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Silva A, Lalani J, James L, O'Donnell S, Amar-Zifkin A, Shemie SD, Zavalkoff S. Donor audits in deceased organ donation: a scoping review. Can J Anaesth 2024; 71:143-151. [PMID: 37910334 PMCID: PMC10858122 DOI: 10.1007/s12630-023-02613-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 11/03/2023] Open
Abstract
PURPOSE We sought to collate and summarize existing literature on donor audits (DA) and how they have been used to guide deceased organ donation and transplantation system performance and quality assurance. SOURCE We searched MEDLINE, Cumulative Index of Nursing and Allied Health Literature, and Web of Science supplemented by Google to identify grey literature on 6 May 2022, to locate studies in English, French, and Spanish. The data were screened, extracted, and analyzed independently by two reviewers. We grouped the results into five categories: 1) motivation for DA, 2) DA methodology, 3) potential and actual donors, 4) missed donation opportunities, and 5) quality improvement. PRINCIPAL FINDINGS The search yielded 2,416 unique publications and 52 were included in this review. Most studies were from the UK (n = 13) and published between 2001 and 2006 (n = 15). The methodologies described for DA were diverse. Our findings showed that the primary motivation for conducting DA was to identify potential donors and the number of potential deceased organ donors is significantly higher than the number of actual donors. Among retrieved studies, the proportion of donation opportunities following neurologic determination of death was 95/222 (43%) compared with 25/181 (14%) for donation after cardiocirculatory death (DCD), suggesting that the missed donation rate is higher for DCD. CONCLUSION Donor audits help identify missed donation opportunities along the deceased donation pathway and can help support the evaluation of quality improvement initiatives.
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Affiliation(s)
- Amina Silva
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
- CHEO Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Jehan Lalani
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Lee James
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Shauna O'Donnell
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Sam D Shemie
- Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Samara Zavalkoff
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Critical Care, Department of Pediatrics, McGill University, Montreal, QC, Canada
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Sahin M, Altinay M, Cinar AS, Yavuz H. Retrospective Analysis of Patients Diagnosed with Brain Death in Our Hospital in the Last 15 Years. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:526-530. [PMID: 38268659 PMCID: PMC10805059 DOI: 10.14744/semb.2023.65928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/18/2023] [Indexed: 01/26/2024]
Abstract
Objectives Retrospective analysis of cases diagnosed with brain death in our hospital in the last 15 years. Methods The files and computer records of the cases diagnosed with brain death in the intensive care units of our hospital between January 2008 and January 2023 were evaluated retrospectively. The demographic data of the cases, the primary disease leading to brain death, the complementary tests used in the diagnosis of brain death, the day on which brain death was diagnosed in the intensive care unit, and the donor status were examined. Results A total of 228 cases diagnosed as brain death were detected. Seven patients with missing data were excluded from the study. 61.99% of the cases were male, 38.01% were female, 14.02% were under 18 years old, 68.34% were between 18 and 65 years old, 17.64% were over 65 years old. Brain death was diagnosed in 69.69% of the patients admitted to the intensive care unit in the first 7 days, 22.17% in 7-14 days, and 8.14% after 14 days. The primary disease causing brain death was found to be 47% hemorrhagic cerebral injury, 21% traumatic hemorrhagic injury, 18% ischemic cerebral injury, and 14% hypoxic cerebral injury. No ancillary testing was used in 38% of the cases. Carotid doppler ultrasound was used in 36%, computed tomography angiography was used in 22%, and transcranialdoppler was used in 4%. Families agreed to be organ transplant donors in 28.95% of the cases. 71.05% family members refused to be organ transplant donors. Conclusion The number of organ donations and the diagnosis of brain death has decreased rapidly with the covid-19 pandemic. In order to increase organ donation, we think that the necessary education should be given at an early age to increase organ donation awareness and social awareness.
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Affiliation(s)
- Murat Sahin
- Department of Anaesthesia and Intensive Care, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Mustafa Altinay
- Department of Anaesthesia and Intensive Care, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Ayse Surhan Cinar
- Department of Anaesthesia and Intensive Care, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
| | - Hanife Yavuz
- Department of Organ and Tissue Transplantation, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
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Akbulut S, Ozer A, Firinci B, Demyati K, Saritas H, Yilmaz S. Assessment of Knowledge and Attitudes Toward Organ Donation Among School Teachers: First National Survey Study. Transplant Proc 2022; 54:575-581. [PMID: 35256202 DOI: 10.1016/j.transproceed.2021.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/16/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM The most important factors affecting organ donation are socioeconomic, educational, and cultural factors. The aim of this study was to evaluate the attitudes, knowledge levels, and behaviors of school teachers toward organ donation METHODS: This study surveyed 2400 school teachers working in official public schools. Turkey was divided into 26 regions based on the similarity of social, economic, and geographic factors identified by the Turkish Statistical Institute. Teachers were distributed equally in the city center and towns based on population. The survey procedures were carried out using computer-assisted personal interviewing. RESULTS Among teachers, 89.6% had a bachelor's degree and 8.5% had a master's degree. In addition, 32.5% worked in primary schools, 33.1% worked in secondary schools, and 34.4% worked in high schools. Furthermore, 0.7% had donated an organ; 66.5% were not considering organ donation in the future, of whom 9.0% indicated religion as the reason for not donating an organ, and 34.8% did not indicate any reason. In addition, 96.6% considered organ donation to be proper behavior for humanity and 68% believed that organ donation is appropriate in religious terms. CONCLUSIONS This study showed that school teachers have inadequate knowledge and attitudes toward organ donation. Encouraging children and adolescents to make a well-informed decision about organ donation and to register this choice will depend largely on preparing school teachers with adequate knowledge and motivation toward creating generations with a positive attitude toward organ donation.
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Affiliation(s)
- Sami Akbulut
- Department of Public Health, Inonu University Faculty of Medicine, Malatya, Turkey; Liver Transplant Institute, Inonu University, Malatya, Turkey.
| | - Ali Ozer
- Department of Public Health, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Betul Firinci
- Department of Public Health, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Khaled Demyati
- Liver Transplant Institute, Inonu University, Malatya, Turkey; Department of Surgery, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Hasan Saritas
- Department of Surgical Nursing, Inonu University Faculty of Nursing, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University, Malatya, Turkey
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Liu CW, Chen LN, Anwar A, Lu Zhao B, Lai CKY, Ng WH, Suhitharan T, Ho VK, Liu JCJ. Comparing organ donation decisions for next-of-kin versus the self: results of a national survey. BMJ Open 2021; 11:e051273. [PMID: 34785552 PMCID: PMC8596040 DOI: 10.1136/bmjopen-2021-051273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Intensive care audits point to family refusal as a major barrier to organ donation. In this study, we sought to understand refusal by accounting for the decision-maker's mindset. This focused on: (1) how decisions compare when made on behalf of a relative (vs the self); and (2) confidence in decisions made for family members. DESIGN Cross-sectional survey in Singapore. SETTING Participants were recruited from community settings via door-to-door sampling and community eateries. PARTICIPANTS 973 adults who qualified as organ donors in Singapore. RESULTS Although 68.1% of participants were willing to donate their own organs, only 51.8% were willing to donate a relative's organs. Using machine learning, we found that consistency was predicted by: (1) religion, and (2) fears about organ donation. Conversely, participants who were willing to donate their own organs but not their relative's were less driven by these factors, and may instead have resorted to heuristics in decision-making. Finally, we observed how individuals were overconfident in their decision-making abilities: although 78% had never discussed organ donation with their relatives, the large majority expressed high confidence that they would respect their relatives' wishes on death. CONCLUSIONS These findings underscore the distinct psychological processes involved when donation decisions are made for family members. Amidst a global shortage of organ donors, addressing the decision-maker's mindset (eg, overconfidence, the use of heuristics) may be key to actualizing potential donors identified in intensive care units.
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Affiliation(s)
- Christopher Weiyang Liu
- Department of Pain Medicine, Singapore General Hospital, Singapore
- Anaesthesiology Academic Clinical Program, Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lynn N Chen
- Department of Anesthesiology, Singapore General Hospital, Singapore
| | - Amalina Anwar
- Division of Social Sciences, Yale-NUS College, Singapore
| | - Boyu Lu Zhao
- Division of Social Sciences, Yale-NUS College, Singapore
| | - Clin K Y Lai
- Division of Social Sciences, Yale-NUS College, Singapore
| | - Wei Heng Ng
- Division of Social Sciences, Yale-NUS College, Singapore
| | - Thangavelautham Suhitharan
- Anaesthesiology Academic Clinical Program, Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Vui Kian Ho
- Anaesthesiology Academic Clinical Program, Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Jean C J Liu
- Division of Social Sciences, Yale-NUS College, Singapore
- Neuroscience and Behavioral Disorders Programme, Duke-NUS Medical School, Singapore
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Correlation of Organ Donors' Age With Duration Between Admission and First Brain Death Examination: A Five-Year Study in South Korea. Transplant Proc 2021; 53:1817-1822. [PMID: 33965244 DOI: 10.1016/j.transproceed.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/22/2021] [Accepted: 02/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Deceased organ donation can be performed only with the consent of the donor or their family members. The aim of this study was to determine whether donor age is related to families' decision-making regarding consent for organ donation. METHODS We obtained the data of 2451 organ donors with brain death (men 1645, women 806; mean age, 46.5 ± 16.2 years) registered with the Korean Network for Organ Sharing for the period between December 2012 and December 2017. The duration between the admission of the patient and the first brain death assessment was determined. RESULTS The mean duration from admission to the first brain death examination was significantly longer in the 0 to 30 age group (16.23 ± 6.01 days) compared with the 31 to 83 age group (6.7 ± 1.07 days) (P < .001). There was a strong negative correlation (r = 0.795, P = .010) between age and the mean duration from admission to the first brain death examination. CONCLUSION Because the family members of younger potential organ donors needed more time to provide consent, the first brain death examination and, therefore, the donation process was delayed in cases of young donors.
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Costa-Font J, Rudisill C, Salcher-Konrad M. 'Relative Consent' or 'Presumed Consent'? Organ donation attitudes and behaviour. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:5-16. [PMID: 32651683 PMCID: PMC7822792 DOI: 10.1007/s10198-020-01214-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
Legislation, in the form of presumed consent, has been argued to boost organ donation but most evidence disregards the practice of seeking relative's consent, which can either 'veto' donation decisions, or 'legitimize them', by removing any possible conflict with the donor's family. We study the effect of presumed consent alongside family consent on individuals' willingness to donate (WTD) one's own and relatives' organs, and on actual organ donation behaviours. Using data from 28 European countries for the period 2002-2010, we found that presumed consent (PC) policies are associated with increased willingness to donate organs, but this effect was attenuated once internal family discussions on organ donation were controlled for. Our findings indicate that relative's consent acts as a veto of donation intentions and attenuates the effect of regulation on actual donations. More specifically, PC increases WTD one's own and relatives' organs in countries where no family consent is required. Consistently, we find that family consent attenuates the influence of regulatory environment on actual donations. The effect is driven by the influence of family discussions which increased WTD, and in combination with presumed consent translated into higher organ donation rates.
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Affiliation(s)
- Joan Costa-Font
- London School of Economics and Political Science (LSE), Houghton Street, London, WC2A 2AE UK
| | - Caroline Rudisill
- Arnold School of Public Health, University of South Carolina, Columbia, SC USA
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Prevalence and Potential Correlates of Family Refusal to Organ Donation for Brain-Dead Declared Patients: A 12-Year Retrospective Screening Study. Transplant Proc 2020; 53:548-554. [PMID: 32943213 DOI: 10.1016/j.transproceed.2020.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/08/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study was designed to determine prevalence and potential correlates of family refusal to organ donation for patients declared brain dead thorough a 12-year retrospective data analysis. METHODS Of 111 cases declared brain dead by our hospital within a 12-year period between 2008 and 2019, a total of 82 potentially brain-dead organ donors were included in this retrospective study. Data on sociodemographic characteristics, length of intensive care unit stay, cause of death, decedent's wishes, interview time, family decision, and reasons for refusal were recorded. RESULTS The rate of family refusal to organ donation was 51.2% and because of religious concerns (64.3%) in most of cases. The likelihood of family consent to organ donation was significantly higher for an adult vs a child (60.0% vs 25.9%, P = .004) and for a schooler and adolescent age vs a younger child (55.6 vs 22.5%, P = .004). Patients who were declared brain dead after nontraumatic intracranial hemorrhage (60.4%) vs encephalitis (18.2%) had higher rates of family consent to organ donation (P = .023). CONCLUSIONS In conclusion, our findings revealed family refusal to organ donation in at least half of cases and higher likelihood of family consent to organ donation depending on age of patient (adult vs children) and cause of death (brain injury vs encephalitis). The religious concerns and distrust in the health care system were the 2 major causes of family refusal, whereas no significant difference was noted across different family refusal reasons in terms of sociodemographic factors, length of intensive care unit stay, awareness of decedent's wishes, or time of family interview.
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Gardiner D, Charlesworth M, Rubino A, Madden S. The rise of organ donation after circulatory death: a narrative review. Anaesthesia 2020; 75:1215-1222. [PMID: 32430909 DOI: 10.1111/anae.15100] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 11/29/2022]
Abstract
Solid organ transplantation saves and transforms lives. The original type of organ donation from deceased patients was controlled donation after circulatory death, previously referred to as non-heart beating organ donation. The rise of donation after circulatory death in the UK came about through advances in critical care and transplant medicine and support from several key organisations in developing a robust ethical, legal and professional framework. The transplant waiting list reached a historic peak in 2009-2010 of 8000 patients, but fell by 25% to 6000 in 2017-2018. There has also been a steady rise in the number of deceased donors and the number of donations after circulatory death. The contribution of donation after circulatory death to the total number of donations rose steadily between 2000 and 2012 and has remained about 40% since. Although the situation has improved for patients waiting for a transplant, deaths and long waits remain common. Changes to legislative, technical and peri-mortem procedures may greatly change future practices in donation after circulatory death in the UK.
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Affiliation(s)
- D Gardiner
- National Clinical Lead for Organ Donation, NHS Blood and Transplant, Nottingham, UK
| | - M Charlesworth
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Rubino
- Department of Cardiothoracic Anaesthesia, Critical Care and ECMO, Royal Papworth Hospital, Cambridge, UK
| | - S Madden
- NHS Blood and Transplant, Bristol, UK
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Palsson TP, Sigvaldason K, Kristjansdottir TE, Thorkelsson T, Blondal AT, Karason S, Palsson R. The potential for organ donation in Iceland: A nationwide study of deaths in intensive care units. Acta Anaesthesiol Scand 2020; 64:663-669. [PMID: 31950492 DOI: 10.1111/aas.13551] [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: 04/05/2019] [Revised: 12/30/2019] [Accepted: 01/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The deceased organ donation rate in Iceland has been low compared with other Western countries. The aim of this study was to explore the potential for organ donation after brain death in Iceland. METHODS Observational cohort study of patients with catastrophic brain injury who died in intensive care units (ICUs) at hospitals in Iceland in 2003-2016. Medical records were retrospectively reviewed to identify potential donors (PDs), using the WHO Critical Pathway for Deceased Donation. Trends in annual incidence of PDs, conversion to actual donors, and family refusals were assessed. RESULTS Among 1537 patients who died in the ICU, 125 (8.1%) were identified as PDs. Of 103 PDs who were declared brain dead, consent for organ donation was pursued in 84 cases and granted in 63. Fifty-six became actual donors. The annual donation rate averaged 13 per million population (pmp), but rose abruptly in the final 2 years to 36 and 27 pmp, respectively. This was paralleled by an increase in annual incidence of PDs from an average of 28 pmp to 54 and 42 pmp, respectively. The donor conversion rate increased during the study period (P = .026). Twenty-three PDs (18%) were not pursued without an apparent reason. CONCLUSIONS The donation rate increased markedly in the last 2 years of the study period after remaining low for more than a decade. This change can largely be explained by a high incidence of PDs and a low family refusal rate. Missed donation opportunities suggest a potential to maintain a high donation rate in the future.
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Affiliation(s)
- Thordur P. Palsson
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
| | - Kristinn Sigvaldason
- Division of Anesthesia and Intensive Care Medicine Landspitali—The National University Hospital of Iceland Reykjavik Iceland
| | - Thora E. Kristjansdottir
- Division of Anesthesia and Intensive Care Medicine Landspitali—The National University Hospital of Iceland Reykjavik Iceland
| | - Thordur Thorkelsson
- Division of Neonatal Intensive Care Children’s Medical Center Landspitali—The National University Hospital of Iceland Reykjavik Iceland
| | - Asbjorn T. Blondal
- Division of Anesthesia and Intensive Care Akureyri Hospital Akureyri Iceland
| | - Sigurbergur Karason
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Division of Anesthesia and Intensive Care Medicine Landspitali—The National University Hospital of Iceland Reykjavik Iceland
| | - Runolfur Palsson
- Faculty of Medicine School of Health Sciences University of Iceland Reykjavik Iceland
- Internal Medicine Services Landspitali—The National University Hospital of Iceland Reykjavik Iceland
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Popoola AA, Bolaji BO, Olanrewaju TO, Ajiboye TO. Deceased donor organ transplantation potential: A peep into an untapped gold mine. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:245-253. [PMID: 32129219 DOI: 10.4103/1319-2442.279947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Organ transplantation is the gold standard for treating end-stage organ diseases, many of whom are on waiting lists. The reasons for this include the nonavailability of suitable organs to be transplanted. In many nations, most of these challenges have been surmounted by the adoption of deceased donor program, which is not so in sub-Saharan countries such as Nigeria. This study is to audit the potentially transplantable organs available from potential deceased donors from a Nigerian tertiary hospital. This is a study of deaths in the intensive care unit (ICU) and the accident and emergency units of the University of Ilorin Teaching Hospital, Nigeria. Data included the biodata, social history, diagnosis or indications for admission, time of arrival and death, causes of death, associated comorbidities, potential organs available, social history, and availability of relations at the time of death. There were 104 deaths in the ICU and 10 patients in the accident and emergency unit. There were 66 males (57.9%) and 48 females (42.1%). Eighty patients were Muslims (70.2%) and 34 were Christians (19.8%). A total of 33 participants were unmarried (28.9%),whereas 81 (71.1%) were married. The tribes of the patients were Yoruba (105, 92.1%), Igbo (7, 6.1%), Hausa (1, 0.9%), and Nupe (1, 0.9%). The age range was 0.08-85 years. Twenty-two (19.3%) had primary and the remaining had at least secondary education. The causes of death were myriad, and there were relatives available at the times of all deaths. The Maastricht classification of the deaths were Class I - 1 (0.9%), Class II - 37 (32.2%), Class III - 9 (7.8%), Class IV - 20 (17.4%), and Class V - 47(40.9%). There were no transplantable organs in 42 (36.5%), one organ in eight (7%), two organs in two (7%), three organs in one (0.9%), four organs in 13 (11.3%), five organs in six (5.2%), six organs in 11 (9.6%), seven organs in 11 (9.6%), eight organs in five (13%), and nine organs in five (4.3%). Deceased donor sources of organs are worthy of being exploited to improve organ transplantation in Nigeria.
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Affiliation(s)
- Ademola Alabi Popoola
- Department of Surgery, University of Ilorin, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Benjamin Olusomi Bolaji
- Department of Anesthesia, University of Ilorin, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Tajudeen Olalekan Ajiboye
- Department of Accident and Emergency, University of Ilorin, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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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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Schulte K, Borzikowsky C, Rahmel A, Kolibay F, Polze N, Fränkel P, Mikle S, Alders B, Kunzendorf U, Feldkamp T. Decline in Organ Donation in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:463-468. [PMID: 30064626 DOI: 10.3238/arztebl.2018.0463] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 02/20/2018] [Accepted: 06/11/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND The annual number of post-mortem organ donations in Germany has declined by more than 30% since 2010. The causes of this development have not yet been adequately determined. METHODS All patients hospitalized in Germany between 2010 and 2015 (112 172 869 hospitalizations in total) were included in this nationwide secondary analysis. Among the deceased patients we identified those who had died in the presence of a brain damage and for whom organ donation was not excluded either by a medical contraindication or by the patient's not having been artificially ventilated. The analysis was also conducted separately for six German university hospitals. RESULTS Over the period 2010-2015, the number of potential organ donors per year in Germany rose by 13.9%, from 23 937 to 27 258. This development was due to an increase in the number of deaths with severe brain damage as well as an increase in the percentage of patients who were treated with invasive ventilation before death. The contact quotient, i.e., the percentage of potential donors for whom contact was made with the German Foundation for Organ Transplantation (Deutsche Stiftung Organtransplantation, DSO) fell over this period from 11.4% to 8.2%. At the same time, the realization quotient (the percentage of potential donors who became actual donors) fell from 5.4% to 3.2%, and the conversion quotient (the percentage of potential donors for whom contact was made who became actual donors) fell from 47% to 39.1%. From 2010 to 2012, the falling realization quotient was accounted for mainly by the falling conversion quotient; from 2012 to 2015, it was accounted for mainly by the falling contact quotient. The contact and realization quotients among the six university hospitals studied differed markedly (by factors of 17.5 and 23.3, respectively), while the conversion quotients differed only minimally (by a factor of 1.3). CONCLUSION The decline in post-mortem organ donation is due to a deficiency in the recognition and reporting of potential organ donors in hospital. If this process were better supported on the organizational and political level, far more organs could be transplanted.
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Affiliation(s)
- Kevin Schulte
- Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Kiel; Institute of Medical Informatics and Statistics, Christian-Albrechts University, Kiel; German Organ Transplantation Foundation (DSO), Frankfurt am Main; The Medical Director's Staff Division of Clinical Affairs, University Hospital of Cologne; Department of Quality and Risk Management, University Hospital Leipzig; Department of Quality and Risk Management, University Hospital RWTH Aachen; Department of Quality Management, University Hospital of the Ruhr University Bochum, Knappschaft Hospital; Department of Anesthesiology, Surgical Intensive Care Medicine and Pain Therapy, University Hospital of the Ruhr University Bochum, Knappschaft Hospital
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Contiero PP, Wilson DM. Understanding ambivalence toward organ donation and transplantation: An exploratory study of nursing students. NURSE EDUCATION TODAY 2019; 76:191-195. [PMID: 30822605 DOI: 10.1016/j.nedt.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/16/2019] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND There is a continuing shortage of organs for transplantation purposes worldwide. Determining why this is a recurring problem is necessary as organ transplantation is a highly successful life saving measure. It is possible that ambivalence is key to this shortage. OBJECTIVES To explore the possible existence of ambivalence toward organ donation and transplantation among Canadian nursing students, and gaining insights into this ambivalence when present. DESIGN An exploratory study using a structured questionnaire to explore the existence of ambivalence in relation to donating and receiving an organ for transplantation purposes. METHODS A total of 170 undergraduate nursing students at a Canadian university participated in this study by completing a brief questionnaire distributed to all five classes of nursing students who were taking a mandatory research course during the 2017-18 university calendar year. The survey tool was designed to collect quantitative and qualitative data in relation to their ambivalence toward organ donation and transplantation. RESULTS Nursing students are more willing to receive an organ than to donate. The willingness to donate or receive an organ was related to their personal beliefs and moral codes, religion, level of knowledge, and the existence of ambivalence. CONCLUSIONS This study reveals important insights into ambivalence about donating and receiving organs. The study found it was very easy to introduce ambivalence among nursing students, with this information highly relevant for student education and other applications.
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Affiliation(s)
- Paloma Peroni Contiero
- University of São Paulo, Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo 14040-902, Brazil.
| | - Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta T6G 1C9, Canada; Faculty of Education and Health Sciences, University of Limerick, Ireland; Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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Evolution of Deceased Organ Donation Activity Versus Efficiency Over a 15-year Period: An International Comparison. Transplantation 2019; 102:1768-1778. [PMID: 29677069 DOI: 10.1097/tp.0000000000002226] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The donation rate (DR) per million population is not ideal for an efficiency comparison of national deceased organ donation programs. The DR does not account for variabilities in the potential for deceased donation which mainly depends on fatalities from causes leading to brain death. In this study, the donation activity was put into relation to the mortality from selected causes. Based on that metric, this study assesses the efficiency of different donation programs. METHODS This is a retrospective analysis of 2001 to 2015 deceased organ donation and mortality registry data. Included are 27 Council of Europe countries, as well as the United States. A donor conversion index (DCI) was calculated for assessing donation program efficiency over time and in international comparisons. RESULTS According to the DCI and of the countries included in the study, Spain, France, and the United States had the most efficient donation programs in 2015. Even though mortality from the selected causes decreased in most countries during the study period, differences in international comparisons persist. This indicates that the potential for deceased organ donation and its conversion into actual donation is far from being similar internationally. CONCLUSIONS Compared with the DR, the DCI takes into account the potential for deceased organ donation, and therefore is a more accurate metric of performance. National donation programs could optimize performance by identifying the areas where most potential is lost, and by implementing measures to tackle these issues.
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15
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Life From Death-The Brain Dead Organ Donor Process As an Intersection of Family Bereavement and Needs and Clinician Awareness and Empathy. Crit Care Med 2019; 47:606-607. [PMID: 30882431 DOI: 10.1097/ccm.0000000000003674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Michetti CP, Newcomb A, Thota V, Liu C. Organ donation education in the ICU setting: a qualitative and quantitative analysis of family preferences. J Crit Care 2018; 48:135-139. [DOI: 10.1016/j.jcrc.2018.08.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 12/01/2022]
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17
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Moorlock G, Draper H. Empathy, social media, and directed altruistic living organ donation. BIOETHICS 2018; 32:289-297. [PMID: 29542172 PMCID: PMC6001484 DOI: 10.1111/bioe.12438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/08/2017] [Accepted: 11/27/2017] [Indexed: 06/13/2023]
Abstract
In this article we explore some of the ethical dimensions of using social media to increase the number of living kidney donors. Social media provides a platform for changing non-identifiable 'statistical victims' into 'real people' with whom we can identify and feel empathy: the so-called 'identifiable victim effect', which prompts charitable action. We examine three approaches to promoting kidney donation using social media which could take advantages of the identifiable victim effect: (a) institutionally organized campaigns based on historical cases aimed at promoting non-directed altruistic donation; (b) personal case-based campaigns organized by individuals aimed at promoting themselves/or someone with whom they are in a relationship as a recipient of directed donation; (c) institutionally organized personal case-based campaigns aimed at promoting specific recipients for directed donation. We will highlight the key ethical issues raised by these approaches, and will argue that the third option, despite raising ethical concerns, is preferable to the other two.
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18
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López JS, Soria-Oliver M, Aramayona B, García-Sánchez R, Martínez JM, Martín MJ. An Integrated Psychosocial Model of Relatives' Decision About Deceased Organ Donation (IMROD): Joining Pieces of the Puzzle. Front Psychol 2018; 9:408. [PMID: 29692744 PMCID: PMC5902731 DOI: 10.3389/fpsyg.2018.00408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
Organ transplantation remains currently limited because the demand for organs far exceeds the supply. Though organ procurement is a complex process involving social, organizational, and clinical factors, one of the most relevant limitations of organ availability is family refusal to donate organs of a deceased relative. In the past decades, a remarkable corpus of evidence about the factors conditioning relatives' consent has been generated. However, research in the field has been carried out mainly by means of merely empirical approaches, and only partial attempts have been made to integrate the existing empirical evidence within conceptual and theoretically based frameworks. Accordingly, this work articulates the proposal of an Integrated Psychosocial Model of Relatives' Organ Donation (IMROD) which offers a systematic view of the factors and psychosocial processes involved in family decision and their interrelations. Relatives' experience is conceptualized as a decision process about the possibility of vicariously performing an altruistic behavior that takes place under one of the most stressful experiences of one's lifetime and in the context of interaction with different healthcare professionals. Drawing on this, in the proposed model, the influence of the implied factors and their interrelations/interactions are structured and interpreted according to their theoretically based relation with processes like rational/heuristic decision-making, uncertainty, stress, bereavement, emotional reactions, sense of reciprocity, sense of freedom to decide, and attitudes/intentions toward one's own and the deceased's organ donation. Our model also develops a processual perspective and suggests different decisional scenarios that may be reached as a result of the combinations of the considered factors. Each of these scenarios may imply different balances between factors that enhance or hinder donation, such as different levels of uncertainty and potential decisional conflict. Throughout our work, current controversial or inconsistent results are discussed and interpreted on the basis of the relationships that are posited in the proposed model. Finally, we suggest that the structure of the relationships and interactions contained in our model can be used by future research to guide the formulation of hypotheses and the interpretation of results. In this sense, specific guidelines and research questions are also proposed.
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Affiliation(s)
- Jorge S López
- Departamento de Psicología y Pedagogía, Universidad Pública de Navarra, Pamplona, Spain.,Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Soria-Oliver
- Facultad de Ciencias de la Salud, UNIR-Universidad Internacional de la Rioja, Logroño, Spain
| | - Begoña Aramayona
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rubén García-Sánchez
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - José M Martínez
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - María J Martín
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
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19
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Morgan J, Hopkinson C, Hudson C, Murphy P, Gardiner D, McGowan O, Miller C. The Rule of Threes: three factors that triple the likelihood of families overriding first person consent for organ donation in the UK. J Intensive Care Soc 2017; 19:101-106. [PMID: 29796065 DOI: 10.1177/1751143717738194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Between 1 April 2012 and 31 March 2015, 263 of the 2244 families in the UK whose loved ones had registered to donate organs for transplantation after their death on the NHS Organ Donor Register chose to override this decision; an override rate of 11.7%. Multivariable logistic regression analysis was applied to data relating to various aspects of the family approach in order to identify factors associated with such overrides. The factors associated with family overrides were failure to involve the Specialist Nurse for Organ Donation in the family approach (odds ratio 3.0), donation after circulatory death (odds ratio 2.7) and Black, Asian or Minority Ethnicity (odds ratio 2.7). This highlights the need to further engage with these groups in exploring donation as an end of life choice, and suggests that there may be, from the perspective of the family, fundamental differences between donation after brainstem death and circulatory death. It further adds to the body of data linking involvement of the Specialist Nurse for Organ Donation in the family approach to improved UK consent rates.
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Affiliation(s)
- James Morgan
- Department of Anaesthesia and Critical Care, Leeds Teaching Hospitals NHS Trust, UK
| | | | - Cara Hudson
- NHS Blood and Transplant Directorate, Bristol, UK
| | - Paul Murphy
- Department of Anaesthesia and Critical Care, Leeds Teaching Hospitals NHS Trust, UK.,NHS Blood and Transplant Directorate, Bristol, UK
| | - Dale Gardiner
- NHS Blood and Transplant Directorate, Bristol, UK.,Department of Adult Critical Care, Nottingham University Hospitals NHS Trust, UK
| | | | - Cathy Miller
- NHS Blood and Transplant Directorate, Bristol, UK
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20
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Schmidt S, Schulte A, Schwarz S, Hofmann N, Tietz S, Boergel M, Sixt SU. Fresh osteochondral allografts-procurement and tissue donation in Europe. Injury 2017; 48:1296-1301. [PMID: 28551055 DOI: 10.1016/j.injury.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fresh osteochondral allografts are a well-established treatment for large, full-thickness cartilage defects. The clinical outcome for carefully selected patients is very favorable, especially for the young and active and graft survival up to 25 years has been described in the literature. Furthermore, a high patient satisfaction rate has been reported, but the biggest obstacle to overcome is the availability of tissue for transplantation. Large fresh bone allografts for cartilage damage repair only can be harvested from organ donors following organ removal or cadaveric donors, preferably in the setting of an operation room to minimize possible contamination of the tissue. Apart from the logistic challenges this entails, an experienced recovery team is needed. Furthermore, the public as well as medical staff is much less aware of the possibility and requirements of tissue donation than organ donation and families of deceased are rarely approached for bone and cartilage donation. This review aims to highlight the current situation of organ and tissue donation in Europe with special focus on the processing of bones and possible safety and quality concerns. We analyze what may prevent consent and what might be done to improve the situation of tissue donation.
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Affiliation(s)
- S Schmidt
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany.
| | - A Schulte
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - S Schwarz
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - N Hofmann
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - S Tietz
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - M Boergel
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany
| | - S U Sixt
- Deutsche Gesellschaft für Gewebetransplantation, Hannover, Germany; Clinic for Anesthesiology, University Hospital of Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
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21
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Gelbart B. Challenges of paediatric organ donation. J Paediatr Child Health 2017; 53:534-539. [PMID: 28398658 DOI: 10.1111/jpc.13541] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 11/29/2022]
Abstract
Paediatric organ donation represents a small fraction of overall organ donation in Australia and New Zealand and indeed world-wide. Many factors contribute to low donation rates including low paediatric intensive care mortality, consent rates and medical suitability relating to disease, age and size. In the past decade, the re-emergence of donation after circulatory death has changed the landscape for the paediatric population. This article reviews the current status and challenges of organ donation for the paediatric population.
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Affiliation(s)
- Ben Gelbart
- Paediatric Intensive Care Unit, Royal Children's Hospital, Murdoch Children's Research Institute, DonateLife, Victoria, Melbourne, Victoria, Australia
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22
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Mihály S, Smudla A, Kovács J. Practices Around Communication About Organ Donation in Hungary. Transplant Proc 2016; 48:2529-2533. [PMID: 27742341 DOI: 10.1016/j.transproceed.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND One obstacle to organ donation is the high proportion of relatives who refuse consent in presumed-consent countries. The aim of this study was to survey the features of family approaches and to identify those that may have significant impact on family refusals. METHODS A 46-item validated questionnaire was designed and used in 2011 and 2012 to investigate factors around all family communications about brain death and organ donation. The data of 188 cases were collected by telephone calls. We asked for the demographic data of donors; place, timing, duration, type, and result of approach; number, age, gender, and qualification of the staff; affinity, gender, age, education, and religion of the involved relatives; and finally the applied method to treat family refusal if it existed. RESULTS Usually 1 physician talked with 2 relatives. Timing had significant impact on objection rate (χ2 = 0.044). Single-discussion meetings (56.38%) were an average 1 hour 13 minutes before the brain death declaration, and they were initiated an average 19 hours 49 minutes before brain death when more than one meeting took place (43.62%). Conversations lasted for 11-22 minutes. Mann-Whitney U test revealed association between duration of donor family communication and occurrence of refusal (P = .021). It was found that the relatives' education level, the number of staff, and the number of family members strongly influenced the occurrence of refusals. CONCLUSIONS The careful preparation, organized direction, and support by intensive care unit staff can decrease the number of family refusals.
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Affiliation(s)
- S Mihály
- Organ Coordination Office, Hungarian National Blood Transfusion Service, Budapest, Hungary.
| | - A Smudla
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - J Kovács
- Institute of Behavioral Sciences, Semmelweis University, Budapest, Hungary
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Twamley H, Haigh A, Williment C, Hudson C, Whitney J, Neuberger J. Prospective audit to evaluate the potential of the coronial system to increase solid organ donation. BMJ Open 2016; 6:e010231. [PMID: 27401356 PMCID: PMC4947805 DOI: 10.1136/bmjopen-2015-010231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Anecdotal evidence suggests that organ donation from deceased donors referred to the Coroner/Procurator Fiscal (PF) could be increased if all followed best practice. The aim of this prospective audit was to establish how referrals affected organ donation and to develop evidence-based guidelines to ensure that organ donation can be facilitated safely without interfering in the Coroner/PF's investigative process. DESIGN Prospective audit. SETTING All acute National Health Service Hospitals in the UK where deceased organ donation was considered. PARTICIPANTS 1437 deceased patients who met the eligibility criteria for organ donation and were referred to Coroner/PF. MAIN OUTCOME MEASURES Number of cases where permission for transplantation was given, number of organs where permission was refused and number of organs which might have been transplanted if all had followed best practice. RESULTS Full permission for organ retrieval was given in 87% cases and partial permission in 9%. However, if full permission had been given where no autopsy was performed or restrictions seemed unjustified, up to 77 organs (22 lungs, 22 kidneys, 9 pancreases, 9 livers, 8 hearts and 7 small bowels) could have been available for transplant. CONCLUSIONS Coroners/PFs and their officers show strong support for transplantation but improvement in practice could result in a small but significant increase in life-saving and life-enhancing transplants.
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Affiliation(s)
- Huw Twamley
- Consultant in Anaesthesia and Critical Care, Royal Preston Hospital, Preston, UK
| | | | - Claire Williment
- Head of Transplant Development, NHS Blood and Transplant, Bristol
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24
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Knowledge, Attitudes, and Willingness Toward Organ Donation Among Health Professionals in China. Transplantation 2016; 99:1379-85. [PMID: 26038874 DOI: 10.1097/tp.0000000000000798] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purposes of this study were to assess the knowledge, attitudes, and willingness toward organ donation among the health professionals in China. METHODS Questionnaires were delivered to 400 health professionals from 7 hospitals in Dalian and 1 hospital in Chaozhou of China between October 2013 and January 2014. RESULTS In all, 400 health professionals were approached, 373 valid responses were returned. Over 90% of the participants knew about organ donation, but only 17.4% had taken part in some training courses or lectures about organ donation. Health professionals (64.9%) knew the shortage status of organ, and doctors knew more than nurses and nonclinical staffs (P < 0.01). Health professionals (97.3%) knew brain death, and 68.9% professionals thought brain death was the reasonable criteria to judge death. Doctors showed a higher knowledge level about brain death than nurses and nonclinical staffs (P < 0.01). Altogether, 60.1% approved deceased donation; however, only 48.5% approved living donation. Doctors' attitudes were more positive than nurses and nonclinical both in deceased donation (P < 0.01) and in living donation (P < 0.05). In all, 49.3% were willing to donate their own organs postmortem, and doctors had higher willingness to donation postmortem compared with nurses and nonclinical staffs (P < 0.01). The most (49.2%) commonly cited reason for refraining from donation was: "afraid that organs would be picked up inhumanely and body would be disfigured". CONCLUSIONS Health professionals showed lower favorable attitudes and willingness toward organ donation than Chinese general public. A proportion of Chinese health professionals' knowledge about organ donation was limited.
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25
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Hall B, Parkin MSW. UK policy initiatives and the effect on increasing organ donation. ACTA ACUST UNITED AC 2016; 25:307-11. [DOI: 10.12968/bjon.2016.25.6.307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bethany Hall
- Neonatal Staff Nurse, Neonatal Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London
| | - Matthew SW Parkin
- Senior Staff Nurse, Cardiothoracic Intensive Care Unit, St George's University Hospitals NHS Foundation Trust, London
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26
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Buffin J, Little R, Jain N, Warrens AN. A peer outreach initiative to increase the registration of minorities as organ donors. Clin Kidney J 2015; 8:623-8. [PMID: 26413291 PMCID: PMC4581384 DOI: 10.1093/ckj/sfv066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/01/2015] [Indexed: 11/29/2022] Open
Abstract
Background Black, Asian and minority ethnic (BAME) communities are disproportionately affected by inequalities in transplant services in the UK. There are some indications from pilot programmes that appeals for BAME organ donors may be more effectively communicated by employing grassroots, community-networking approaches, but such initiatives have not been adequately described or evaluated. Methods Lay individuals from BAME communities were trained as peer outreach workers. They attended a series of public events to promote knowledge of organ donation and transplantation among the public. Information was gathered from 806 evaluation forms completed by event attendees at 34 separate events. From these, 54 follow-up interviews were conducted with event attendees who completed evaluation forms, indicated that they intended to sign up to the NHS Organ Donor Register (ODR) within the next month and consented to follow-up. Results Peer outreach initiatives of the type evaluated are associated with increased numbers of BAME people registering as organ donors. A total of 8.8% of event attendees signed up to the NHS ODR. The programme was most effective with people who had previously considered becoming organ donors but who did not know how to go about it. It was less effective with people who had not previously considered it, or who were scared about signing up, or who feared family or religious disapproval. Conclusions Peer outreach programmes with BAME communities can be an effective way of reducing inequalities by increasing the number of people on the NHS ODR and encouraging people to think about the issue.
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Affiliation(s)
- Jez Buffin
- School of Social Work , University of Central Lancashire , Preston , UK
| | - Robert Little
- School of Social Work , University of Central Lancashire , Preston , UK
| | | | - Anthony N Warrens
- Renal and Transplantation Medicine, Barts and The London School of Medicine and Dentistry , Queen Mary University of London , London , UK
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28
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Escudero D, Valentín MO, Escalante JL, Sanmartín A, Perez-Basterrechea M, de Gea J, Martín M, Velasco J, Pont T, Masnou N, de la Calle B, Marcelo B, Lebrón M, Pérez JM, Burgos M, Gimeno R, Kot P, Yus S, Sancho I, Zabalegui A, Arroyo M, Miñambres E, Elizalde J, Montejo JC, Domínguez-Gil B, Matesanz R. Intensive care practices in brain death diagnosis and organ donation. Anaesthesia 2015; 70:1130-9. [PMID: 26040194 DOI: 10.1111/anae.13065] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 12/30/2022]
Abstract
We conducted a multicentre study of 1844 patients from 42 Spanish intensive care units, and analysed the clinical characteristics of brain death, the use of ancillary testing, and the clinical decisions taken after the diagnosis of brain death. The main cause of brain death was intracerebral haemorrhage (769/1844, 42%), followed by traumatic brain injury (343/1844, 19%) and subarachnoid haemorrhage (257/1844, 14%). The diagnosis of brain death was made rapidly (50% in the first 24 h). Of those patients who went on to die, the Glasgow Coma Scale on admission was ≤ 8/15 in 1146/1261 (91%) of patients with intracerebral haemorrhage, traumatic brain injury or anoxic encephalopathy; the Hunt and Hess Scale was 4-5 in 207/251 (83%) of patients following subarachnoid haemorrhage; and the National Institutes of Health Stroke Scale was ≥ 15 in 114/129 (89%) of patients with strokes. Brain death was diagnosed exclusively by clinical examination in 92/1844 (5%) of cases. Electroencephalography was the most frequently used ancillary test (1303/1752, 70.7%), followed by transcranial Doppler (652/1752, 37%). Organ donation took place in 70% of patients (1291/1844), with medical unsuitability (267/553, 48%) and family refusal (244/553, 13%) the main reasons for loss of potential donors. All life-sustaining measures were withdrawn in 413/553 of non-donors (75%).
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Affiliation(s)
- D Escudero
- Intensive Care Unit, Central University Hospital of Asturias, Oviedo, Spain
| | - M O Valentín
- Spanish National Transplant Organization (ONT), Madrid, Spain
| | - J L Escalante
- Intensive Care Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | - A Sanmartín
- Intensive Care Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - M Perez-Basterrechea
- Unit of Transplants, Cell Therapy and Regenerative Medicine, Central University Hospital of Asturias, Oviedo, Spain
| | - J de Gea
- Intensive Care Unit, Virgen de la Arrixaca Hospital, Murcia, Spain
| | - M Martín
- Intensive Care Unit, Central University Hospital of Asturias, Oviedo, Spain
| | - J Velasco
- Intensive Care Unit, Son Espases University Hospital, Palma de Mallorca, Spain
| | - T Pont
- Intensive Care Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - N Masnou
- Intensive Care Unit, Vall D'Hebron Hospital, Barcelona, Spain
| | - B de la Calle
- Intensive Care Unit, Gregorio Marañón University Hospital, Madrid, Spain
| | - B Marcelo
- Intensive Care Unit, Infanta Cristina University Hospital, Badajoz, Spain
| | - M Lebrón
- Intensive Care Unit, Carlos Haya Hospital, Málaga, Spain
| | - J M Pérez
- Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - M Burgos
- Intensive Care Unit, Virgen de las Nieves University Hospital, Granada, Spain
| | - R Gimeno
- Intensive Care Unit, La Fe University Hospital, Valencia, Spain
| | - P Kot
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - S Yus
- Intensive Care Unit, La Paz University Hospital, Madrid, Spain
| | - I Sancho
- Intensive Care Unit, Miguel Servet University Hospital, Zaragoza, Spain
| | - A Zabalegui
- Intensive Care Unit, General Yagüe Hospital, Burgos, Spain
| | - M Arroyo
- Intensive Care Unit, General Yagüe Hospital, Burgos, Spain
| | - E Miñambres
- Intensive Care Unit, Marqués de Valdecilla University Hospital, Santander, Spain
| | - J Elizalde
- Intensive Care Unit, Asistential Complex of Navarra, Pamplona, Spain
| | - J C Montejo
- Intensive Care Unit, 12 de Octubre University Hospital, Madrid, Spain
| | - B Domínguez-Gil
- Spanish National Transplant Organization (ONT), Madrid, Spain
| | - R Matesanz
- Spanish National Transplant Organization (ONT), Madrid, Spain
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Coombs M. A scoping review of family experience and need during end of life care in intensive care. Nurs Open 2015; 2:24-35. [PMID: 27708798 PMCID: PMC5047309 DOI: 10.1002/nop2.14] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/02/2015] [Indexed: 11/07/2022] Open
Abstract
AIM To scope systematically and collate qualitative studies on family experience and need during end of life care in intensive care, from the perspective of family members. DESIGN Scoping review of qualitative research. METHODS Standardized processes of study identification, data extraction and data synthesis were used. Multiple bibliographic databases were accessed during 2011 and updated in 2013. RESULTS From an initial 876 references, 16 studies were identified for inclusion. These were predominantly single site, North American studies that explored issues relating to the temporal stages in the end of life trajectory and the requirement for information and emotional support at end of life. With a strong focus on family need and experience during the transition from active treatment to end of life care, more work is required to understand how doctors and nurses can support families from treatment withdrawal through to death.
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Affiliation(s)
- Maureen Coombs
- Graduate School of Nursing Midwifery and Health Victoria University Wellington Wellington 6242 New Zealand; Capital and Coast District Health Board Wellington Regional Hospital Wellington 6242 New Zealand
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Adanir T, Erdogan I, Hunerli G, Unveren G, Dasci H, Cetin H, Ozsan I, Aydin U. The Effect of Psychological Support for the Relatives of Intensive Care Unit Patients on Cadaveric Organ Donation Rate. Transplant Proc 2014; 46:3249-52. [DOI: 10.1016/j.transproceed.2014.05.086] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 05/27/2014] [Indexed: 10/24/2022]
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Weiss J, Coslovsky M, Keel I, Immer FF, Jüni P. Organ donation in Switzerland--an analysis of factors associated with consent rate. PLoS One 2014; 9:e106845. [PMID: 25208215 PMCID: PMC4160222 DOI: 10.1371/journal.pone.0106845] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background and Aim Switzerland has a low post mortem organ donation rate. Here we examine variables that are associated with the consent of the deceased’s next of kin (NOK) for organ donation, which is a prerequisite for donation in Switzerland. Methods and Analysis During one year, we registered information from NOK of all deceased patients in Swiss intensive care units, who were approached for consent to organ donation. We collected data on patient demographics, characteristics of NOK, factors related to the request process and to the clinical setting. We analyzed the association of collected predictors with consent rate using univariable logistic regression models; predictors with p-values <0.2 were selected for a multivariable logistic regression. Results Of 266 NOK approached for consent, consent was given in 137 (51.5%) cases. In multivariable analysis, we found associations of consent rates with Swiss nationality (OR 3.09, 95% CI: 1.46–6.54) and German language area (OR 0.31, 95% CI: 0.14–0.73). Consent rates tended to be higher if a parent was present during the request (OR 1.76, 95% CI: 0.93–3.33) and if the request was done before brain death was formally declared (OR 1.87, 95% CI: 0.90–3.87). Conclusion Establishing an atmosphere of trust between the medical staff putting forward a request and the NOK, allowing sufficient time for the NOK to consider donation, and respecting personal values and cultural differences, could be of importance for increasing donation rates. Additional measures are needed to address the pronounced differences in consent rates between language regions.
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Affiliation(s)
- Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Michael Coslovsky
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Isabelle Keel
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Franz F. Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
- * E-mail:
| | - Peter Jüni
- CTU Bern, Department of Clinical Research and Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Redelmeier DA, Woodfine JD, Thiruchelvam D, Scales DC. Maternal organ donation and acute injuries in surviving children. J Crit Care 2014; 29:923-9. [PMID: 25115273 DOI: 10.1016/j.jcrc.2014.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/11/2014] [Accepted: 07/14/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study is to test whether maternal deceased organ donation is associated with rates of subsequent acute injuries among surviving children after their mother's death. METHODS This is a longitudinal cohort analysis of children linked to mothers who died of a catastrophic brain event in Ontario, Canada, between April 1988 and March 2012. Surviving children were distinguished by whether their mother was an organ donor after death. The primary outcome was an acute injury event in surviving children during the year after their mother's death. RESULTS Surviving children (n=454) had a total of 293 injury events during the year after their mother's death, equivalent to an average of 65 events per 100 children per year and a significant difference comparing children of mothers who were organ donors to children of mothers who were not organ donors (21 vs 82, P<.001). This difference in subsequent injury rates between groups was equal to a 76% relative reduction in risk (95% confidence interval, 62%-85%). CONCLUSIONS Deceased organ donation was associated with a reduction in excess acute injuries among surviving children after their mother's death. An awareness of this positive association provides some reassurance about deceased organ donation programs.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Ontario, Canada; Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Ontario, Canada; Institute for Clinical Evaluative Sciences in Ontario, Ontario, Canada; Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Center for Leading Injury Prevention Practice Education & Research, Ontario, Canada.
| | - Jason D Woodfine
- Department of Medicine, University of Toronto, Ontario, Canada; Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Ontario, Canada; Institute for Clinical Evaluative Sciences in Ontario, Ontario, Canada.
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Ontario, Canada; Institute for Clinical Evaluative Sciences in Ontario, Ontario, Canada.
| | - Damon C Scales
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Interdepartmental Division of Critical Care, University of Toronto, Ontario, Canada.
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Kumar V, Ahlawat R, Gupta AK, Sharma RK, Minz M, Sakhuja V, Jha V. Potential of organ donation from deceased donors: study from a public sector hospital in India. Transpl Int 2014; 27:1007-14. [DOI: 10.1111/tri.12355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 04/29/2014] [Accepted: 05/19/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Vivek Kumar
- Department of Nephrology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Ravinder Ahlawat
- Department of Hospital Administration; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Anil K. Gupta
- Department of Hospital Administration; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Rakesh K. Sharma
- Department of Hospital Administration; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Mukut Minz
- Department of Renal Transplant Surgery; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Vinay Sakhuja
- Department of Nephrology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Vivekanand Jha
- Department of Nephrology; Postgraduate Institute of Medical Education and Research; Chandigarh India
- George Institute for Global Health; New Delhi India
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Ralph A, Chapman JR, Gillis J, Craig JC, Butow P, Howard K, Irving M, Sutanto B, Tong A. Family perspectives on deceased organ donation: thematic synthesis of qualitative studies. Am J Transplant 2014; 14:923-35. [PMID: 24612855 DOI: 10.1111/ajt.12660] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/27/2013] [Accepted: 12/27/2013] [Indexed: 01/25/2023]
Abstract
A major barrier to meeting the needs for organ transplantation is family refusal to give consent. This study aimed to describe the perspectives of donor families on deceased donation. We conducted a systematic review and thematic synthesis of qualitative studies. Electronic databases were searched to September 2012. From 34 studies involving 1035 participants, we identified seven themes: comprehension of sudden death (accepting finality of life, ambiguity of brain death); finding meaning in donation (altruism, letting the donor live on, fulfilling a moral obligation, easing grief); fear and suspicion (financial motivations, unwanted responsibility for death, medical mistrust); decisional conflict (pressured decision making, family consensus, internal dissonance, religious beliefs); vulnerability (valuing sensitivity and rapport, overwhelmed and disempowered); respecting the donor (honoring the donor's wishes, preserving body integrity) and needing closure (acknowledgment, regret over refusal, unresolved decisional uncertainty, feeling dismissed). Bereaved families report uncertainty about death and the donation process, emotional and cognitive burden and decisional dissonance, but can derive emotional benefit from the "lifesaving" act of donation. Strategies are needed to help families understand death in the context of donation, address anxieties about organ procurement, foster trust in the donation process, resolve insecurities in decision making and gain a sense of closure.
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Affiliation(s)
- A Ralph
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Summers DM, Johnson RJ, Hudson AJ, Collett D, Murphy P, Watson CJE, Neuberger JM, Bradley JA. Standardized deceased donor kidney donation rates in the UK reveal marked regional variation and highlight the potential for increasing kidney donation: a prospective cohort study†. Br J Anaesth 2013; 113:83-90. [PMID: 24335581 PMCID: PMC4062298 DOI: 10.1093/bja/aet473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The UK has implemented a national strategy for organ donation that includes a centrally coordinated network of specialist nurses in organ donation embedded in all intensive care units and a national organ retrieval service for deceased organ donors. We aimed to determine whether despite the national approach to donation there is significant regional variation in deceased donor kidney donation rates. Methods The UK prospective audit of deaths in critical care was analysed for a cohort of patients who died in critical care between April 2010 and December 2011. Multivariate logistic regression was used to identify the factors associated with kidney donation. The logistic regression model was then used to produce risk-adjusted funnel plots describing the regional variation in donation rates. Results Of the 27 482 patients who died in a critical care setting, 1528 (5.5%) became kidney donors. Factors found to influence donation rates significantly were: type of critical care [e.g. neurointensive vs general intensive care: OR 1.53, 95% confidence interval (CI) 1.34–1.75, P<0.0001], patient ethnicity (e.g. ‘Asian’ vs ‘white’: OR 0.17, 95% CI 0.11–0.26, P<0.0001), age (e.g. age >69 vs age 18–39 yr: OR 0.2, 0.15–0.25, P<0.0001), and cause of death [e.g. ‘other’ (excluding ‘stroke’ and ‘trauma’) vs ‘trauma’: OR 0.04, 95% CI 0.03–0.05, P<0.0001]. Despite correction for these variables, kidney donation rates for the 20 UK kidney donor regions showed marked variation. The overall standardized donation rate ranged from 3.2 to 7.5%. Four regions had donation rates of >2 standard deviations (sd) from the mean (two below and two above). Regional variation was most marked for donation after circulatory death (DCD) kidney donors with 9 of the 20 regions demonstrating donation rates of >2 sd from the mean (5 below and 4 above). Conclusions The marked regional variation in kidney donation rates observed in this cohort after adjustment for factors strongly associated with donation rates suggests that there is considerable scope for further increasing kidney donation rates in the UK, particularly DCD.
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Affiliation(s)
- D M Summers
- Department of Surgery, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Box 202, Cambridge CB2 0QQ, UK Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge, UK NHS Blood and Transplant, Bristol, UK
| | | | | | - D Collett
- NHS Blood and Transplant, Bristol, UK
| | - P Murphy
- NHS Blood and Transplant, Bristol, UK
| | - C J E Watson
- Department of Surgery, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Box 202, Cambridge CB2 0QQ, UK Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge, UK
| | | | - J A Bradley
- Department of Surgery, School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Box 202, Cambridge CB2 0QQ, UK Cambridge National Institute for Health Research Biomedical Research Centre, Cambridge, UK
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Sairanen T, Koivisto A, Koivusalo AM, Rantanen K, Mustanoja S, Meretoja A, Putaala J, Strbian D, Kaste M, Isoniemi H, Tatlisumak T. Lost potential of kidney and liver donors amongst deceased intracerebral hemorrhage patients. Eur J Neurol 2013; 21:153-9. [DOI: 10.1111/ene.12288] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/23/2013] [Indexed: 12/21/2022]
Affiliation(s)
- T. Sairanen
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - A. Koivisto
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
- Faculty of Medicine; University of Helsinki; Helsinki Finland
| | - A.-M. Koivusalo
- Intensive Care Unit; Helsinki University Central Hospital; Helsinki Finland
| | - K. Rantanen
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - S. Mustanoja
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - A. Meretoja
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
- Departments of Neurology, Medicine, and the Florey; Royal Melbourne Hospital; University of Melbourne; Melbourne Victoria Australia
| | - J. Putaala
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - D. Strbian
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - M. Kaste
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
| | - H. Isoniemi
- Transplantation and Liver Surgery Clinic; Helsinki University Central Hospital; Helsinki Finland
| | - T. Tatlisumak
- Department of Neurology; Helsinki University Central Hospital; Helsinki Finland
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Reed MJ, Lua SBH. Uncontrolled organ donation after circulatory death: potential donors in the emergency department. Emerg Med J 2013; 31:741-4. [PMID: 23708913 DOI: 10.1136/emermed-2013-202675] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The continuing shortfall of organs for transplantation has led to interest in Maastricht Category II (uncontrolled) Donation after Circulatory Death (DCD) organ donation. As preparation for a proposed pilot, this study aimed to explore the potential of uncontrolled DCD organ donation from patients presenting in cardiac arrest to the emergency department (ED) who are unsuccessfully resuscitated. METHODS We identified all patients who died in our ED following unsuccessful resuscitation after cardiac arrest who were aged between 16 years and 60 years, whose collapse was witnessed, in whom the paramedics arrived within 15 min, whose death in the ED was less than 2 h after their collapse, who were on the organ donation register and who arrived in the ED during the working week (Monday to Friday between 9:00 and 17:00). RESULTS During a 14-month period from 1 August 2008 to 30 September 2009, 564 patients had a cardiac arrest in the Lothian region. Four patients may have been eligible to participate in an uncontrolled DCD organ donation programme. CONCLUSIONS Identifying potential organ donors in the ED who are unsuccessfully resuscitated from cardiac arrest may contribute to reducing the shortfall of organs for transplantation, although numbers are likely to be small. If such a programme was to be introduced during weekday working hours, there may be around four donors a year. However, even one additional donor per year from hospitals across the UK with an ED and a transplantation service would add considerably to the overall organ donation rate.
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Affiliation(s)
- Matthew James Reed
- Emergency Medicine Research Group Edinburgh (EMeRGE), Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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The incidence of potential missed organ donors in intensive care units and emergency rooms: a retrospective cohort. Intensive Care Med 2013; 39:1452-9. [PMID: 23702637 DOI: 10.1007/s00134-013-2952-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/03/2013] [Indexed: 01/14/2023]
Abstract
PURPOSE There is a shortage of organ donors in Canada. The number of potential organ donors that are not referred to organ procurement organizations in Canada is unknown. METHODS We conducted a retrospective cohort study of all deaths in ICUs and emergency rooms not referred to the Human Organ Procurement and Exchange Program in four hospitals between 1 January 2008 and 31 December 2010. The primary outcome was the number of normal and expanded criteria heart-beating donors and circulatory death (DCD) donors. RESULTS Of 2,931 deaths, 64 patients were identified as having a high probability for progression to heart-beating donation (Glasgow Coma Score of 3 and three or more absent brainstem reflexes) and 130 patients were assessed for possible DCD donation. The number of potential abdominal and lung heart-beating donors ranged from 3.2 to 7.5 and 0.5 to 2.7 per million population. The number of potential DCD abdominal and lung donors ranged from 3.9 to 6.5 and 2.7 to 4.3 per million population. Potential heart-beating abdominal (p = 0.04) and lung (p = 0.06) donors increased after legislation mandating donation discussion. Non-pupillary brainstem reflexes were documented in fewer than 60 % of records. Life-sustaining treatment was withdrawn in 19 of 46 (41.3 %) cardiac arrest patients not requiring high doses of vasoactive drugs within 24 h. CONCLUSION The number of heart-beating or DCD organ donors represented by missed referrals may represent up to 7.5 donors per million population. Improved documentation of brainstem reflexes and encouraging referral of patients suffering cardiac arrest to ICU specialists may improve donor numbers.
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Walker W, Broderick A, Sque M. Factors Influencing Bereaved Families’ Decisions About Organ Donation. West J Nurs Res 2013; 35:1339-59. [DOI: 10.1177/0193945913484987] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reports on the process and outcomes of a systematic integrative literature review, designed to enhance understanding of the factors influencing bereaved families’ decisions to agree or decline the donation of their deceased relative’s organs for transplantation. Research originating from eight Western countries ( N = 20 studies) provided an international perspective to the review. Thematic analysis and synthesis of textual data culminated in the development of three global themes (past, present, and future) that captured the temporal dimensions of family decision making. The review findings provide valuable insight into ways of increasing the rate of consent to organ donation through the development family-centered care interventions that reflect the needs of the bereaved. Further research to explore the pathway of donation after circulatory death and the experiences of bereaved families who decline organ donation is essential to providing a more complete understanding of the factors affecting donation decisions.
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Affiliation(s)
| | | | - Magi Sque
- University of Wolverhampton, England
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Redelmeier DA, Markel F, Scales DC. Organ donation after death in Ontario: a population-based cohort study. CMAJ 2013; 185:E337-44. [PMID: 23549970 DOI: 10.1503/cmaj.122047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Shortfalls in deceased organ donation lead to shortages of solid organs available for transplantation. We assessed rates of deceased organ donation and compared hospitals that had clinical services for transplant recipients (transplant hospitals) to those that did not (general hospitals). METHODS We conducted a population-based cohort analysis involving patients who died from traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage or other catastrophic neurologic conditions in Ontario, Canada, between Apr. 1, 1994, and Mar. 31, 2011. We distinguished between acute care hospitals with and without transplant services. The primary outcome was actual organ donation determined through the physician database for organ procurement procedures. RESULTS Overall, 87,129 patients died from catastrophic neurologic conditions during the study period, of whom 1930 became actual donors. Our primary analysis excluded patients from small hospitals, reducing the total to 79,746 patients, of whom 1898 became actual donors. Patients who died in transplant hospitals had a distribution of demographic characteristics similar to that of patients who died in other large general hospitals. Transplant hospitals had an actual donor rate per 100 deaths that was about 4 times the donor rate at large general hospitals (5.0 v. 1.4, p < 0.001). The relative reduction in donations at general hospitals was accentuated among older patients, persisted among patients who were the most eligible candidates and amounted to about 121 fewer actual donors per year (adjusted odds ratio 0.58, 95% confidence interval 0.36-0.92). Hospital volumes were only weakly correlated with actual organ donation rates. INTERPRETATION Optimizing organ donation requires greater attention to large general hospitals. These hospitals account for most of the potential donors and missed opportunities for deceased organ donation.
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Gauher ST, Khehar R, Rajput G, Hayat A, Bakshi B, Chawla H, Cox BM, Warrens AN. The factors that influence attitudes toward organ donation for transplantation among UK university students of Indian and Pakistani descent. Clin Transplant 2013; 27:359-67. [DOI: 10.1111/ctr.12096] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 11/30/2022]
Affiliation(s)
| | - Ravi Khehar
- Imperial College Business School; London; UK
| | | | - Alia Hayat
- Imperial College Business School; London; UK
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Morgan M, Kenten C, Deedat S. Attitudes to deceased organ donation and registration as a donor among minority ethnic groups in North America and the U.K.: a synthesis of quantitative and qualitative research. ETHNICITY & HEALTH 2012; 18:367-390. [PMID: 23249284 DOI: 10.1080/13557858.2012.752073] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES A systematic review and synthesis of quantitative and qualitative research were undertaken to examine attitudes to deceased donation and registration as an organ donor among ethnic minorities in the U.K. and North America. DESIGN A systematic search and assessments of relevance and quality were conducted. Parallel syntheses were then undertaken of 14 quantitative and 12 qualitative papers followed by their integration. The synthesis was organised around five barriers that emerged as key issues: (1) knowledge regarding deceased donation and registration as a donor; (2) discussion of donation/registration with family members; (3) faith and cultural beliefs; (4) bodily concerns including disfigurement and intactness; and (5) trust in doctors and the health care system. RESULTS In all countries, knowledge of organ donation and registration remained low despite public campaigns, with African-Americans and Black African and Black Caribbean populations in the U.K. often regarding organ donation as a 'white' issue. Each of the four attitudinal barriers was also more prevalent among ethnic minorities compared with the majority population. However, the significance of trust and uncertainties regarding religion/faith differed between groups, reflecting salient aspects of ethnic identity and experiences. Differences were also identified within ethnic groups associated with age and generation, although respect for the views of elders often influenced younger peoples' willingness to donate. CONCLUSION There is a need for a more nuanced understanding of ethnicity and of variations in attitudes associated with country of origin, age/generation, socio-economic status and area of residence, to inform public campaigns and promote sensitive discussions with bereaved ethnic minority families. The traditional focus on knowledge and attitudes also requires to be complemented by a greater emphasis on organisational and service-related barriers and changes required to enhance ethnic minorities' access to registration as a donor and consent to deceased donation.
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Affiliation(s)
- Myfanwy Morgan
- Department of Primary Care and Public Health Sciences, King's College London, London, UK.
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Abstract
The Scottish National Blood Transfusion Service became the preferred provider of tissues in 2000. At that time, the only tissues procured were heart valves and some tendons from multiorgan donors. These sources and the range of tissues were not enough to provide for the clinical needs of Scottish patients. A systematic review was undertaken using the International Classification of Disease codes to assess what the potential pool of tissue donors would be by region, hospital and hospital department. Such data would enable us to focus our limited resources to maximize the yield of tissues to meet clinical demand. The data from this study were validated by a case-note audit in one hospital in Edinburgh. It was shown that the maximum tissue donor potential of approximately 48.5 per million population was in the central belt of Scotland in hospitals with large emergency medicine departments.
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Affiliation(s)
- G Galea
- SNBTS Tissues and Cells Directorate, Edinburgh, Scotland, UK
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Matesanz R, Coll E, Domínguez-Gil B, de la Rosa G, Marazuela R, Arráez V, Elorrieta P, Fernández-García A, Fernández-Renedo C, Galán J, Gómez-Marinero P, Martín-Delagebasala C, Martín-Jiménez S, Masnou N, Salamero P, Sánchez-Ibáñez J, Serna E, Martínez-Soba F, Pastor-Rodríguez A, Bouzas E, Castro P. Benchmarking in the process of donation after brain death: a methodology to identify best performer hospitals. Am J Transplant 2012; 12:2498-506. [PMID: 22682056 DOI: 10.1111/j.1600-6143.2012.04128.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A benchmarking approach was developed in Spain to identify and spread critical success factors in the process of donation after brain death. This paper describes the methodology to identify the best performer hospitals in the period 2003-2007 with 106 hospitals throughout the country participating in the project. The process of donation after brain death was structured into three phases: referral of possible donors after brain death (DBD) to critical care units (CCUs) from outside units, management of possible DBDs within the CCUs and obtaining consent for organ donation. Indicators to assess performance in each phase were constructed and the factors influencing these indicators were studied to ensure that comparable groups of hospitals could be established. Availability of neurosurgery and CCU resources had a positive impact on the referral of possible DBDs to CCUs and those hospitals with fewer annual potential DBDs more frequently achieved 100% consent rates. Hospitals were grouped into each subprocess according to influencing factors. Hospitals with the best results were identified for each phase and hospital group. The subsequent study of their practices will lead to the identification of critical factors for success, which implemented in an adapted way should fortunately lead to increasing organ availability.
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Affiliation(s)
- R Matesanz
- Organización Nacional de Trasplantes, Madrid, Spain.
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de la Rosa G, Domínguez-Gil B, Matesanz R, Ramón S, Alonso-Álvarez J, Araiz J, Choperena G, Cortés JL, Daga D, Elizalde J, Escudero D, Escudero E, Fernández-Renedo C, Frutos MA, Galán J, Getino MA, Guerrero F, Lara M, López-Sánchez L, Macías S, Martínez-Guillén J, Masnou N, Pedraza S, Pont T, Sánchez-Rodríguez A. Continuously evaluating performance in deceased donation: the Spanish quality assurance program. Am J Transplant 2012; 12:2507-13. [PMID: 22703439 DOI: 10.1111/j.1600-6143.2012.04138.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The Spanish Quality Assurance Program applied to the process of donation after brain death entails an internal stage consisting of a continuous clinical chart review of deaths in critical care units (CCUs) performed by transplant coordinators and periodical external audits to selected centers. This paper describes the methodology and provides the most relevant results of this program, with information analyzed from 206,345 CCU deaths. According to the internal audit, 2.3% of hospital deaths and 12.4% of CCU deaths in Spain yield potential donors (clinical criteria consistent with brain death). Out of the potential donors, 54.6% become actual donors, 26% are lost due to medical unsuitability, 13.3% due to refusals to donation, 3.1% due to maintenance problems and 3% due to other reasons. Although the national pool of potential donors after brain death has progressively decreased from 65.2 per million population (pmp) in 2001 to 49 pmp in 2010, the number of actual donors after brain death has remained at about 30 pmp. External audits reveal that the number of actual donors could be 21.6% higher if all potential donors were identified and preventable losses avoided. We encourage other countries to develop similar comprehensive approaches to deceased donation performance.
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Affiliation(s)
- G de la Rosa
- Organización Nacional de Trasplantes, Madrid, Spain.
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Tellett L, Pyle L, Coombs M. End of life in intensive care: Is transfer home an alternative? Intensive Crit Care Nurs 2012; 28:234-41. [DOI: 10.1016/j.iccn.2012.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 01/10/2012] [Accepted: 01/20/2012] [Indexed: 11/17/2022]
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Jansen NE, de Groot YJ, van Leiden HA, Haase-Kromwijk BJJM, Kompanje EJO, Hoitsma AJ. Imprecise definitions of starting points in retrospectively reviewing potential organ donors causes confusion: call for a reproducible method like ‘imminent brain death’. Transpl Int 2012; 25:830-7. [DOI: 10.1111/j.1432-2277.2012.01505.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stel VS, Kramar R, Leivestad T, Hoitsma AJ, Metcalfe W, Smits JM, Ravani P, Jager KJ. Time trend in access to the waiting list and renal transplantation: a comparison of four European countries. Nephrol Dial Transplant 2012; 27:3621-31. [PMID: 22555254 DOI: 10.1093/ndt/gfs089] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To examine the time trend and international differences in access to the waiting list and renal transplantation of patients with end-stage kidney disease. METHODS We included all patients (n = 30 961) from Austria, Norway, the Netherlands and Scotland who started renal replacement therapy (RRT) between 1995 and 2003 with their kidney transplant waiting list data (until 31 December 2005) and follow-up data on RRT and mortality (until 31 December 2007). The outcome measure was access to the waiting list within 2 years and to a first renal transplant within 4 years from the start of RRT, expressed as incidence per million age-related population (p.m.a.r.p.) per year. To estimate trends over time, mean percentage annual change (MPAC) and 95% confidence interval (CI) were calculated. RESULTS In each country, the number of patients starting RRT > 65 years increased significantly over time, whereas the number of renal transplants did not increase to the same extent. Only in Norway were almost all patients on the waiting list transplanted within 4 years of RRT start if they were < 65 years. In patients who started RRT > 65 years, the access to renal transplantation was high in Norway (49 p.m.a.r.p.) and low in Austria ( < 26 p.m.a.r.p.), the Netherlands and Scotland (both < 10 p.m.a.r.p.) but increased significantly in Austria (MPAC = 9.8%; 95% CI = 3.9-16.9) and the Netherlands (MPAC = 9.0%; 95% CI = 3.2-15.0). CONCLUSION Only in Norway, virtually all patients on the waiting list < 65 years received a transplant within 4 years after the start of RRT and, remarkably, also most of those > 65 years of age.
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Affiliation(s)
- Vianda S Stel
- ERA–EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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