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Cipolletta S, Tomaino SCM, Brena A, Di Ciaccio P, Gentile M, Procaccio F, Cardillo M. Life beyond life: Perceptions of post-mortem organ donation and consent to donate-A focus group study in Italy. Br J Health Psychol 2023; 28:1222-1240. [PMID: 37434302 DOI: 10.1111/bjhp.12681] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVES Many factors such as personal and cultural beliefs, misinformation, fear of death and inadequate will registering procedures can influence post-mortem organ donation. The present study aimed to explore the perceptions, beliefs and information around post-mortem donation and will expression in different groups of the Italian population, to orient future interventions and raise awareness. DESIGN Qualitative research with focus groups. METHODS A total of 38 focus groups involving 353 participants including the general population (young adults: 18-39, mature adults: 40-70), local and hospital health professionals, critical area health professionals (emergency room and intensive care), registry office employees and opinion leaders, were conducted in six regions from different parts of Italy between June and November 2021. Thematic analysis was conducted with the use of Atlas.ti9. RESULTS Five overarching themes were identified: dilemmas regarding donation, resistance to donation, facilitators of donation, difficulties in terms of will expression and proposals to encourage will expression. Possible facilitators were having personal and professional experiences with organ donation, feeling useful for society, having reliable information and trust in the health care system. Potential barriers to donation were doubts and fears about brain death, bodily integrity concerns, religious beliefs, misinformation and distrust in the health care system. CONCLUSIONS These results highlighted the significance of a bottom-up perspective with regard to identifying the personal perceptions and beliefs with regard to donation, underlining the urgency of creating tailored interventions to sensitize different groups of the population in terms of promoting an informed choice and a culture of donation.
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Affiliation(s)
| | | | - Alessandra Brena
- Department of General Psychology, University of Padua, Padua, Italy
| | - Paola Di Ciaccio
- Centro Nazionale Trapianti, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Margherita Gentile
- Centro Nazionale Trapianti, Istituto Superiore di Sanità (ISS), Rome, Italy
| | | | - Massimo Cardillo
- Centro Nazionale Trapianti, Istituto Superiore di Sanità (ISS), Rome, Italy
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Grossi AA, Puoti F, Fiaschetti P, Di Ciaccio P, Maggiore U, Cardillo M. Kidney transplantation and withdrawal rates among wait-listed first-generation immigrants in Italy. Eur J Public Health 2022; 32:372-378. [PMID: 35381065 PMCID: PMC9159323 DOI: 10.1093/eurpub/ckac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 11/14/2022] Open
Abstract
Background Multiple barriers diminish access to kidney transplantation (KT) in immigrant compared to non-immigrant populations. It is unknown whether immigration status reduces the likelihood of KT after wait-listing despite universal healthcare coverage with uniform access to transplantation. Methods We retrospectively collected data of all adult waiting list (WL) registrants in Italy (2010–20) followed for 5 years until death, KT in a foreign center, deceased-donor kidney transplant (DDKT), living-donor kidney transplant (LDKT) or permanent withdrawal from the WL. We calculated adjusted relative probability of DDKT, LDKT and permanent WL withdrawal in different immigrant categories using competing-risks multiple regression models. Results Patients were European Union (EU)-born (n = 21 624), Eastern European-born (n = 606) and non-European-born (n = 1944). After controlling for age, sex, blood type, dialysis vintage, case-mix and sensitization status, non-European-born patients had lower LDKT rates compared to other immigrant categories: LDKT adjusted relative probability of non-European-born vs. Eastern European-born 0.51 (95% CI: 0.33–0.79; P = 0.002); of non-European-born vs. EU-Born: 0.65 (95% CI: 0.47–0.82; P = 0.001). Immigration status did not affect the rate of DDKT or permanent WL withdrawal. Conclusions Among EU WL registrants, non-European immigration background is associated with reduced likelihood of LDKT but similar likelihood of DDKT and permanent WL withdrawal. Wherever not available, new national policies should enable coverage of travel and medical fees for living-donor surgery and follow-up for non-resident donors to improve uptake of LDKT in immigrant patients, and provide KT education that is culturally competent, individually tailored and easily understandable for patients and their potential living donors.
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Affiliation(s)
- Alessandra Agnese Grossi
- Department of Human Sciences, Innovation and Territory, University of Insubria, Como, Italy.,Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Francesca Puoti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Pamela Fiaschetti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Paola Di Ciaccio
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Umberto Maggiore
- Nephrology Unit, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Massimo Cardillo
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
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Procaccio F, Masiero L, Vespasiano F, Grossi PA, Gagliotti C, Pantosti A, Caprio M, Lombardini L, Nanni Costa A, Giacon B, Saracino A, Mancini P, Giannattasio P, Sangiorgi G, Licari M, Valeri M, Munoz Lopez M, Moschini M, Giacometti R, Panebianco A, Littera R, Butera A, Bonizzoli M, Pilati L, Dovas A, Lazzarini F, Coluccio E, Vesconi S, Ghirardini A, Puoti F, Ricci A, Di Ciaccio P. Organ donor screening for carbapenem-resistant gram-negative bacteria in Italian intensive care units: the DRIn study. Am J Transplant 2020; 20:262-273. [PMID: 31400257 DOI: 10.1111/ajt.15566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 02/12/2019] [Revised: 08/01/2019] [Accepted: 08/03/2019] [Indexed: 01/25/2023]
Abstract
The 759 cases of brain death declaration (BDD [Italian law, 6 hours of observation time]) that occurred in 190 Italian intensive care units (ICUs) between May and September 2012 were studied to quantify carbapenem-resistant gram-negative bacteria (CR-GN) isolated in organ donors, to evaluate adherence to national screening guidelines, and to identify risk factors for CR-GN isolation. Mandatory blood, bronchoalveolar lavage, and urine cultures were performed on the BDD day in 99% of used donors. Because results were rarely made available before transplant, >20% of transplants were performed before obtaining any microbiological information, and organs from 15 of 22 CR-GN cases were used. Two (lung-liver) of the 37 recipients died, likely because of donor-derived early CR-GN sepsis. ICU stay >3 days (odds ratio [OR] = 7.49, P = .004), fever (OR = 3.11, P = .04), age <60 years (OR = 2.80, P = .06), and positive ICU epidemiology (OR = 8.77, P = .07) were associated with CR-GN isolation. An association between single ICU and risk of CR-GN was observed, as a result of differences across ICUs (ICC = 29%; 95% confidence interval [CI] 6.5%-72%) probably related to inadequate practices of infection control. Continuous education aimed at implementing priority actions, including stewardship programs for a rational use of antimicrobials, is a priority in healthcare systems and transplant networks. Improved awareness among ICU personnel regarding the importance of early CR-GN detection and timely alert systems might facilitate decisions regarding organ suitability and eventually save recipient lives.
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Affiliation(s)
| | - Lucia Masiero
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome, Italy
| | | | - Paolo A Grossi
- Clinica delle Malattie Infettive e Tropicali, Università degli Studi dell'Insubria, Varese, Italy
| | - Carlo Gagliotti
- Agenzia Sanitaria e Sociale Regionale Emilia-Romagna, Bologna, Italy
| | - Annalisa Pantosti
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
| | - Mario Caprio
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, Rome, Italy
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Jager KJ, Stel VS, Branger P, Guijt M, Busic M, Dragovic M, Diekmann F, Manyalich M, Di Ciaccio P, Nanni Costa A, Collett D, Mumford L, Haase B, Hemke A, Deme O, Mihály S, Murphy M, Couchoud C, Massy Z, Lingemann M, Rahmel A. The effect of differing kidney disease treatment modalities and organ donation and transplantation practices on health expenditure and patient outcomes. Nephrol Dial Transplant 2019; 33:560-562. [PMID: 29106604 DOI: 10.1093/ndt/gfx082] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/03/2017] [Indexed: 12/26/2022] Open
Abstract
The Effect of Differing Kidney Disease Treatment Modalities and Organ Donation and Transplantation Practices on Health Expenditure and Patient Outcomes (EDITH) aims to obtain information on long-term kidney transplant outcomes, long-term health outcomes of living kidney donors and detailed outcomes and costs related to the different treatment modalities of end-stage kidney disease. Nine partners from seven European Union countries will participate in this project.
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Affiliation(s)
- Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Peter Branger
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Marja Guijt
- Eurotransplant International Foundation, Leiden, The Netherlands
| | - Mirela Busic
- Ministry of Health of the Republic of Croatia, Zagreb, Croatia
| | | | - Fritz Diekmann
- Institut d'Incestigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Kidney Transplant Unit, Hospital Clínic, Barcelona, Spain
| | - Martí Manyalich
- IDIBAPS and Donation and Transplantation Institute (DTI), Barcelona, Spain
| | | | | | | | | | | | - Aline Hemke
- Nederlandse Transplantatie Stichting, Leiden, The Netherlands
| | | | | | - Mark Murphy
- European Kidney Patients' Federation, Panama City, Panama
| | - Cécile Couchoud
- REIN Registry, Biomedicine Agency, La Plaine-Saint Denis, France
| | - Ziad Massy
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Versailles-Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France.,INSERM Unit 1018, CESP, University Paris-Saclay, University of Versailles-Saint-Quentin-en-Yvelines, Université Paris Sud, Villejuif, France
| | - Marie Lingemann
- Deutsche Stiftung Organ Transplantation, Frankfurt am Main, Germany
| | - Axel Rahmel
- Deutsche Stiftung Organ Transplantation, Frankfurt am Main, Germany
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Caramia V, Ghirardini A, Di Ciaccio P, Vespasiano F, Mareri M, Nanni Costa A. From the EU Legislation to the Application of the Single European Code: Support to the Implementation. Transfus Med Hemother 2017; 44:391-394. [PMID: 29344014 DOI: 10.1159/000481144] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022] Open
Abstract
The Italian National Transplant Centre (CNT) is coordinating with the Italian National Blood Centre (CNS) the Joint Action '!' (www.eurocet128.eu), already built the European Tissue Establishment and Tissue and Cell Product Compendia between 2011 and 2014 in order to provide European Member States with a tool which would grant traceability of tissues and cells at human transplant purpose across the European Union. The two compendia are available on an online platform hosted and managed by the European Commission.
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Affiliation(s)
- Valentina Caramia
- Italian National Transplant Centre, Istituto Superiore di Sanità, Rome, Italy
| | - Angelo Ghirardini
- Italian National Transplant Centre, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Di Ciaccio
- Italian National Transplant Centre, Istituto Superiore di Sanità, Rome, Italy
| | | | - Maura Mareri
- Italian National Transplant Centre, Istituto Superiore di Sanità, Rome, Italy
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Mareri M, Filippetti M, Ghirardini A, Vespasiano F, Ciaccio PD, Nanni Costa A. The EUROCET Network: Support for Coding, Vigilance and Surveillance. Transfus Med Hemother 2012; 38:352-356. [PMID: 22403518 DOI: 10.1159/000334848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/25/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND: In the last years, there have been increasing concerns about the safety and traceability of human tissues and cells in Europe. In order to regulate this part of medical practice, the European Commission issued 3 directives between 2004 and 2006 and endorsed EUROCET to support member states in fulfilling some of their obligations. MATHODS: EUROCET created a connection with the European Union (EU) Competent Authorities (CAs) and set up a website where lists of the CAs, the authorized Tissue Establishments (TEs) and the activity data are published and updated. Moreover, EUROCET is involved within the Vigilance and Surveillance of Substances of Human Origin (SOHO V&S) project, aiming to support the EU member states in the establishment of vigilance and surveillance systems for tissues and cells. EUROCET is also working with EU stakeholders to develop a common coding system concerning donation and products. RESULTS: There are 33 countries in EUROCET and 57 CAs. 3,974 TEs are recorded: 1,108 for tissues, 1,480 for haematopoietic progenitor cells and 1,386 for assisted reproduction. On the website, it is possible to find the 2010 activity data report. CONCLUSION: Based on its cooperation with the CAs, EUROCET represents them in the European network. Nowadays, the EU member states can rely on a web portal and database in order to put the tissue and cell directives into practice.
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