patients on dialysis is consistently lower in Canada than in the United States, although the gap has narrowed in recent years. The observed heterogeneity in policy and outcomes offers important potential opportunities for each health system to learn from the other. This article compares and contrasts transnational dialysis-related health policies, focusing on key levers including payment, finance, regulation, and organization. We also describe how policy levers can incentivize favorable practice patterns to support high-quality/high-value, person-centered care and to catalyze the emergence of transformative technologies for alternative kidney replacement strategies.
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Affiliation(s)
- Marcello Tonelli
- Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium, European Kidney Health Alliance
| | - Jonathan Himmelfarb
- Kidney Research Institute, School of Medicine, Seattle, Washington .,Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington
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Kazzaz YM, Da'ar OB. Assessing comfort level of organ donation competencies among pediatric intensivists in Saudi Arabia: a national survey. BMC MEDICAL EDUCATION 2020; 20:358. [PMID: 33046074 PMCID: PMC7552448 DOI: 10.1186/s12909-020-02262-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND As increasing the number of organ donations presents a global challenge, Saudi Arabia is no different. Intensivists can play a major role in maximizing the organ donation process and minimize the challenges. The purpose of this study was to investigate Saudi pediatric intensivists' comfort and importance levels of organ donation competencies. METHODS We conducted a cross-sectional survey whose sampling frame included 100 pediatric intensivists. The pediatrician intensivists were identified through an updated list provided by the Saudi Critical Care Society. We assessed 14 competencies categorized into four domains: the general donation, donation after brain death (DBD), neurological determination of death, and medicolegal, religious, and ethical domains. Then we investigated the association between these competencies and physicians' characteristics. RESULTS With a response rate of 76%, we found that 40-60% of the surveyed pediatric intensivists rated their comfort in 6 out of 14 competencies as high or very high. There was a statistically significant gap in the intensivists' rating of 10 competencies (i.e., high importance but low comfort levels). Ordinal regression showed that comfort levels with the general donation, neurological determination of death, and medicolegal, religious, and ethical domains were higher in intensivists who were frequently involved with DBD than those who had never been exposed. CONCLUSIONS Pediatric intensivists expressed low comfort levels to organ donation competencies that are essential for maximizing donation rates. Adapting mandatory comprehensive donation education programs and dedicated physician specialists may be beneficial in critical care units aiming to increase donation rates.
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Affiliation(s)
- Yasser M Kazzaz
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Omar B Da'ar
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Health Systems, College of Public Health and Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Abstract
OBJECTIVES To describe how children currently die in Spanish PICUs, their epidemiologic characteristics and clinical diagnoses. DESIGN Prospective multicenter observational study. SETTING Eighteen PICUs participating in the MOdos de Morir en UCI Pediátrica-2 (MOMUCI-2) study in Spain. PATIENTS Children 1 to 16 years old who died in PICU during 2017 and 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS During the 2-year study period, 250 deaths were recorded. Seventy-three children (29.3%) were younger than 1 year, 131 (52.6%) were between 1 and 12 years old, and 45 (18.1%) were older than 12. One-hundred eighty patients (72%) suffered from an underlying chronic disease, 54 (21.6%) had been admitted to PICU in the past 6 months, and 71 (28.4%) were severely disabled upon admission. Deaths occurred more frequently on the afternoon-night shift (62%) after a median PICU length of stay of 3 days (1-12 d). Nearly half of the patients died (48.8%) after life-sustaining treatment limitation, 71 died (28.4%) despite receiving life-sustaining therapies and cardiopulmonary resuscitation, and 57 (22.8%) were declared brain dead. The most frequent type of life-sustaining treatment limitation was the withdrawal of mechanical ventilation (20.8%), followed by noninitiation of cardiopulmonary resuscitation (18%) and withdrawal of vasoactive drugs (13.7%). Life-sustaining treatment limitation was significantly more frequent in patients with an underlying neurologic-neuromuscular disease, respiratory disease as the cause of admission, a previous admission to PICU in the past 6 months, and severe disability. Multivariate analyses indicated that life-sustaining treatment limitation, chronicity, and poor Pediatric Cerebral Performance Category score were closely related. CONCLUSIONS Currently, nearly half of the deaths in Spanish PICUs occur after the withdrawal of life-sustaining treatments. These children are more likely to have had previous admissions to the PICU, be severely disabled or to suffer from chronic diseases. Healthcare professionals who treat critically ill children ought to be aware of this situation and should therefore be prepared and trained to provide the best end-of-life care possible.
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Chan HY. Remapping the organ donation ethical climate: a care ethics consideration. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:295-308. [PMID: 31811525 DOI: 10.1007/s11019-019-09934-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Organ donation has gained much attention as the need for transplant exceeds the supply of organs. Various proposals have been put forward to address the organ shortage challenge, ranging from offering incentives to donors, addressing family refusals to donations and instituting presumed consent laws. Presumed consent as the favoured approach has not been universally effective in increasing actual transplants despite its appeal. Few considerations have been given to the broader ethical climate influencing the organ donation debate. This paper examines the ethical climate surrounding organ donation and identifies the challenges existing within such environments. It explores care ethics and its application to the donation system, demonstrating how it can influence the organ donation phases. The conclusion drawn from the analysis is that a caring ethical climate in the pre, during and post-transplant system respects donor autonomy, addresses family reluctance to agree to donation, facilitates the needs of the donee and creates an environment that promotes non-maleficence for all stakeholders.
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Vanholder R, Stel VS, Jager KJ, Lameire N, Loud F, Oberbauer R, de Jong RW, Zoccali C. How to increase kidney transplant activity throughout Europe-an advocacy review by the European Kidney Health Alliance. Nephrol Dial Transplant 2020; 34:1254-1261. [PMID: 30629203 DOI: 10.1093/ndt/gfy390] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022] Open
Abstract
Kidney transplantation offers better outcomes and quality of life at lower societal costs compared with other options of renal replacement therapy. In this review of the European Kidney Health Alliance, the current status of kidney transplantation throughout Europe and suggestions for improvement of transplantation rates are reported. Although the European Union (EU) has made considerable efforts in the previous decade to stimulate transplantation activity, the discrepancies among European countries suggest that there is still room for improvement. The EU efforts have partially been neutralized by external factors such as economic crises or legal issues, especially the illicit manipulation of waiting lists. Hence, growth in the application of transplantation throughout Europe virtually remained unchanged over the last few years. Continued efforts are warranted to further stimulate transplantation rates, along with the current registration and data analysis efforts supported by the EU in the Effect of Differing Kidney Disease Treatment Modalities and Organ Donation and Transplantation Practices on Health Expenditure and Patient Outcomes project. Future actions should concentrate on organization, harmonization and improvement of the legal consent framework, population education and financial stimuli.
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Affiliation(s)
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Norbert Lameire
- Nephrology Section, Ghent University Hospital, Ghent, Belgium
| | | | - Rainer Oberbauer
- Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Rianne W de Jong
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Carmine Zoccali
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases, Ospedali Riuniti, Reggio Calabria, Italy
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Krmpotic K, Isenor C, Beed S. Deceased organ donation in Nova Scotia: Presumed consent and system transformation. Healthc Manage Forum 2020; 33:210-213. [PMID: 32323580 DOI: 10.1177/0840470420919129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In recent years, rates of deceased organ donation in Nova Scotia have remained stagnant, falling behind provinces that have invested in their organ donation programs. The Nova Scotia provincial government has recently committed to health system transformation, which will include enactment of presumed consent legislation in 2020. Although impressive rates of deceased organ donation are often observed in countries with presumed consent legislation, improvements in performance can more often be attributed to the accompanying health system transformation. Key components of high performing deceased organ donation systems include highly trained organ donation specialists, practice guidelines, healthcare professional education, performance metric reviews, accountability frameworks, and public awareness campaigns in addition to adequate legislation. For Nova Scotia's organ donation program to succeed, the provincial government must also invest the frontline financial resources required to develop and maintain adequate program infrastructure and implement key strategies to support a culture of donation.
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Affiliation(s)
- Kristina Krmpotic
- 3688Dalhousie University, Halifax, Nova Scotia, Canada.,432234Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Cynthia Isenor
- 432234Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Stephen Beed
- 3688Dalhousie University, Halifax, Nova Scotia, Canada.,432234Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,3688Dalhousie University, Halifax, Nova Scotia, Canada
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Sarti A, Sutherland S, Landriault A, Dhanani S, Healey A, Cardinal P. Evaluating the Implementation of Ontario's Organ and Tissue Donation Physician Leadership Model: Mapping a Way Forward. J Healthc Leadersh 2020; 12:27-34. [PMID: 32308517 PMCID: PMC7135194 DOI: 10.2147/jhl.s240488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background The demand for solid organ transplantation has spurred countries around the world to search for innovative policies and practices to increase the supply of organs. Spain has become a global reference point for organ donation with the highest transplantation rates. In Ontario, Canada the Ontario Trillium Gift of Life (TGLN) has sought to replicate some of the successes in Spain. In particular, TGLN's implementation of the Physician Leadership Model has been viewed as a promising strategy to improve donation conversion rates. Objective The objective of this study was to evaluate the implementation of TGLNs (TGLN) Physician Leadership Model by examining critical implementation process variables (education/training, communication, satisfaction, participation and reach). Methods This mixed-method implementation evaluation included data from all members of the Physician Leadership Model including the Chief Medical Officer, five Regional Medical Leads (RMLs), and the 52 Hospital Donation Physicians (HDPs). Social Network Analysis (SNA) surveys were sent to all 52 HDPs and yielded an 85% rate. Analysis included constructing sociograms and qualitatively analyzing interviews. Results TGLN's PLM was poised for success by utilizing the existing RMLs' network as a foundation. The social network analysis measures, particularly participation and reach, indicated the PLM was quite dense (ie, the degree to which members are connected) at baseline. HDPs reported communication to be facilitated by their connections to their RMLs. Early evaluative data indicated that lack of education and training was viewed by HDPs as a barrier, and thus more capacity would need to be directed to this issue. Overall, HDPs reported that various intended outcomes were being met. Conclusion We have demonstrated that an implementation evaluation helps us to understand which elements of the PLM were successful and which elements required immediate attention. This evaluation helped to highlight the successes and challenges in implementing the TGLN Physician Leadership Model in Ontario. Social network analysis of publicly funded capacity building systems has been identified as a promising area for health program evaluation to answer questions at a system level, such as identifying service provisions among information exchange networks and ultimately better health care.
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Affiliation(s)
- Aimee Sarti
- Department of Critical Care, Ottawa Hospital, Ottawa, ON, Canada
| | | | - Angele Landriault
- Practice and Performance Unit, Royal College of Physicians and Surgeons of Canada (RCPSC), Ottawa, ON, Canada
| | - Sonny Dhanani
- Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Andrew Healey
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pierre Cardinal
- Department of Critical Care, Ottawa Hospital, Ottawa, ON, Canada
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Assessment of Restored Kidney Transplantation Including the Use of Wider Criteria for Accepting Renal Donors After Cancer Excision. Transplant Direct 2019; 5:e498. [PMID: 31773051 PMCID: PMC6831121 DOI: 10.1097/txd.0000000000000946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/26/2022] Open
Abstract
The transplantation of kidneys after cancer excision (restored kidney transplantation, RKT) warrants further evaluation as a source of kidneys for transplantation. We determined whether larger cancers can be safely transplanted, the risks of adverse events from RKT, and whether RKT confers a survival advantage for patients waiting for transplantation.
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Mazo C, Gómez A, Sandiumenge A, Baena J, Báguena M, Nuvials FX, Ferrer R, Boned S, Rubiera M, Pont T. Intensive Care to Facilitate Organ Donation: A Report on the 4-Year Experience of a Spanish Center With a Multidisciplinary Model to Promote Referrals Out of the Intensive Care Unit. Transplant Proc 2019; 51:3018-3026. [DOI: 10.1016/j.transproceed.2019.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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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.
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López‐Lazcano AI, López‐Pelayo H, Lligoña A, Sánchez N, Vilas‐Riotorto V, Priego A, Sánchez‐González R, Rodríguez‐Urrutia A, Quesada‐Franco M, Maldonado JR, Pintor L. Translation, adaptation, and reliability of the Stanford Integrated Psychosocial Assessment for Transplantation in the Spanish population. Clin Transplant 2019; 33:e13688. [DOI: 10.1111/ctr.13688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/17/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ana Isabel López‐Lazcano
- Grup Recerca Addicions Clínic (GRAC‐GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Red de Trastornos Adictivos Madrid Spain
| | - Hugo López‐Pelayo
- Grup Recerca Addicions Clínic (GRAC‐GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Red de Trastornos Adictivos Madrid Spain
| | - Anna Lligoña
- Grup Recerca Addicions Clínic (GRAC‐GRE), Department of Psychiatry, Clinical Institute of Neuroscience, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Red de Trastornos Adictivos Madrid Spain
| | - Nuria Sánchez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Consultation Liaison Psychiatry Unit, Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
| | - Vanessa Vilas‐Riotorto
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Consultation Liaison Psychiatry Unit, Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
| | - Angel Priego
- Consultation Liaison Psychiatry Unit, Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
| | - Roberto Sánchez‐González
- Department of Psychiatry Centre Emili Mira Institut de Neuropsiquiatria i Addiccions Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute) Barcelona Spain
- Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM) Madrid Spain
| | - Amanda Rodríguez‐Urrutia
- Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM) Madrid Spain
- Department of Psychiatry Hospital Universitari Vall d'Hebron Barcelona Spain
- Group of Psychiatry, Mental Health and Addictions Vall d'Hebron Research Institut (VHIR) Barcelona Spain
| | - Marta Quesada‐Franco
- Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM) Madrid Spain
- Department of Psychiatry Hospital Universitari Vall d'Hebron Barcelona Spain
| | - Jose R. Maldonado
- Department of Psychiatry and Behavioral Sciences Stanford University School of Medicine Stanford California
| | - Luis Pintor
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain
- Consultation Liaison Psychiatry Unit, Psychiatry Department, Clinical Institute of Neurosciences, Hospital Clínic i Universitari de Barcelona Universitat de Barcelona Barcelona Spain
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Witjes M, Jansen NE, van Dongen J, Herold IHF, Otterspoor L, Haase-Kromwijk BJJM, van der Hoeven JG, Abdo WF. Appointing nurses trained in organ donation to improve family consent rates. Nurs Crit Care 2019; 25:299-304. [PMID: 31294520 PMCID: PMC7507830 DOI: 10.1111/nicc.12462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022]
Abstract
Background One of the most important bottlenecks in the organ donation process worldwide is the high family refusal rate. Aims and objectives The main aim of this study was to examine whether family guidance by trained donation practitioners increased the family consent rate for organ donation. Design This was a prospective intervention study. Methods Intensive and coronary care unit nurses were trained in communication about donation (ie, trained donation practitioners) in two hospitals. The trained donation practitioners were appointed to guide the families of patients with a poor medical prognosis. When the patient became a potential donor, the trained donation practitioner was there to guide the family in making a well‐considered decision about donation. We compared the family consent rate for donation with and without the guidance of a trained donation practitioner. Results The consent rate for donation with guidance by a trained donation practitioner was 58.8% (20/34), while the consent rate without guidance by a trained donation practitioner was 41.4% (41/99, P = 0.110) in those patients where the family had to decide on organ donation. Conclusions Our data suggest that family guidance by a trained donation practitioner could benefit consent rates for organ donation. Relevance to clinical practice Trained nurses play an important role in supporting the families of patients who became potential donors to guide them through the decision‐making process after organ donation request.
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Affiliation(s)
- Marloes Witjes
- Dutch Transplant Foundation, Leiden, The Netherlands.,Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jacqueline van Dongen
- Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Ingeborg H F Herold
- Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Luuk Otterspoor
- Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Wilson F Abdo
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Santos RPD, Carvalho ARDS, Peres LAB. Kidney transplantation epidemiology in Brazil. Nefrologia 2019; 39:402-410. [DOI: 10.1016/j.nefro.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/14/2018] [Accepted: 07/03/2018] [Indexed: 10/27/2022] Open
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Potter JE, Gatward JJ, Kelly MA, McKay L, McCann E, Elliott RM, Perry L. Simulation-Based Communication Skills Training for Experienced Clinicians to Improve Family Conversations About Organ and Tissue Donation. Prog Transplant 2019; 27:339-345. [PMID: 29187126 DOI: 10.1177/1526924817731881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The approach, communication skills, and confidence of clinicians responsible for raising deceased organ donation may influence families' donation decisions. The aim of this study was to increase the preparedness and confidence of intensive care clinicians allocated to work in a "designated requester" role. DESIGN We conducted a posttest evaluation of an innovative simulation-based training program. Simulation-based training enabled clinicians to rehearse the "balanced approach" to family donation conversations (FDCs) in the designated requester role. Professional actors played family members in simulated clinical settings using authentic scenarios, with video-assisted reflective debriefing. Participants completed an evaluation after the workshop. Simple descriptive statistical analysis and content analysis were performed. RESULTS Between January 2013 and July 2015, 25 workshops were undertaken with 86 participants; 82 (95.3%) returned evaluations. Respondents were registered practicing clinicians; over half (44/82; 53.7%) were intensivists. Most attended a single workshop. Evaluations were overwhelmingly positive with the majority rating workshops as outstanding (64/80; 80%). Scenario fidelity, competence of the actors, opportunity to practice and receive feedback on performance, and feedback from actors, both in and out of character, were particularly valued. Most (76/78; 97.4%) reported feeling more confident about their designated requester role. DISCUSSION Simulation-based communication training for the designated requester role in FDCs increased the knowledge and confidence of clinicians to raise the topic of donation.
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Affiliation(s)
- Julie Elizabeth Potter
- 1 New South Wales Organ and Tissue Donation Service, Sydney, Australia.,2 Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Jonathan J Gatward
- 3 Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - Michelle A Kelly
- 4 School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Leigh McKay
- 1 New South Wales Organ and Tissue Donation Service, Sydney, Australia
| | - Ellie McCann
- 5 National Centre for Immunisation, Research and Surveillance
| | - Rosalind M Elliott
- 1 New South Wales Organ and Tissue Donation Service, Sydney, Australia.,2 Faculty of Health, University of Technology Sydney, Ultimo, Australia.,3 Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia
| | - Lin Perry
- 2 Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Matesanz R, Domínguez-Gil B. Opt-out legislations: the mysterious viability of the false. Kidney Int 2019; 95:1301-1303. [DOI: 10.1016/j.kint.2019.02.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/14/2019] [Indexed: 01/24/2023]
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Martín-Delgado MC, Martínez-Soba F, Masnou N, Pérez-Villares JM, Pont T, Sánchez Carretero MJ, Velasco J, De la Calle B, Escudero D, Estébanez B, Coll E, Pérez-Blanco A, Perojo L, Uruñuela D, Domínguez-Gil B. Summary of Spanish recommendations on intensive care to facilitate organ donation. Am J Transplant 2019; 19:1782-1791. [PMID: 30614624 DOI: 10.1111/ajt.15253] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/13/2018] [Accepted: 12/27/2018] [Indexed: 01/25/2023]
Abstract
With the aim of consolidating recommendations about the practice of initiating or continuing intensive care to facilitate organ donation (ICOD), an ad hoc working group was established, comprising 10 intensivists designated by the Spanish Society of Intensive Care and Coronary Units (SEMICYUC) and the Spanish National Transplant Organization (ONT). Consensus was reached in all recommendations through a deliberative process. After a public consultation, the final recommendations were institutionally adopted by SEMICYUC, ONT, and the Transplant Committee of the National Health-Care System. This article reports on the resulting recommendations on ICOD for patients with a devastating brain injury for whom the decision has been made not to apply any medical or surgical treatment with a curative purpose on the grounds of futility. Emphasis is made on the systematic referral of these patients to donor coordinators, the proper assessment of the likelihood of brain death and medical suitability, and on transparency in communication with the patient's family. The legal and ethical aspects of ICOD are addressed. ICOD is considered a legitimate practice that offers more patients the opportunity of donating their organs upon their death and helps to increase the availability of organs for transplantation.
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Affiliation(s)
| | | | - Nuria Masnou
- Donation and Transplant Coordination Unit, Doctor Josep Trueta University Hospital, Gerona, Spain
| | | | - Teresa Pont
- Donation and Transplant Coordination Unit, Vall d'Hebrón University Hospital, Barcelona, Spain
| | | | - Julio Velasco
- Intensive Care Unit, Son Espases University Hospital, Palma de Mallorca, Spain
| | | | - Dolores Escudero
- Intensive Care Unit, Central de Asturias University Hospital, Oviedo, Spain
| | - Belén Estébanez
- Donation and Transplant Coordination Unit, La Paz University Hospital, Madrid, Spain
| | | | | | - Lola Perojo
- Organización Nacional de Trasplantes, Madrid, Spain
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Measures influencing post-mortem organ donation rates in Germany, the Netherlands, Spain and the UK : A systematic review. Anaesthesist 2019; 68:377-383. [PMID: 31101922 DOI: 10.1007/s00101-019-0600-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/28/2019] [Accepted: 04/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND German post-mortem organ donation rates have been declining since 2010. Several transplantation scandals led to a negative portrayal of organ donation in the media. Spain, the UK and the Netherlands achieved a rise in organ donation rates while retaining organ donation legislation. METHODS A systematic review of publications focusing on (1) organ donation legislation, (2) data on post-mortem organ donation rates and (3) measures to increase post-mortem organ donation rates in Europe was conducted in November 2017 in PubMed, PsycINFO and Web of Science. Quality parameters of the World Bank and the World Health Organization (WHO) were studied to analyze national health services, frequent causes of death and life expectancy. RESULTS Quality parameters of national health services were similar in all countries. The Netherlands and Germany have an opt in system. An increase of 37.4% in post-mortem organ donation rates from 2008 to 2015 in the UK was accomplished through the establishment of a donation task force, adopting parts of the Spanish model, while maintaining an opt in system. Spain has the highest organ donation rate worldwide (39.7 per million persons in 2015). The implementation of transplantation coordinators and the change in legislation in Germany in 2012 has so far shown no effect. Public awareness of organ donation in the Netherlands increased following various information campaigns. CONCLUSION Donation after cardiac death (DCD), expanded donor criteria, increasing public awareness and introduction of an organ donor register should be discussed as measures to increase organ donation rates in Germany.
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