1
|
Siminoff LA, Alolod GP, Wilson-Genderson M, Yuen EYN, Traino HM. A Comparison of Request Process and Outcomes in Donation After Cardiac Death and Donation After Brain Death: Results From a National Study. Am J Transplant 2017; 17:1278-1285. [PMID: 27753206 PMCID: PMC5395358 DOI: 10.1111/ajt.14084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/22/2016] [Accepted: 10/08/2016] [Indexed: 01/25/2023]
Abstract
Available literature points to healthcare providers' discomfort with donation after cardiac death (DCD) and their perception of public reluctance toward the procedure. Using a national sample, we report on the communication content of actual DCD and donation after brain death (DBD) approaches by organ procurement organization (OPO) requesters and compare family decision makers' (FDMs') experiences of both modalities. We recruited 1601 FDMs using a validated protocol; 347 (21.7%) were of potential DCD donors. Semistructured telephone interviews yielded FDMs' sociodemographic data, donation attitudes, assessment of approach, final outcomes, and substantiating reasons. Initial analysis consisted of bivariate analyses. Multilevel mixture models compared groups representing authorization outcome and DCD/DBD status. No significant differences in family authorization were found between DCD and DBD cases. Statistically significant associations were found between sociodemographic characteristics and authorization, with white FDMs more likely to authorize DCD or DBD than black FDMs. FDMs of both modalities had similar evaluations of requester skills, topics discussed, satisfaction, and refusal reasons. The findings suggest that the DCD/DBD distinction may not be notable to families. We recommend the use of similar approach strategies and communication skills and the development of education campaigns about the public's acceptance of DCD.
Collapse
Affiliation(s)
- L A Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - G P Alolod
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - M Wilson-Genderson
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - E Y N Yuen
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - H M Traino
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| |
Collapse
|
2
|
|
3
|
Prommer E. Organ Donation and Palliative Care: Can Palliative Care Make a Difference? J Palliat Med 2014; 17:368-71. [DOI: 10.1089/jpm.2013.0375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eric Prommer
- Division of Hematology/Oncology, Mayo Clinic College of Medicine, Scottsdale, Arizona
| |
Collapse
|
4
|
Asad AL, Anteby M, Garip F. Who donates their bodies to science? The combined role of gender and migration status among California whole-body donors. Soc Sci Med 2014; 106:53-8. [PMID: 24534732 DOI: 10.1016/j.socscimed.2014.01.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 01/16/2014] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
The number of human cadavers available for medical research and training, as well as organ transplantation, is limited. Researchers disagree about how to increase the number of whole-body bequeathals, citing a shortage of donations from the one group perceived as most likely to donate from attitudinal survey data - educated white males over 65. This focus on survey data, however, suffers from two main limitations: First, it reveals little about individuals' actual registration or donation behavior. Second, past studies' reliance on average survey measures may have concealed variation within the donor population. To address these shortcomings, we employ cluster analysis on all whole-body donors' data from the Universities of California at Davis, Irvine, Los Angeles, and San Francisco. Two donor groups emerge from the analyses: One is made of slightly younger, educated, married individuals, an overwhelming portion of whom are U.S.-born and have U.S.-born parents, while the second includes mostly older, separated women with some college education, a relatively higher share of whom are foreign-born and have foreign-born parents. Our results demonstrate the presence of additional donor groups within and beyond the group of educated and elderly white males previously assumed to be most likely to donate. More broadly, our results suggest how the intersectional nature of donors' demographics - in particular, gender and migration status - shapes the configuration of the donor pool, signaling new ways to possibly increase donations.
Collapse
Affiliation(s)
- Asad L Asad
- Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
| | - Michel Anteby
- Organizational Behavior Area, Harvard Business School, Harvard University, Morgan Hall 321, Boston, MA 02163, USA.
| | - Filiz Garip
- Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, MA 02138, USA.
| |
Collapse
|
5
|
Stiegler P, Sereinigg M, Puntschart A, Seifert-Held T, Zmugg G, Wiederstein-Grasser I, Marte W, Meinitzer A, Stojakovic T, Zink M, Stadlbauer V, Tscheliessnigg K. A 10min "no-touch" time - is it enough in DCD? A DCD animal study. Transpl Int 2012; 25:481-92. [PMID: 22348340 DOI: 10.1111/j.1432-2277.2012.01437.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Donation after cardiac death (DCD) is under investigation because of the lack of human donor organs. Required times of cardiac arrest vary between 75s and 27min until the declaration of the patients' death worldwide. The aim of this study was to investigate brain death in pigs after different times of cardiac arrest with subsequent cardiopulmonary resuscitation (CPR) as a DCD paradigm. DCD was simulated in 20 pigs after direct electrical induction of ventricular fibrillation. The "no-touch" time varied from 2min up to 10min; then 30min of CPR were performed. Brain death was determined by established clinical and electrophysiological criteria. In all animals with cardiac arrest of at least 6min, a persistent loss of brainstem reflexes and no reappearance of bioelectric brain activity occurred. Reappearance of EEG activity was found until 4.5min of cardiac arrest and subsequent CPR. Brainstem reflexes were detectable until 5min of cardiac arrest and subsequent CPR. According to our experiments, the suggestion of 10min of cardiac arrest being equivalent to brain death exceeds the minimum time after which clinical and electrophysiological criteria of brain death are fulfilled. Therefore shorter "no-touch" times might be ethically acceptable to reduce warm ischemia time.
Collapse
Affiliation(s)
- Philipp Stiegler
- Department of Transplantation Surgery, Medical University of Graz, Graz, Austria
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Song HG, Young Kwon J, Soo Han H, Bae YC, Moon C. First Contact to Odors: Our Current Knowledge about Odorant Receptor. SENSORS 2008; 8:6303-6320. [PMID: 27873871 PMCID: PMC3707451 DOI: 10.3390/s8106303] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 10/07/2008] [Accepted: 10/08/2008] [Indexed: 11/16/2022]
Abstract
Chemical senses – especially smell – are known to be important for the fundamental life events such as sensing predators, selecting mates, as well as finding food. The chemical senses are decoded in the olfactory system which is able to detect and differentiate thousands of odorous substances comprised of chemically divergent structures (i.e. odorants). The high selectivity of the olfactory system is heavily dependent on the receptors for each odorants (i.e. odorant receptors). Thus, studying odorant receptors may not only facilitate our understanding the initial events of olfaction but provide crucial knowledge for developing a novel, odorant receptor-based biosensor for chemical screening. Here we provide a review of recent advances in our understanding of odorant receptors.
Collapse
Affiliation(s)
- Hyoung-Gon Song
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Young Kwon
- Department of Biological Science, Sungkyunkwan University, Suwon, Republic of Korea
| | - Hyung Soo Han
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Brain Science & Engineering Institute, Kyungpook National University, Daegu, Republic of Korea
| | - Yong-Chul Bae
- Department of Oral Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
- Brain Science & Engineering Institute, Kyungpook National University, Daegu, Republic of Korea
| | - Cheil Moon
- Department of Oral Anatomy and Neurobiology, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea.
- Brain Science & Engineering Institute, Kyungpook National University, Daegu, Republic of Korea.
| |
Collapse
|
7
|
The role of bile salt toxicity in the pathogenesis of bile duct injury after non-heart-beating porcine liver transplantation. Transplantation 2008; 85:1625-31. [PMID: 18551070 DOI: 10.1097/tp.0b013e318170f5f7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intrahepatic bile duct strictures are a serious complication after non-heart-beating (NHB) liver transplantation. Bile salt toxicity has been identified as an important factor in the pathogenesis of bile duct injury and cholangiopathies. The role of bile salt toxicity in the development of biliary strictures after NHB liver transplantation is unclear. METHODS In a porcine model of NHB liver transplantation, we studied the effect of different periods of warm ischemia in the donor on bile composition and subsequent bile duct injury after transplantation. After induction of cardiac arrest in the donor, liver procurement was delayed for 0 min (group A), 15 min (group B), or more or equal to 30 min (group C). Livers were subsequently transplanted after 4 hr of cold preservation. In the recipients, bile flow was measured, and bile samples were collected daily to determine the bile salt-to-phospholipid ratio. Severity of bile duct injury was semiquantified by using a histologic grading scale. RESULTS Posttransplantation survival was directly related to the duration of warm ischemia in the donor. The bile salt-to-phospholipid ratio in bile produced early after transplantation was significantly higher in group C, compared with group A and B. Histopathologic condition showed the highest degree of bile duct injury in group C. CONCLUSION Prolonged warm ischemia in NHB donors is associated with the formation of toxic bile after transplantation, with a high biliary bile salt-to-phospholipid ratio. These data suggest that bile salt toxicity contributes to the pathogenesis of bile duct injury after NHB liver transplantation.
Collapse
|
8
|
Understanding the antecedents of the acceptance of donation after cardiac death by healthcare professionals. Crit Care Med 2008; 36:1075-81. [PMID: 18379230 DOI: 10.1097/ccm.0b013e3181691b2b] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A 3-yr study funded by the U.S. Department of Health and Human Services was conducted to identify potential barriers to and opportunities for increasing the number hospitals with donation after cardiac death (DCD) protocols, the support of DCD by individuals involved in the donation request process, and the number DCD donors recovered. This study reports the qualitative findings. DESIGN Methods used included an advisory committee and an extensive array of key informant interviews and focus groups. SETTING Hospitals and telephone contact. SUBJECTS Discussions with nurses, physicians, social service staff, clergy, administrators, and organ procurement organization staff. A total of 216 people participated. INTERVENTIONS Collection and analysis of information regarding perceptions of DCD, potential barriers and opportunities, and strategies for gaining support. MEASUREMENT AND MAIN RESULTS Key barriers included a lack of knowledge about DCD, psychological barriers for DCD vs. brain death, concerns about whether death has been reached, saving vs. killing patients, trust in the organ procurement organization, moving from saving patients to being a donation advocate, and concerns with the DCD process. Opportunities included education initiatives, well-trained requesters, a cultural shift, a consistent DCD protocol separating care from recovery, process monitoring, and a strong sense of teamwork. CONCLUSIONS Our findings provide a better understanding of healthcare professionals' knowledge, attitudes, and behaviors regarding DCD. Understanding these issues is critical to the implementation of strategic plans for DCD programs. One of the biggest barriers to overcome is a lack of knowledge of DCD, which leads to misperceptions, which in turn contribute to negative attitudes and/or discomfort by healthcare professionals. Communication efforts that are able to educate healthcare professionals and eliminate misperceptions will increase support for DCD. Key to future success requires confident and well-trained DCD requesters.
Collapse
|
9
|
Ethics in Transplantation: Allotransplantation and Xenotransplantation. KIDNEY TRANSPLANTATION 2008. [PMCID: PMC7152151 DOI: 10.1016/b978-1-4160-3343-1.50043-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
10
|
Kelso CM, Lyckholm LJ, Coyne PJ, Smith TJ. Palliative Care Consultation in the Process of Organ Donation after Cardiac Death. J Palliat Med 2007; 10:118-26. [PMID: 17298260 DOI: 10.1089/jpm.2006.0118] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Palliative care consultation has been demonstrated to be useful in many situations in which expert symptom management, communication around sensitive issues, and family support may serve to enhance or improve care. The process of organ donation is an example of this concept, specifically the process of donation after cardiac death (DCD). DCD allows patients with severe, irreversible brain injuries that do not meet standard criteria for brain death to donate organs when death is declared by cardiopulmonary criteria. The DCD method of donation has been deemed an ethically appropriate means of organ donation and is supported by the organ procurement and medical communities, as well as the public. The palliative care (PC) team can make a significant contribution to the care of the patient and family in the organ donation process. In this paper we describe the controlled DCD process at one institution that utilizes the PC team to provide expert end-of-life care, including comprehensive medical management and family support. PC skills and principles applicable to the DCD process include communication, coordination of care, and skillful ventilator withdrawal. If death occurs within 90 minutes of withdrawal of life support, organs may be successfully recovered for transplantation. If the patient survives longer than 90 minutes, his or her care continues to be provided by the PC team. Palliative care can contribute to standardizing quality end-of-life care practices in the DCD process and provide education for involved personnel. Further experience, research and national discussions will be helpful in refining these practices, to make this difficult and challenging experience as gentle and supportive as possible for the courageous families who participate in this process.
Collapse
Affiliation(s)
- Catherine McVearry Kelso
- Department of Internal Medicine, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA 23298, USA
| | | | | | | |
Collapse
|
11
|
Shemie SD, Baker AJ, Knoll G, Wall W, Rocker G, Howes D, Davidson J, Pagliarello J, Chambers-Evans J, Cockfield S, Farrell C, Glannon W, Gourlay W, Grant D, Langevin S, Wheelock B, Young K, Dossetor J. National recommendations for donation after cardiocirculatory death in Canada: Donation after cardiocirculatory death in Canada. CMAJ 2006; 175:S1. [PMID: 17124739 PMCID: PMC1635157 DOI: 10.1503/cmaj.060895] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
These recommendations are the result of a national, multidisciplinary, year-long process to discuss whether and how to proceed with organ donation after cardiocirculatory death (DCD) in Canada. A national forum was held in February 2005 to discuss and develop recommendations on the principles, procedures and practice related to DCD, including ethical and legal considerations. At the forum's conclusion, a strong majority of participants supported proceeding with DCD programs in Canada. The forum also recognized the need to formulate and emphasize core values to guide the development of programs and protocols based on the medical, ethical and legal framework established at this meeting. Although end-of-life care should routinely include the opportunity to donate organs and tissues, the duty of care toward dying patients and their families remains the dominant priority of health care teams. The complexity and profound implications of death are recognized and should be respected, along with differing personal, ethnocultural and religious perspectives on death and donation. Decisions around withdrawal of life-sustaining therapies, management of the dying process and the determination of death by cardiocirculatory criteria should be separate from and independent of donation and transplant processes. The recommendations in this report are intended to guide individual programs, regional health authorities and jurisdictions in the development of DCD protocols. Programs will develop based on local leadership and advance planning that includes education and engagement of stakeholders, mechanisms to assure safety and quality and public information. We recommend that programs begin with controlled DCD within the intensive care unit where (after a consensual decision to withdraw life-sustaining therapy) death is anticipated, but has not yet occurred, and unhurried consent discussions can be held. Uncontrolled donation (where death has occurred after unanticipated cardiac arrest) should only be considered after a controlled DCD program is well established. Although we recommend that programs commence with kidney donation, regional transplant expertise may guide the inclusion of other organs. The impact of DCD, including pre-and post-mortem interventions, on donor family experiences, organ availability, graft function and recipient survival should be carefully documented and studied.
Collapse
Affiliation(s)
- Sam D Shemie
- Division of Pediatric Critical Care, Montreal Children's Hospital, McGill University Health Centre, Montréal, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Deveaux TE. Non-heart-beating organ donation: Issues and ethics for the critical care nurse. JOURNAL OF VASCULAR NURSING 2006; 24:17-21. [PMID: 16504847 DOI: 10.1016/j.jvn.2005.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 11/14/2005] [Accepted: 11/14/2005] [Indexed: 10/25/2022]
Abstract
Non-heart-beating organ donation is an important topic that continues to be misunderstood by many health care professionals. As organ transplantation has become an accepted mode of treatment for end-stage organ failure, the need for organs has increased. Non-heart-beating organ donation provides an option for families wishing to donate when their loved one does not meet brain death criteria. The author will review the history of organ donation, focusing on the process of non-heart-beating organ donation. A patient case study is presented to facilitate understanding of the critical care nursing role essential to the success of this process that can provide a positive outcome for families involved in very tragic situations.
Collapse
Affiliation(s)
- Theresa E Deveaux
- Maryland Vascular Center, Baltimore Washington Medical Center, Glen Burnie, Maryland 21061, USA
| |
Collapse
|