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van Overdijk PAH, Grossi AA, van Delft CH, Jansen NE, van den Hoogen MWF, Paredes-Zapata D. Disparities in kidney transplantation accessibility among immigrant populations in Europe: A systematic review and meta-analysis. Transplant Rev (Orlando) 2024; 38:100814. [PMID: 38065001 DOI: 10.1016/j.trre.2023.100814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/25/2023] [Accepted: 11/26/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Disparities in access to healthcare for patients with an immigration background are well-known. The aim of this study was to determine whether disparities among immigrant populations translate into a relative difference in the number of kidney transplants (KT) performed in documented immigrant patients (first and second generation) relative to native-born patients in Europe. METHODS A literature search was performed in PubMed from inception to 11-10-2022. Studies were eligible if: (1) written in English, (2) included immigrant and native-born KT patients, (3) performed in countries registered as Council of Europe members, (4) focused on documented first- and second-generation immigrant populations [1]. Systematic reviews, literature reviews, and case reports or articles about emigration, non-KT, and undocumented immigrants were excluded. The outcome measurement was a relative percentage of KTs to the total population per 100.000 residents. By dividing the immigrant percentages by the native-born resident percentages, the odds ratio (OR) was calculated in a meta-analysis. The risk of bias was assessed; articles with high risk of bias were excluded in a second meta-analysis. RESULTS Out of 109 articles, 5 were included (n = 24,614). One Italian study (n = 24,174) had a ratio below 1, being 0.910 (95%CI 0.877-0.945). The other four articles (n = 196, n = 283, n = 77, n = 119) had ratios above 1: 1.36 (95%CI 0.980-1.87), 2.04 (95%CI 1.56-2.68), 2.23 (95%CI 1.53-3.25) and 2.64 (95%CI 1.68-4.15). After performing a meta-analysis, the OR did not show a significant difference: 1.68 (95%CI 1.03-2.75). After bias correction, this remained unchanged: 1.78 (95%CI 0.961-3.31). CONCLUSIONS In our meta-analysis we did not find a significant difference in the relative number of KTs performed in immigrant versus native-born populations in Europe. However, a lesser likelihood for immigrants to receive a pre-emptive kidney transplantation was found. Large heterogeneity between studies (e.g. different sample size, patient origins, study duration, adult vs children patients) was a shortcoming to our analysis. Nevertheless, our article is the first review in this understudied topic. As important questions (e.g. on ethnicity, living donor rate) remain, future studies are needed to address them.
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Affiliation(s)
- Pieter A H van Overdijk
- Bachelor Student Technical Medicine, Erasmus MC, PO Box 2040, Rotterdam 3000 CA, the Netherlands.
| | - Alessandra A Grossi
- Department of Human Sciences, Innovations and Territory, University of Insubria, Via O. Rossi 9, Varese 21100, Italy; Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Via O. Rossi 9, 21100 Varese, Italy
| | - Céline H van Delft
- Bachelor Student in Medicine, Erasmus MC, PO Box 2040, Rotterdam 3000 CA, the Netherlands
| | - Nichon E Jansen
- Senior Policy Advisor, Senior Researcher, Dutch Transplant Foundation, Postbus 2304, Leiden 2301 CH, the Netherlands
| | - Martijn W F van den Hoogen
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center Rotterdam, PO BOX 2040, Rotterdam 3000 CA, the Netherlands
| | - David Paredes-Zapata
- Consultant, Nephrologist, Donation and Transplant Coordination Section, Hospital Clinic, Associate Professor University of Barcelona, Surgical Department, C. de Villarroel, Barcelona 170 08036, Spain
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2
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Kotsopoulos AM, Jansen NE, Vos P, Witjes M, Volbeda M, Epker JL, Sonneveld HPC, Simons KS, Bronkhorst EM, van der Hoeven HG, Abdo WF. Determining the impact of timing and of clinical factors during end-of-life decision-making in potential controlled donation after circulatory death donors. Am J Transplant 2020; 20:3574-3581. [PMID: 32506559 PMCID: PMC7754148 DOI: 10.1111/ajt.16104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/05/2020] [Accepted: 05/23/2020] [Indexed: 01/25/2023]
Abstract
Controlled donation after circulatory death (cDCD) occurs after a decision to withdraw life-sustaining treatment and subsequent family approach and approval for donation. We currently lack data on factors that impact the decision-making process on withdraw life-sustaining treatment and whether time from admission to family approach, influences family consent rates. Such insights could be important in improving the clinical practice of potential cDCD donors. In a prospective multicenter observational study, we evaluated the impact of timing and of the clinical factors during the end-of-life decision-making process in potential cDCD donors. Characteristics and medication use of 409 potential cDCD donors admitted to the intensive care units (ICUs) were assessed. End-of-life decision-making was made after a mean time of 97 hours after ICU admission and mostly during the day. Intracranial hemorrhage or ischemic stroke and a high APACHE IV score were associated with a short decision-making process. Preserved brainstem reflexes, high Glasgow Coma Scale scores, or cerebral infections were associated with longer time to decision-making. Our data also suggest that the organ donation request could be made shortly after the decision to stop active treatment and consent rates were not influenced by daytime or nighttime or by the duration of the ICU stay.
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Affiliation(s)
- Angela M. Kotsopoulos
- Department of Intensive Care MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Piet Vos
- Department of Intensive CareElisabeth TweeSteden HospitalTilburgThe Netherlands
| | - Marloes Witjes
- Department of Intensive Care MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Meint Volbeda
- Department of Intensive Care MedicineUMCG University Medical CenterGroningenThe Netherlands
| | - Jelle L. Epker
- Department of Intensive Care MedicineErasmus University Medical CenterRotterdamThe Netherlands
| | | | - Koen S. Simons
- Department of Intensive Care MedicineJeroen Bosch HospitalDen BoschThe Netherlands
| | - Ewald M. Bronkhorst
- Department of Health EvidenceRadboud University Medical CenterNijmegenThe Netherlands
| | - Hans G. van der Hoeven
- Department of Intensive Care MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Wilson F. Abdo
- Department of Intensive Care MedicineRadboud University Medical CenterNijmegenThe Netherlands
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3
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Kotsopoulos AMM, Vos P, Jansen NE, Bronkhorst EM, van der Hoeven JG, Abdo WF. Prediction Model for Timing of Death in Potential Donors After Circulatory Death (DCD III): Protocol for a Multicenter Prospective Observational Cohort Study. JMIR Res Protoc 2020; 9:e16733. [PMID: 32459638 PMCID: PMC7380979 DOI: 10.2196/16733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background Controlled donation after circulatory death (cDCD) is a major source of organs for transplantation. A potential cDCD donor poses considerable challenges in terms of identification of those dying within the predefined time frame of warm ischemia after withdrawal of life-sustaining treatment (WLST) to circulatory arrest. Several attempts have been made to develop models predicting the time between treatment withdrawal and circulatory arrest. This time window determines whether organ donation can occur and influences the quality of the donated organs. However, the selected patients used for these models were not always restricted to potential cDCD donors (eg, patients with cancer or severe infections were also included). This severely limits the generalizability of those data. Objective The objectives of this study are the following: (1) to develop a model predicting time to death within 60 minutes in potential cDCD patients; (2) to validate and update previous prediction models on time to death after WLST; (3) to determine timing and patient characteristics that are associated with prognostication and the decision-making process that leads to initiating end-of-life care; (4) to evaluate the impact of timing of family approach on organ donation approval; and (5) to assess the influence of variation in WLST processes on postmortem organ donor potential and actual postmortem organ donors. Methods In this multicenter observational prospective cohort study, all patients admitted to the intensive care unit of 3 university hospitals and 3 teaching hospitals who met the criteria of the cDCD protocol as defined by the Dutch Transplant Foundation were included. The target of enrolment was set to 400 patients. Previously developed models will be refitted in our data set. To further update previous prediction models, we will apply least absolute shrinkage and selection operator (LASSO) as a tool for efficient variable selection to develop the multivariable logistic regression model. Results This protocol was funded in August 2014 by the Dutch Transplant Foundation. We expect to have the results of this study in July 2020. Patient enrolment was completed in July 2018 and data collection was completed in April 2020. Conclusions This study will provide a robust multimodal prediction model, based on clinical and physiological parameters, that can predict time to circulatory arrest in cDCD donors. In addition, it will add valuable insight in the process of WLST in cDCD donors and will fill an important knowledge gap in this essential field of health care. Trial Registration ClinicalTrials.gov NCT04123275; https://clinicaltrials.gov/ct2/show/NCT04123275 International Registered Report Identifier (IRRID) DERR1-10.2196/16733
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Affiliation(s)
| | - Piet Vos
- Department of Intensive Care, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
| | | | - Ewald M Bronkhorst
- Department of Health Evidence, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, Netherlands
| | | | - Wilson F Abdo
- Department of Intensive Care, Radboudumc, Nijmegen, Netherlands
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4
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Witjes M, Jansen NE, van Dongen J, Herold IHF, Otterspoor L, Haase-Kromwijk BJJM, van der Hoeven JG, Abdo WF. Appointing nurses trained in organ donation to improve family consent rates. Nurs Crit Care 2019; 25:299-304. [PMID: 31294520 PMCID: PMC7507830 DOI: 10.1111/nicc.12462] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022]
Abstract
Background One of the most important bottlenecks in the organ donation process worldwide is the high family refusal rate. Aims and objectives The main aim of this study was to examine whether family guidance by trained donation practitioners increased the family consent rate for organ donation. Design This was a prospective intervention study. Methods Intensive and coronary care unit nurses were trained in communication about donation (ie, trained donation practitioners) in two hospitals. The trained donation practitioners were appointed to guide the families of patients with a poor medical prognosis. When the patient became a potential donor, the trained donation practitioner was there to guide the family in making a well‐considered decision about donation. We compared the family consent rate for donation with and without the guidance of a trained donation practitioner. Results The consent rate for donation with guidance by a trained donation practitioner was 58.8% (20/34), while the consent rate without guidance by a trained donation practitioner was 41.4% (41/99, P = 0.110) in those patients where the family had to decide on organ donation. Conclusions Our data suggest that family guidance by a trained donation practitioner could benefit consent rates for organ donation. Relevance to clinical practice Trained nurses play an important role in supporting the families of patients who became potential donors to guide them through the decision‐making process after organ donation request.
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Affiliation(s)
- Marloes Witjes
- Dutch Transplant Foundation, Leiden, The Netherlands.,Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jacqueline van Dongen
- Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Ingeborg H F Herold
- Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Luuk Otterspoor
- Department of Intensive Care Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Wilson F Abdo
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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5
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Witjes M, Jansen NE, van der Hoeven JG, Abdo WF. Interventions aimed at healthcare professionals to increase the number of organ donors: a systematic review. Crit Care 2019; 23:227. [PMID: 31221214 PMCID: PMC6587298 DOI: 10.1186/s13054-019-2509-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background The last decade, there have been many initiatives worldwide to increase the number of organ donors. However, it is not clear which initiatives are most effective. The aim of this study is to provide an overview of interventions aimed at healthcare professionals in order to increase the number of organ donors. Methods We systematically searched PubMed, EMBASE, CINAHL, PsycINFO, and the Cochrane Library for English language studies published until April 24, 2019. We included studies describing interventions in hospitals aimed at healthcare professionals who are involved in the identification, referral, and care of a family of potential organ donors. After the title abstract and full-text selection, two reviewers independently assessed each study’s quality and extracted data. Results From the 18,854 records initially extracted from five databases, we included 22 studies in our review. Of these 22 studies, 14 showed statistically significant effects on identification rate, family consent rate, and/or donation rate. Interventions that positively influenced one or more of these outcomes were training of emergency personnel in organ donation, an electronic support system to identify and/or refer potential donors, a collaborative care pathway, donation request by a trained professional, and additional family support in the ICU by a trained nurse. The methodological quality of the studies was relatively low, mainly because of the study designs. Conclusions Although there is paucity of data, collaborative care pathways, training of healthcare professionals and additional support for relatives of potential donors seem to be promising interventions to increase the number of organ donors. Trial registration PROSPERO, CRD42018068185 Electronic supplementary material The online version of this article (10.1186/s13054-019-2509-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marloes Witjes
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands.,Dutch Transplant Foundation, Leiden, The Netherlands
| | | | - Johannes G van der Hoeven
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands
| | - Wilson F Abdo
- Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, Internal post 710, 6500 HB, Nijmegen, The Netherlands.
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6
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Vorstius Kruijff PE, Witjes M, Jansen NE, Slappendel R. Barriers to Registration in the National Donor Registry in Nations Using the Opt-In System: A Review of the Literature. Transplant Proc 2018; 50:2997-3009. [PMID: 30577159 DOI: 10.1016/j.transproceed.2018.01.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/23/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND To increase the number of postmortem organ and tissue donors, donor registries (DRs) have been introduced. The aim of this review was to understand why people in nations with an Opt-in system, who are for or against donation after death, do not register in the DR. Knowing these barriers will help in developing policies to increase the registration rate in the DR. METHODS For this review, 2 authors independently assessed the eligibility of the identified studies from 2000 to 2015 in the Pubmed- Medline database. Included were observational and interventional studies concerned with reported barriers to residents joining the national DR in Denmark, The Netherlands, and the United Kingdom. RESULTS We included 15 relevant articles for the review. The main barriers to signing the DR in nations using the Opt-in system were: religion; medical mistrust, anxiety, and affective emotions; lack of information; concern about insufficient time to mourn, and that the funeral may be delayed and the deceased not look presentable; physical integrity; ignorance about how to register in the DR; own benefit; and social status. CONCLUSIONS The outcome suggests that the main barriers to enrolling in the DR are based on people's doubts about their own ability to perform the registration and cope with the consequences, knowledge, outcome expectations, and concerns about what others will think of them for agreeing to donation. However, not all barriers are easily modifiable, owing to their association with affect or emotions.
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Affiliation(s)
- P E Vorstius Kruijff
- Department of Quality and Safety, Amphia Teaching Hospital, Breda, The Netherlands.
| | - M Witjes
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Organ Procurement, Dutch Transplant Foundation, Leiden, The Netherlands
| | - N E Jansen
- Department of Organ Procurement, Dutch Transplant Foundation, Leiden, The Netherlands
| | - R Slappendel
- Department of Anesthesia, University of Antwerp, Antwerpen, Belgium
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7
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Ismail SY, Kums E, Mahmood SK, Hoitsma AJ, Jansen NE. Increasing Consent and Assent Rate for Organ and Tissue Donation: Communication About Donation-Telephone Advice by Psychologist. Transplant Proc 2018; 50:3017-3024. [PMID: 30577161 DOI: 10.1016/j.transproceed.2018.06.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/27/2018] [Indexed: 11/18/2022]
Abstract
A high percentage of family refusal is found for several outcomes in the Donor Register. Misconceptions and concerns regarding donation impede next of kin from making a well-considered decision. The donation request is the moment in which such concerns should be addressed by the requestor. The Communication about Donation-Telephone Advice by Psychologist (CaD-TAP) is a direct telephone intervention for requestors who are about to request the relatives for donation. The aim of this intervention is to improve requestors' communication skills regarding the donation request and thereby increase the consent rate for organ and/or tissue donation. The intervention started on the April 1, 2014, and lasted until December 31, 2014. To determine the effects, the consent and assent rates were compared between requestors who received the CaD-TAP intervention and those who did not. The requestors who received the CaD-TAP intervention (N = 141) had a significantly (P < .001) higher consent rate (58%) compared with the group who did not receive the intervention (N = 1563, consent rate: 34%). More tissue donor requestors received the intervention (74%) and most interventions took place outside office hours (82%). No significant difference was found in the effect of the intervention with regard to type of donation, time, or day. Furthermore, the intervention increased requestors' self-confidence in requesting for donation (P < .001), and a higher self-confidence indicated a significant association with increased consent rate. The intervention is unanimously experienced as positive and valuable by users. Based on these results the intervention is effective in increasing the consent rate for organ and tissue donation.
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Affiliation(s)
- S Y Ismail
- Erasmus Medical Center, Psychiatry-Medical Psychology and Psychotherapy, Rotterdam, The Netherlands.
| | - E Kums
- Dutch Transplant Foundation, Leiden, The Netherlands
| | - S K Mahmood
- Erasmus Medical Center, Psychiatry-Medical Psychology and Psychotherapy, Rotterdam, The Netherlands
| | - A J Hoitsma
- Dutch Transplant Foundation, Leiden, The Netherlands
| | - N E Jansen
- Dutch Transplant Foundation, Leiden, The Netherlands
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8
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Kotsopoulos AMM, Böing-Messing F, Jansen NE, Vos P, Abdo WF. External validation of prediction models for time to death in potential donors after circulatory death. Am J Transplant 2018; 18:890-896. [PMID: 28980398 DOI: 10.1111/ajt.14529] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/08/2017] [Accepted: 09/26/2017] [Indexed: 01/25/2023]
Abstract
Predicting time to death in controlled donation after circulatory death (cDCD) donors following withdrawal of life-sustaining treatment (WLST) is important but poses a major challenge. The aim of this study is to determine factors predicting time to circulatory death within 60 minutes after WSLT and validate previously developed prediction models. In a single-center retrospective study, we used the data of 92 potential cDCD donors. Multivariable regression analysis demonstrated that absent cough-, corneal reflex, lower morphine dosage, and midazolam use were significantly associated with death within 60 minutes (area under the curve [AUC] 0.89; 95% confidenence interval [CI] 0.87-0.91). External validation of the logistic regression models of de Groot et al (AUC 0.86; 95% CI 0.77-0.95), Wind et al (AUC 0.62; 95% CI 0.49-0.76), Davila et al (AUC 0.80; 95% CI 0.708-0.901) and the Cox regression model by Suntharalingam et al (Harrell's c-index 0.63), exhibited good discrimination and could fairly identify which patients died within 60 minutes. Previous prediction models did not incorporate the process of WLST. We believe that future studies should also include the process of WLST as an important predictor.
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Affiliation(s)
- A M M Kotsopoulos
- Department of Intensive Care Elisabeth Twee, Steden Hospital, Tilburg, The Netherlands
| | - F Böing-Messing
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - N E Jansen
- The Dutch Transplant Foundation, Leiden, The Netherlands
| | - P Vos
- Department of Intensive Care Elisabeth Twee, Steden Hospital, Tilburg, The Netherlands
| | - W F Abdo
- Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Witjes M, Kotsopoulos A, Herold IHF, Otterspoor L, Simons KS, van Vliet J, de Blauw M, Festen B, Eijkenboom JJA, Jansen NE, van der Hoeven JG, Abdo WF. The Influence of End-of-Life Care on Organ Donor Potential. Am J Transplant 2017; 17:1922-1927. [PMID: 28371278 DOI: 10.1111/ajt.14286] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/16/2017] [Accepted: 03/18/2017] [Indexed: 01/25/2023]
Abstract
Many patients with acute devastating brain injury die outside intensive care units and could go unrecognized as potential organ donors. We conducted a prospective observational study in seven hospitals in the Netherlands to define the number of unrecognized potential organ donors outside intensive care units, and to identify the effect that end-of-life care has on organ donor potential. Records of all patients who died between January 2013 and March 2014 were reviewed. Patients were included if they died within 72 h after hospital admission outside the intensive care unit due to devastating brain injury, and fulfilled the criteria for organ donation. Physicians of included patients were interviewed using a standardized questionnaire regarding logistics and medical decisions related to end-of-life care. Of the 5170 patients screened, we found 72 additional potential organ donors outside intensive care units. Initiation of end-of-life care in acute settings and lack of knowledge and experience in organ donation practices outside intensive care units can result in under-recognition of potential donors equivalent to 11-34% of the total pool of organ donors. Collaboration with the intensive care unit and adjusting the end-of-life path in these patients is required to increase the likelihood of organ donation.
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Affiliation(s)
- M Witjes
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands.,Dutch Transplant Foundation, Leiden, The Netherlands
| | - A Kotsopoulos
- Department of Intensive Care, St. Elisabeth hospital, Tilburg, The Netherlands
| | - I H F Herold
- Department of Intensive Care, Catharina hospital, Eindhoven, The Netherlands
| | - L Otterspoor
- Department of Intensive Care, Catharina hospital, Eindhoven, The Netherlands
| | - K S Simons
- Department of Intensive Care, Jeroen Bosch hospital, Den Bosch, The Netherlands
| | - J van Vliet
- Department of Intensive Care, Rijnstate hospital, Arnhem, The Netherlands
| | - M de Blauw
- Department of Intensive Care, Rijnstate hospital, Arnhem, The Netherlands
| | - B Festen
- Department of Intensive Care, Gelderse Vallei hospital, Ede, The Netherlands
| | - J J A Eijkenboom
- Department of Intensive Care, Maxima medical center, Veldhoven, The Netherlands
| | - N E Jansen
- Dutch Transplant Foundation, Leiden, The Netherlands
| | - J G van der Hoeven
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - W F Abdo
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
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Kuiper MA, Jansen NE. [Legislative amendment legitimises current organ donation practices]. Ned Tijdschr Geneeskd 2013; 157:A6456. [PMID: 24004928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
On 23rd April 2013, the Dutch Senate unanimously approved a proposal from Minister Schippers of the Ministry of Health for an amendment of the Organ Donation Act.
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jansen NE, van Leiden HA, Haase-Kromwijk BJJM, van der Meer NJM, Kruijff EV, van der Lely N, van Zon H, Meinders AJ, Mosselman M, Hoitsma AJ. Appointing 'trained donation practitioners' results in a higher family consent rate in the Netherlands: a multicenter study. Transpl Int 2011; 24:1189-97. [PMID: 21902727 DOI: 10.1111/j.1432-2277.2011.01326.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The consent process for organ and tissue donation is complex, both for families and professionals. To help professionals in broaching this subject we performed a multicenter study. We compared family consent to donation in three hospitals between December 2007 and December 2009. In the intervention hospital, trained donation practitioners (TDP) guided 66 families throughout the time in the ICU until a decision regarding donation had been reached. In the first control hospital, without any family guidance or training, 107 families were approached. In the second control hospital 'hostesses', who were not trained in donation questions, supported 99 families during admittance. A total of 272 families were requested to donate. We primarily compared consent rates, but also asked families about their experiences through a questionnaire. Family consent rate was significantly higher in the intervention hospital: 57.6% (38/66), than in the control hospitals: 34.6% (37/107) and 39.4% (39/99). The 69% response rate to the questionnaire -~5 months after death - showed no confounding variables that could have influenced the consent rate. Appointing TDPs in the intervention hospital to guide families during admittance and the donation decision-making process, results in higher family consent rates.
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de Groot YJ, Jansen NE, Bakker J, Kuiper MA, Aerdts S, Maas AIR, Wijdicks EFM, van Leiden HA, Hoitsma AJ, Kremer BHPH, Kompanje EJO. Imminent brain death: point of departure for potential heart-beating organ donor recognition. Intensive Care Med 2010; 36:1488-94. [PMID: 20232039 PMCID: PMC2921050 DOI: 10.1007/s00134-010-1848-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 01/15/2010] [Indexed: 01/09/2023]
Abstract
PURPOSE There is, in European countries that conduct medical chart review of intensive care unit (ICU) deaths, no consensus on uniform criteria for defining a potential organ donor. Although the term is increasingly being used in recent literature, it is seldom defined in detail. We searched for criteria for determination of imminent brain death, which can be seen as a precursor for organ donation. METHODS We organized meetings with representatives from the field of clinical neurology, neurotraumatology, intensive care medicine, transplantation medicine, clinical intensive care ethics, and organ procurement management. During these meetings, all possible criteria were discussed to identify a patient with a reasonable probability to become brain dead (imminent brain death). We focused on the practical usefulness of two validated coma scales (Glasgow Coma Scale and the FOUR Score), brain stem reflexes and respiration to define imminent brain death. Further we discussed criteria to determine irreversibility and futility in acute neurological conditions. RESULTS A patient who fulfills the definition of imminent brain death is a mechanically ventilated deeply comatose patient, admitted to an ICU, with irreversible catastrophic brain damage of known origin. A condition of imminent brain death requires either a Glasgow Coma Score of 3 and the progressive absence of at least three out of six brain stem reflexes or a FOUR score of E(0)M(0)B(0)R(0). CONCLUSION The definition of imminent brain death can be used as a point of departure for potential heart-beating organ donor recognition on the intensive care unit or retrospective medical chart analysis.
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Affiliation(s)
- Yorick J de Groot
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Jansen NE, Haase-Kromwijk BJJM, van Leiden HA, Weimar W, Hoitsma AJ. A plea for uniform European definitions for organ donor potential and family refusal rates. Transpl Int 2009; 22:1064-72. [DOI: 10.1111/j.1432-2277.2009.00930.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jansen NE, van Leiden HA, Sieber-Rasch MH, Hoitsma AJ, Haase-Kromwijk BJJM. [More potential organ donors than actual donations in 52 intensive-care units in the Netherlands, 2001-2004]. Ned Tijdschr Geneeskd 2007; 151:696-701. [PMID: 17447597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To assess the number of potential organ donors and the main reasons why organ donation is not performed. DESIGN Retrospective. METHOD The number of potential heart-beating (HB) and non-heart-beating (NHB) donors was assessed by reviewing the medical records of 588o patients who died between 2001 and 2004 in 52 intensive-care units (ICUs) in 30 hospitals. The number of actual donations was also assessed. RESULTS The potential of HB donors was 2.5 to possibly 6.6% of all ICU deaths and HB donation was performed in 1.9% of all ICU deaths. The potential of NHB donors of category III was at least 4.2% of all ICU deaths and NHB donation was performed in 1.0% of all ICU deaths. The main difficulty in the donation process was objection from family members, which was reported in 45% of all potential HB and NHB donors and in 59% of all donation requests to relatives. Of the potential HB and NHB donors 7.3% were not identified as potential donors. CONCLUSION These results confirm that organ-donor potential is greater than the number of actual donations. Objection from family members is the main limiting factor.
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Affiliation(s)
- N E Jansen
- Nederlandse Transplantatie Stichting, Postbus 2304, 2301 CH Leiden.
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van Stuijvenberg M, Jansen NE, Steyerberg EW, Derksen-Lubsen G, Moll HA. Frequency of fever episodes related to febrile seizure recurrence. Acta Paediatr 1999; 88:52-5. [PMID: 10090548 DOI: 10.1080/08035259950170600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The aim of this study was to assess the number of fever episodes as a risk factor for febrile seizure recurrence during the first 6 months after the last previous febrile seizure. In a 6-month follow-up study of 155 children, aged 3 months to 5 y, with a first or a recurrent febrile seizure, the occurrence of fever episodes and febrile seizure recurrences was prospectively documented. Using logistic regression analysis the association between the baseline characteristics and the number of fever episodes and the outcome, a febrile seizure recurrence, was studied. In total, 260 fever episodes were registered; 29 children experienced 1 or more febrile seizure recurrence during follow-up. Two factors were associated with febrile seizure recurrence: the number of fever episodes [odds ratio (OR)= 1.8; 95% confidence interval (CI): 1.4-2.4)] and age at study entry (OR=0.6; 95% CI: 0.3-1.1). In a multivariable model, only the number of fever episodes remained significant. In conclusion, the number of fever episodes increases the risk of a febrile seizure recurrence with a factor of 1.8 per fever episode in the first 6 months after a febrile seizure.
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Affiliation(s)
- M van Stuijvenberg
- Department of Paediatrics, Sophia Children's Hospital, Rotterdam, The Netherlands
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